Endocrine Abstracts

A 38-year-old gentleman was referred to the endocrine clinic after a male fertility test done as part of investigation for infertility showed the following:

Volume 4.4 ml

Total sperm number =6.16 Mill/ejac

Sperm concentration 1.4 Mill/ml

Progressive motility 10%

Nonprogressive motility 1%

Impotence 89%

55% sperm vitality

Previous semen analysis tests were also consistent with a diagnosis of oligospermia. The patient had been trying to conceive for four years with no success. He had normal erections, normal morning erections and libido. He denied headaches, visual disturbances, galactorrhoea or weight change. He had no change in shoe/ring/hat size and described a normal sense of smell. He denied use of opiate, steroids, recreational or other prescribed medications. There was no history of mumps in the past. He did not smoke. Testicular examination showed an atrophic left testicle and normal sized right testicle. He was at Tanner Stage V. Systemic examination was unremarkable. Visual fields were normal to confrontation. A hormone profile revealed the following:

FSH 13.5 U/l (0.7–11.1) ↑

LH 9.2 U/l (0.8–7.6) ↑

Testosterone 18.4 nmol/l (2.5–29.57)

Oestradiol 172 pmol/l (0–146)

Cortisol am 526 nmol/l (145–619)

TSH 2.199 (0.3–3.0 micIU/ml)

T4 12.33 (11–18 pmol/l)

GH <0.05 ug/l (0–3)

Other blood tests including complete blood count, liver profile, lipid profile, renal profile, random blood glucose, corrected serum calcium, iron profile and serum ferritin were within normal limits. He has been referred for genetic screening for chromosomal analysis, tests for Y microdeletion and cystic fibrosis screen. He is also booked for an US scan of the testes. Results are awaited. The patient was counselled regarding the possibility of cryopreservation in view of his impending primary testicular failure and oligospermia.