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Low Sperm Count and Seminal Vesicle Infection

Date:2011-11-23 click:
A 35-year-old man went to a private clinic for a pre-martial check up, and was told he was infertile. He was diagnosed to have tuberculosis 5 months ago and was on the standard anti-TB therapy. There was no significant past medical history and he did not drink nor smoke. He had non-penetrative sex with his soon-to-be-married girlfriend but he denied any other sexual contact. He was extremely concerned about the possible infertility. On examination he looked thin and slightly pale. There were signs of a small pleural effusion on the left. Abdominal examination was normal. Secondary sexual characteristics were present and the testicles were normal.Side room urine tests were normal.
 
Question 1: How would you investigate this patient?
 
The seminal analysis revealed significant oligospermia.However, a single semen sample is often inadequate for the valuation of the fertility potential. It is recommended that at least two, and preferably three semen samples be obtain a period of at least a month with 3 days of abstinence prior to collection. One important issue in the interpretation of the semen analysis is that the present low sperm count is a reflection of the decreased spermatogenesis started more than 2 months ago. The patient may have had poor health at that time, and the result may not be indicative of the present spermatogenic status.
 
As for blood investigations, we should take a complete blood count, ESR, renal and liver function tests Chest x-rates important to define the pathology. The serum FSH is an important indicator for spermatogenesis, the testosterone and luteinizing hormone (LH) may also be helpful to delineate an underlying endocrine cause.Investigating the possibility of the tuberculous involvement of the prostate and seminal vesicles includes per rectal examination of the prostate, seminal vesicles and evidence of a thickened vas. A ultrasound of the prostate (TRUS) and ultrasound of are helpful. Urine, semen and prostate fluid should be sent for bacterial and AFB cultures.
 
Question 2: What are the differential diagnoses?
Tuberculous involvement of the genital tract is a likely cause of the problem. As the patient still has signs suggest active tuberculous infection, haematogenous spread of the disease to the genital tract is likely. The increased leucocyte count and the decreased motility of the semen also reflect this. The most commonly involved site are the prostate and seminal vesicles if there is no clinically detectable abnormality.
 
Another possible differential diagnosis includes defective spermatogenesis due to primary testicular failure.The decreased motility and sperm count may also be caused by a subliminal infection of the male accessory gland,although it is uncommon to have oligospermia to this extent.The present anti-TB chemotherapy is not a likely cause of this degree of oligospermia, although general ill health can cause a decreasing sperm count.
 
Question 3: How do you manage this patient?
This patient is likely to have tuberculosis involving the genital tract. This can be substantiated by an abnormal examination, increased ESR or positive smear the seminal fluid or urine specimen. The patient may need to be referred back to TB specialist clinic for management.It may involve re-evaluation of the effectiveness and sensitivity of the chemotherapy and revision of drug treatment if necessary.
The measurement of plasma FSH is useful primary from secondary testicular failure with obstructive azoospermia. An elevated level of FSH (more than 2 times the normal value) is presumptive of severe and usually irreversible seminiferous tubular damage. The diagnosis of primary testicular failure is made, and there is no chance to improve the situation. If the serum FSH is normal, testicular biopsy may be consideredto delineate the site of obstruction.Since the decreased sperm motility, count and the presence of leucocytes may indicate a subclinical infection of the male accessory gland, a trial course of antibiotics maybe helpful to improve the sperm count.Since the patient still has not started normal sexual intercourse, it is a bit too early to jump to the conclusion of infertility. But for oligospermia to this extent, the fertility potential is questionable. This low sperm count makes the success rate of in fertilization very low. They may require cytoplasmic sperm injection (ICSI) technique to assist in fertilization. They may also consider other alternative options like donor insemination or adoption.
 
Question 4: Is there an effective treatment?
Patented traditional Chinese medicine - Diuretic and Anti-inflammatory Pill cures infertility in three months. Patients risk for no side effect or drug resistance while taking this medicine. Necrospermia, azoospermia and male infertility are commonly caused by prostatitis, seminal vesiculitis, deferentitis, epididymitis and orchitis. By solving those problems, infertility can be treated completely. 

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