Skip to main content
SpringerLink
Log in

The Infertile Male-3: Endocrinological Evaluation

  • Chapter
Scrotal Pathology

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

  • 2236 Accesses

Abstract

About 14% of European couples suffer from reproductive health disorders, which can result in infertility. In 50% of involuntarily childless couples a male infertility associated factor is found together with abnormal semen parameters. The etiology of male infertility can be related to several congenital or acquired factors acting at pre-testicular (10%), testicular (75%), or post-testicular (15%) level. In 30–40% of cases, no male infertility associated factor is found (idiopathic male infertility). Idiopathic male infertility may be explained by several factors, including endocrine disruption as a result of environmental pollution, reactive oxygen species or genetic abnormalities. The diagnostic work up of the infertile male should include careful medical and reproductive history collection, physical examination, sperm analysis, and hormone evaluation followed by second and, when useful, third level examinations. The general endocrinologist can easily perform a first-line diagnostic evaluation of the infertile couple as the hormonal assessment has an important role in the initial workup of both partners, and semen analysis can be easily interpreted. It is also rather obvious that if the infertility has an endocrine cause the endocrinologist has an important role in the treatment. On the other hand, further diagnostic work up of the couple requires appropriate knowledge of the physiology and pathology of the male and female reproductive tract as well as of second- and third-level diagnostic procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Aizenstein RI, Hibbeln JF, Sagireddy B et al (1997) Klinefelter’s syndrome associated with testicular microlithiasis and mediastinal germ-cell neoplasm. J Clin Ultrasound 25:508–510

    Article  PubMed  CAS  Google Scholar 

  • Anawalt BD, Bebb RA, Matsumoto AM et al (1996) Serum inhibin B levels reflect sertoli cell function in normal men and men with testicular dysfunction. J Clin Endocrinol Metab 81:3341–3345

    Article  PubMed  CAS  Google Scholar 

  • Andersson AM, Petersen JH, Jorgensen N et al (2004) Serum inhibin B and follicle-stimulating hormone levels as tools in the evaluation of infertile men: significance of adequate reference values from proven fertile men. J Clin Endocrinol Metab 89:2873–2879

    Article  PubMed  CAS  Google Scholar 

  • Bach AM, Hann LE, Hadar O et al (2001) Testicular microlithiasis: what is its association with testicular cancer? Radiology 220:70–75

    PubMed  CAS  Google Scholar 

  • Behre HM, Kliesch S, Meschede D et al (1994) Hypogonadismus und infertilitat des mannes. In: Gerok W, Hartmann F, Prfcundschuh M et al (eds) Klinik der gegenwart. Urban und Scwarzenberg, Munchen, pp 1–73

    Google Scholar 

  • Behre HM, Kliesch S, Schadel F et al (1995) Clinical relevance of scrotal and transrectal ultrasonography in andrological patients. Int J Androl 18(Suppl 2):27–31

    PubMed  Google Scholar 

  • Behre HM, Yeung CH, Holstein AF et al (2000) Diagnosis of male infertility and hypogonadism. In: Nieschlag E, Behre HM (eds) Andrology: male reproductive health and dysfunction, 2nd edn. Springer, Heidelberg, pp 90–124

    Google Scholar 

  • Bergmann M, Behre HM, Nieschlag E (1994) Serum FSH and testicular morphology in male infertility. Clin Endocrinol (Oxf) 40:133–136

    Article  CAS  Google Scholar 

  • Brandell RA, Mielnik A, Liotta D et al (1998) AZFb deletions predict the absence of spermatozoa with testicular sperm extraction: preliminary report of a prognostic genetic test. Hum Reprod 13:2812–2815

    PubMed  CAS  Google Scholar 

  • Brooks DD, Wolf A, Smith RA et al (2010) Prostate cancer screening 2010: updated recommendations from the American cancer society. J Natl Med Assoc 102:423–429

    PubMed  Google Scholar 

  • Carani C, Isidori AM, Granata A et al (2005) Multicenter study on the prevalence of sexual symptoms in male hypo- and hyperthyroid patients. J Clin Endocrinol Metab 90:6472–6479

    Article  PubMed  CAS  Google Scholar 

  • Carlsen E, Andersen AG, Buchreitz L et al (2000) Inter-observer variation in the results of the clinical andrological examination including estimation of testicular size. Int J Androl 23:248–253

    Article  PubMed  CAS  Google Scholar 

  • Cast JE, Nelson WM, Early AS et al (2000) Testicular microlithiasis: prevalence and tumor risk in a population referred for scrotal sonography. AJR Am J Roentgenol 175:1703–1706

    PubMed  CAS  Google Scholar 

  • Chillon M, Casals T, Mercier B et al (1995) Mutations in the cystic fibrosis gene in patients with congenital absence of the vas deferens. N Engl J Med 332:1475–1480

    Article  PubMed  CAS  Google Scholar 

  • Cho IR, Keener TS, Nghiem HV et al (2000) Prostate blood flow characteristics in the chronic prostatitis/pelvic pain syndrome. J Urol 163:1130–1133

    Article  PubMed  CAS  Google Scholar 

  • Cihan A, Demir O, Demir T et al (2009) The relationship between premature ejaculation and hyperthyroidism. J Urol 181:1273–1280

    Article  PubMed  Google Scholar 

  • Collins JA, Burrows EA, Willan AR (1993) Occupation and the follow-up of infertile couples. Fertil Steril 60:477–485

    PubMed  CAS  Google Scholar 

  • Collins JA, Burrows EA, Wilan AR (1995) The prognosis for live birth among untreated infertile couples. Fertil Steril 64:22–28

    PubMed  CAS  Google Scholar 

  • Corona G, Maggi M (2010) The role of testosterone in erectile dysfunction. Nat Rev Urol 7:46–56

    Article  PubMed  CAS  Google Scholar 

  • Corona G, Mannucci E, Petrone L et al (2004a) Psycho-biological correlates of hypoactive sexual desire in patients with erectile dysfunction. Int J Impot Res 16:275–281

    Article  PubMed  CAS  Google Scholar 

  • Corona G, Petrone L, Mannucci E et al (2004b) Psycho-biological correlates of rapid ejaculation in patients attending an andrologic unit for sexual dysfunctions. Eur Urol 46:615–622

    Article  PubMed  CAS  Google Scholar 

  • Corona G, Mannucci E, Petrone L et al (2006a) Psychobiological correlates of delayed ejaculation in male patients with sexual dysfunctions. J Androl 27:453–458

    Article  PubMed  Google Scholar 

  • Corona G, Mannucci E, Petrone L et al (2006b) ANDROTEST: a structured interview for the screening of hypogonadism in patients with sexual dysfunction. J Sex Med 3:706–715

    Article  PubMed  Google Scholar 

  • Corona G, Mannucci E, Petrone L et al (2006c) Association of hypogonadism and type II diabetes in men attending an outpatient erectile dysfunction clinic. Int J Impot Res 18:190–197

    Article  PubMed  CAS  Google Scholar 

  • Corona G, Mannucci E, Petrone L et al (2007) NCEP-ATPIII-defined metabolic syndrome, type 2 diabetes mellitus, and prevalence of hypogonadism in male patients with sexual dysfunction. J Sex Med 4:1038–1045

    Article  PubMed  Google Scholar 

  • Corona G, Jannini EA, Mannucci E et al (2008) Different testosterone levels are associated with ejaculatory dysfunction. J Sex Med 5:1991–1998

    Article  PubMed  CAS  Google Scholar 

  • Corona G, Mannucci E, Jannini EA et al (2009a) Hypoprolactinemia: a new clinical syndrome in patients with sexual dysfunction. J Sex Med 6:1457–1466

    Article  PubMed  CAS  Google Scholar 

  • Corona G, Mannucci E, Forti G et al (2009b) Hypogonadism, ED, metabolic syndrome and obesity: a pathological link supporting cardiovascular diseases. Int J Androl 32:587–598

    Article  PubMed  CAS  Google Scholar 

  • Corona G, Jannini EA, Lotti F et al (2010) Premature and delayed ejaculation: two ends of a single continuum influenced by hormonal milieu. Int J Androl doi: 10.1111/j.1365-2605 2010.01059.x

  • De Martino MU, Pastore R, Caprio M et al (2003) Dynamic testing in the evaluation of male gonadal function. J Endocrinol Invest 26:107–113

    PubMed  Google Scholar 

  • Dohle GR, Diemer T, Giwercman A et al (2010) Guidelines on male infertility. AUA Guidelines

    Google Scholar 

  • Egozcue J (1989) Chromosomal aspects of male infertility. In: Serio M (ed) Perspectives in andrology. Raven Press, New York, pp 341–346

    Google Scholar 

  • El-Nashaar A, Shamloul R (2007) Antibiotic treatment can delay ejaculation in patients with premature ejaculation and chronic bacterial prostatitis. J Sex Med 4:491–496

    Article  PubMed  CAS  Google Scholar 

  • ESHRE Capri Workshop Group (1996) Guidelines to the prevalence, diagnosis, tratment and management of infertility. Hum Reprod 11:1775–1807

    Google Scholar 

  • Evers JH, Collins J, Clarke J (2009) Surgery or embolisation for varicoceles in subfertile men. Cochrane Database Syst Rev:CD000479

    Google Scholar 

  • Ficarra V, Cerruto MA, Liguori G et al (2006) Treatment of varicocele in subfertile men: the cochrane review–a contrary opinion. Eur Urol 49:258–263

    Article  PubMed  Google Scholar 

  • Forti G, Krausz C (1998) Clinical review 100: evaluation and treatment of the infertile couple. J Clin Endocrinol Metab 83:4177–4188

    Article  PubMed  CAS  Google Scholar 

  • Forti G, Krausz C, Cilotti A et al (2003) Varicocele and infertility. J Endocrinol Invest 26:564–569

    PubMed  CAS  Google Scholar 

  • Friedler S, Raziel A, Strassburger D et al (1997) Testicular sperm retrieval by percutaneous fine needle sperm aspiration compared with testicular sperm extraction by open biopsy in men with non-obstructive azoospermia. Hum Reprod 12:1488–1493

    Article  PubMed  CAS  Google Scholar 

  • Futterer JJ, Heijmink SW, Spermon JR (2008) Imaging the male reproductive tract: current trends and future directions. Radiol Clin North Am 46:133–147 vii

    Article  PubMed  Google Scholar 

  • Grumbach MM, Styne DM (2003) Puberty: ontogeny, neuroendocrinology, physiology, and disorders. In: Larsen PR, Kronenberg HM, Melmed S et al (eds) Williams textbook of endocrinology, 10th edn. Saunders, Philadelphia, pp 1115–1286

    Google Scholar 

  • Isidori AM, Lenzi A (2008) Scrotal ultrasound: morphological and functional atlas. Forum Service Editore srl, Genova

    Google Scholar 

  • Jannini EA, Lenzi A (2005) Ejaculatory disorders: epidemiology and current approaches to definition, classification and subtyping. World J Urol 23:68–75

    Article  PubMed  Google Scholar 

  • Jarow JP (2001) Effects of varicocele on male fertility. Hum Reprod Update 7:59–64

    Article  PubMed  CAS  Google Scholar 

  • Kasturi SS, Tannir J, Brannigan RE (2008) The metabolic syndrome and male infertility. J Androl 29:251–259

    Article  PubMed  CAS  Google Scholar 

  • Kessaris DN, Mellinger BC (1994) Incidence and implication of testicular microlithiasis detected by scrotal duplex sonography in a select group of infertile men. J Urol 152:1560–1561

    PubMed  CAS  Google Scholar 

  • Kim ED, Lipshultz LI (1996) Role of ultrasound in the assessment of male infertility. J Clin Ultrasound 24:437–453

    Article  PubMed  CAS  Google Scholar 

  • Kim B, Kawashima A, Ryu JA et al (2009) Imaging of the seminal vesicle and vas deferens. Radiographics 29:1105–1121

    Article  PubMed  Google Scholar 

  • Krause W (2008) Male accessory gland infection. Andrologia 40:113–116

    Article  PubMed  CAS  Google Scholar 

  • Krausz C, Degl’Innocenti S (2006) Y chromosome and male infertility: update, 2006. Front Biosci 11:3049–3061

    Article  PubMed  CAS  Google Scholar 

  • Krausz C, Forti G (2000) Clinical aspects of male infertility. Results Probl Cell Differ 28:1–21

    PubMed  CAS  Google Scholar 

  • Krausz C, Quintana-Murci L, McElreavey K (2000) Prognostic value of Y deletion analysis: what is the clinical prognostic value of Y chromosome microdeletion analysis? Hum Reprod 15:1431–1434

    Article  PubMed  CAS  Google Scholar 

  • Lanfranco F, Kamischke A, Zitzmann M et al (2004) Klinefelter’s syndrome. Lancet 364:273–283

    Article  PubMed  CAS  Google Scholar 

  • Lee JC, Bhatt S, Dogra VS (2008) Imaging of the epididymis. Ultrasound Q 24:3–16

    Article  PubMed  Google Scholar 

  • Lenz S, Giwercman A, Elsborg A et al (1993) Ultrasonic testicular texture and size in 444 men from the general population: correlation to semen quality. Eur Urol 24:231–238

    PubMed  CAS  Google Scholar 

  • Lenzi A, Balercia G, Bellastella A et al (2009) Epidemiology, diagnosis, and treatment of male hypogonadotropic hypogonadism. J Endocrinol Invest 32:934–938

    PubMed  CAS  Google Scholar 

  • Liguori G, Trombetta C, Garaffa G et al (2004) Color doppler ultrasound investigation of varicocele. World J Urol 22:378–381

    Article  PubMed  Google Scholar 

  • Lissens W, Liebaers I (1997) The genetics of male infertility in relation to cystic fibrosis. Baillieres Clin Obstet Gynaecol 11:797–817

    Article  PubMed  CAS  Google Scholar 

  • Lotti F, Corona G, Mancini M et al (2009) The association between varicocele, premature ejaculation and prostatitis symptoms: possible mechanisms. J Sex Med 6:2878–2887

    Article  PubMed  CAS  Google Scholar 

  • McDermott VG, Meakem TJ 3rd, Stolpen AH et al (1995) Prostatic and periprostatic cysts: findings on MR imaging. AJR Am J Roentgenol 164:123–127

    PubMed  CAS  Google Scholar 

  • Morelli A, Filippi S, Zhang XH et al (2005) Peripheral regulatory mechanisms in erection. Int J Androl 28(Suppl 2):23–27

    Article  PubMed  CAS  Google Scholar 

  • Morelli A, Corona G, Filippi S et al (2007) Which patients with sexual dysfunction are suitable for testosterone replacement therapy? J Endocrinol Invest 30:880–888

    PubMed  CAS  Google Scholar 

  • Nieschlag E, Behre HM, Nieschlag S (2010) Andrology: male reproductive health and dysfunction. Springer, Berlin

    Google Scholar 

  • Nuti F, Krausz C (2008) Gene polymorphisms/mutations relevant to abnormal spermatogenesis. Reprod Biomed Online 16:504–513

    Article  PubMed  CAS  Google Scholar 

  • Older RA, Watson LR (1996) Ultrasound anatomy of the normal male reproductive tract. J Clin Ultrasound 24:389–404

    Article  PubMed  CAS  Google Scholar 

  • Otite U, Webb JA, Oliver RT et al (2001) Testicular microlithiasis: is it a benign condition with malignant potential? Eur Urol 40:538–542

    Article  PubMed  CAS  Google Scholar 

  • Pappis CH, Argianas SA, Bousgas D et al (1988) Unsuspected urological anomalies in asymptomatic cryptorchid boys. Pediatr Radiol 18:51–53

    Article  PubMed  CAS  Google Scholar 

  • Partsch CJ, Heger S, Sippell WG (2002) Management and outcome of central precocious puberty. Clin Endocrinol (Oxf) 56:129–148

    Article  Google Scholar 

  • Pellati D, Mylonakis I, Bertoloni G et al (2008) Genital tract infections and infertility. Eur J Obstet Gynecol Reprod Biol 140:3–11

    Article  PubMed  Google Scholar 

  • Peterson AC, Bauman JM, Light DE et al (2001) The prevalence of testicular microlithiasis in an asymptomatic population of men 18 to 35 years old. J Urol 166:2061–2064

    Article  PubMed  CAS  Google Scholar 

  • Petrone L, Mannucci E, Corona G et al (2003) Structured interview on erectile dysfunction (SIEDY): a new, multidimensional instrument for quantification of pathogenetic issues on erectile dysfunction. Int J Impot Res 15:210–220

    Article  PubMed  CAS  Google Scholar 

  • Root AW (2010) Reversible isolated hypogonadotropic hypogonadism due to mutations in the neurokinin B regulation of gonadotropin-releasing hormone release. J Clin Endocrinol Metab 95:2625–2629

    Article  PubMed  CAS  Google Scholar 

  • Rosner W, Auchus RJ, Azziz R et al (2007) Position statement: utility, limitations, and pitfalls in measuring testosterone: an endocrine society position statement. J Clin Endocrinol Metab 92:405–413

    Article  PubMed  CAS  Google Scholar 

  • Rowe PJ, Comhaire FH, Hargreave TB et al (1993) WHO manual for the standardized investigation and diagnosis of the infertile couple. Cambridge University Press, Cambridge

    Google Scholar 

  • Schlegel PN (1999) Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 14:131–135

    Article  PubMed  CAS  Google Scholar 

  • Screponi E, Carosa E, Di Stasi SM et al (2001) Prevalence of chronic prostatitis in men with premature ejaculation. Urology 58:198–202

    Article  PubMed  CAS  Google Scholar 

  • Seo JT, Ko WJ (2001) Predictive factors of successful testicular sperm recovery in non-obstructive azoospermia patients. Int J Androl 24:306–310

    Article  PubMed  CAS  Google Scholar 

  • Silber SJ, van Steirteghem A, Nagy Z et al (1996) Normal pregnancies resulting from testicular sperm extraction and intracytoplasmic sperm injection for azoospermia due to maturation arrest. Fertil Steril 66:110–117

    PubMed  CAS  Google Scholar 

  • Takihara H, Cosentino MJ, Sakatoku J et al (1987) Significance of testicular size measurement in andrology: II. Correlation of testicular size with testicular function. J Urol 137:416–419

    PubMed  CAS  Google Scholar 

  • te Velde ER, Eijkemans R, Habbema HD (2000) Variation in couple fecundity and time to pregnancy, an essential concept in human reproduction. Lancet 355:1928–1929

    Article  PubMed  CAS  Google Scholar 

  • Thomas K, Wood SJ, Thompson AJ et al (2000) The incidence and significance of testicular microlithiasis in a subfertile population. Br J Radiol 73:494–497

    PubMed  CAS  Google Scholar 

  • Traggiai C, Stanhope R (2002) Delayed puberty. Best Pract Res Clin Endocrinol Metab 16:139–151

    Article  PubMed  CAS  Google Scholar 

  • Tüttelmann F and Nieschlag E (2010) Classification of andrological disorders. In: Nieschlag E, Behre HM, Nieschlag S (eds) Andrology, male reproductive health and dysfunction, 3rd edn. Springer, Berlin

    Google Scholar 

  • World Health Organization (2000) WHO manual for the standardised investigation and diagnosis of the infertile couple. Cambridge University Press, Cambridge

    Google Scholar 

  • Vermeulen A, Verdonck L, Kaufman JM (1999) A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 84:3666–3672

    Article  PubMed  CAS  Google Scholar 

  • Vicari E (1999) Seminal leukocyte concentration and related specific reactive oxygen species production in patients with male accessory gland infections. Hum Reprod 14:2025–2030

    Article  PubMed  CAS  Google Scholar 

  • Vignozzi L, Corona G, Petrone L et al (2005) Testosterone and sexual activity. J Endocrinol Invest 28:39–44

    PubMed  CAS  Google Scholar 

  • Vohra S, Morgentaler A (1997) Congenital anomalies of the vas deferens, epididymis, and seminal vesicles. Urology 49:313–321

    Article  PubMed  CAS  Google Scholar 

  • Wang C, Nieschlag E, Swerdloff R et al (2009) ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males. Int J Impot Res 21:1–8

    Article  PubMed  Google Scholar 

  • Woodward PJ, Sohaey R, O’Donoghue MJ et al (2002) From the archives of the AFIP: tumors and tumorlike lesions of the testis: radiologic-pathologic correlation. Radiographics 22:189–216

    PubMed  Google Scholar 

  • Woodward PJ, Schwab CM, Sesterhenn IA (2003) From the archives of the AFIP: extratesticular scrotal masses: radiologic-pathologic correlation. Radiographics 23:215–240

    Article  PubMed  Google Scholar 

  • World Health Organization (1987) Towards more objectivity in diagnosis and management of male infertility. Int J Androl 7:1–53

    Google Scholar 

  • World Health Organization (2010) WHO laboratory manual for the examination and processing of human semen. World Health Organization, Geneva

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy

    Francesco Lotti, Giovanni Corona, Csilla Gabriella Krausz, Gianni Forti & Mario Maggi

Authors
  1. Francesco Lotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Corona
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Csilla Gabriella Krausz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gianni Forti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mario Maggi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Lotti .

Editor information

Editors and Affiliations

  1. Ospedale di Cattinara, Ist. Radiologia, Università Trieste, Strada di Fiume 149, Trieste, 34149, Italy

    Michele Bertolotto

  2. Ospedale di Cattinara, Department of Urology, University of Trieste, Strada di Fiume 447, Trieste, 34149, Italy

    Carlo Trombetta

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Lotti, F., Corona, G., Krausz, C.G., Forti, G., Maggi, M. (2011). The Infertile Male-3: Endocrinological Evaluation. In: Bertolotto, M., Trombetta, C. (eds) Scrotal Pathology. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_188

Download citation

  • DOI: https://doi.org/10.1007/174_2011_188

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-12455-6

  • Online ISBN: 978-3-642-12456-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation