Infertility Cases Fairmont
Infertility Cases Fairmont
Prof. Dr.
AbdelFattah Agour
Urology Department
Ain Shams University
Male Infertility
Clinical Cases
Case 1
Infertile couple for 5 years
Female evaluation is normal. The male is 28
years
Physical examination: Normal, virilized male,
24 ml testes bilaterally. No varicocele
Semen analysis: volume 0.6 cc. azoospermia
Laboratory data:
LH 5 (normal 3-11 IU) - FSH 7 (normal 3-11 IU)
Testosterone 500 (normal 250-900 ng/dl)
Case 1
What should be done next for this
patient?
a)
b)
c)
d)
Post-ejaculate urine
Rectal ultrasound
Full endocrine studies
Testis biopsy
Correct answer .. b)
Azoospermia with low ejaculate volume
denoting obstruction at the level of ejaculatory
ducts or hypoplasia of the vas deference and
seminal vesicles.
TRUS, does confirm the diagnosis
Post ejaculate urine is needed in cases of low
ejaculate volume but in the presence of
sperms (in non azoospermic patients).
A semen fructose can also be done
Case 2
33 years old man, married for 2 years, presents with
Case 2
What is the most likely diagnosis?
a)
b)
c)
d)
e)
Correct answer a)
The combination of poor semen quality,
gondotrophins
Idiopathic oligospermia = normal hormone studies
Youngs syndrome is not associated with small testes.
pituitary tumors are rarely associated with elevation
of both gondotrophins
Case 3
21 years old man presents with a 3 year history of
Case 3
What is the appropriate treatment for
Clomid
HCG
Trimethoprim-sulpha
Tetracycline
Nitrofurantoin
Correct answer .. d
Treatment of choice is tetracycline
Even
Case 4
24 year old man presents with a 3 year
Case 4
What is the next best step in the
Correct answer..c
Patients with unexplained low motility should
be evaluated for
Antisperm Antibodies
Case 5
28 years old man presents with a 3 year
Case 5
If a second semen analysis is similar to the
Clomid therapy
HCG
LH, FSH, and testosterone
Varicocele repair
Intrauterine insemination
Correct answer.c
Some authorities would recommend
Varicocele Repair.
Case 6
35 years old man presents with a 4 years history
Case 6
The most practical initial treatment for
ART
Low dose androgen therapy
Clomid therapy.
Correct answer.a
This patient has idiopathic oligospermia. There is no
Clomiphene therapy
has CONTROVERSIAL
EFFICACY
Another option not listed might be intrauterine insemination.
Case 7
28 years old married man who suffered a spinal
cord injury 3 years ago presents with failure of
ejaculation.
Physical Exam: Reveals a paraplegic male who
has 20 ml testes bilaterally, no varicocele.
Semen analysis: Unobtainable
Laboratory data:
Case 7
The best initial treatment for this
patient is?
a)
b)
c)
d)
Electro-ejaculation
Epididymal aspiration
Alloplastic spermatocele
Ephedrine
Correct answer.a
Electro-ejaculation has proved
Case 8
30 year old man with a 2 year history of infertility is
Case 8
The best initial treatment for this
patient is?
a)
b)
c)
d)
Husband insemination
In vitro fertilization
Clomid
HCG
Correct answer.a
This is one of the few unequivocal indications
Case 9
28 years old male with a 5 year history of infertility.
Case 9
The best therapy for this patient is?
a)
b)
c)
d)
Husband insemination
In vitro fertilization and Gamete
manipulation
Clomid
HCG
Correct answerb
Long duration of infertility(>3 years) combined
Case 10
A 38 year old man presents 6 years
Case 10 A
The best treatment for this patient is?
a)
b)
c)
d)
e)
Microscopic vasovasostomy
Non microscopic vasovasostomy
Epididymal aspiration
Artificial insemination
Alloplastic spermatocele
Answer a vs c
Inguinal exploration and microscopic
Case 10
Which of the following most
Correct answer..b
Although all the factors cited might
Case 10 B
If there is no fluid from the testicular
Stop
Do a vasovasostomy
Do a vasoepididymostomy
Do a retrograde dye study
Do a testis biopsy.
Correct answer..b, c
Most surgeons will proceed for
vasoepididymostomy,
however some believe that
vasovasostomy still has a higher
success rate.!!
Case 11
14 y.o boy. Presented with mild scrotal
discomfort.
O/E GIII left varicocele.
Left testicular size 16cc, the Rt 18cc.
Scrotal US confirmed the diagnosis
Correct answer
Thank You