oa South African Medical Journal - Infertility in the male : II : treatment



(Concluded from p. 836) Male infertility is regarded as a symptom or sign of an underlying condition of the testis, the diagnosis of which is in many instances unsatisfactory. For this reason the treatment is often unsatisfactory, except in those conditions where the aetiology is clear, and the damage is not irreversible. The various methods of clinical and special examination are detailed, and the significance of the findings is discussed. The most important single test for male infertility is the semen-analysis. The spermatozoal count may be normal, reduced or there may be azoospermia.The count or density of spermatozoa is the most important factor. Motility and morphology are of lesser importance, but their good quality may compensate for a reduced count and render the patient fertile. Testis biopsy is made in most cases of azoospermia and many cases of severe oligo-zoospermia. It helps to clarify the diagnosis, and especially to recognize obstructions of the vas deferens. An obstructive lesion with normal spermatogenesis lends itself to correction by operation. Where no obstructive lesion exists the faulty spermatogenesis may be due to a variety of causes such as toxic, nutritional, hormonal, and constitutional, etc. The importance f a full investigation is that specific treatment can be given in selected cases, and that the futility of treatment in many cases is recognized and unnecessary and useless treatment can be advised against. Treatment for the male only is discussed, and artificial insemination with donor's or husband's semen does not fall within the scope of this article.


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