An Evidence-Based Approach To History-Taking From The Infertile Man

June 27, 2008

Article Date: 26 Jun 2008 - 2:00 PDT

ORLANDO, FL (UroToday.com) - Dr. Brannigan presented an evidence-based approach to history-taking from the infertile man. Modern methodologies of evidence-based medicine were introduced in 1992 by Dr. Sackett at McMaster University. Systematic, unbiased observations will decrease the reliance on opinion of “authorities”. Level I evidence consists of prospective randomized clinical trials.

Both foods and medications can influence male fertility, he said. Testosterone can suppress spermatogenesis and men should not be on this during attempted pregnancy. Antidepressants can also have a negative impact. Electromagnetic field exposure is a occupational risk for workers such as welders and exposure can impair fertility. Pesticides and herbicides in farming communities result in decreased sperm concentration and motility. Fever impacts sperm count, motility and morphology at 4 weeks and semen analysis should be retested at 8 weeks. Hot tub wet heat can impact sperm motility and recovers if hot tub use is discontinued. Tobacco can decrease semen parameters. There is no safe amount of tobacco use identified, so discontinuation is recommended. Alcohol can increase estrogen levels and decrease semen parameters, so should be limited. Marijuana suppresses LH and testosterone secretion and it, along with cocaine and anabolic steroids should be discontinued.

He concluded the 50% of infertility is male factor and a good history can benefit patient outcomes.

Presented by Robert Brannigan, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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