AUAUniversity Podcast Series: Episode No. 61

Summer School: What General Urologists Can Do To Evaluate & Successfully Treat Male Infertility

This course will focus on what general urologists who have not had fellowship or specialty training in male infertility can do to evaluate and treat male reproductive disorders. Basic science presented will be limited to that which is absolutely essential to understand the basic evaluation and treatment. In 90% of male infertility cases, a good history and careful physical examination, along with a basic semen analysis, which can often be performed by the doctor himself, will allow the general urologist to come up with a tentative diagnosis and treatment plan. More advanced testing is primarily designed to confirm the diagnosis. Key points of history, including inheritance issues, will be discussed. The finer points of physical examination, which in male infertility, due to the ready accessibility of the male reproductive organs to physical examination of a relaxed scrotum, allows the diagnosis to be made without the necessity for imaging studies in the majority of men. Interpretation of semen analysis will be discussed. When and what endocrine evaluations should be performed, including indications for genetic testing such as microY deletion assays and karyotype. When more advanced sperm testing, such as DNA fragmentation and anti-sperm antibody assays, are indicated as well as indications for imaging such a scrotal ultrasound, transrectal ultrasound and testis biopsy. The performance of basic office ultrasound, done by the general urologist, will be explained and the images obtained will be interpreted. The most likely diagnoses resulting from this evaluation will be discussed and treatments that can be employed by general urologists without fellowship training will be gone over in great detail. This will include medical treatments, basic surgical treatments that can be performed by general urologists with minimal microsurgical training and lifestyle recommendations, including supplements that may be of value. A limited presentation of advanced evaluation and treatment methods employed by fellowship trained specialists will be described and the indications for referral to such specialists presented.

Upon completion of the course, participant will be able to:

1. Perform a practical, cost-effective office and laboratory evaluation of the infertile male.
2. Select which medical and surgical treatments are effective and can be employed by general urologists without specialty training.
3. Know when to refer to fellowship- trained specialists, and when to collaborate with IVF doctors.
4. Identify the risk factors for both future infertility and androgen deficiency and how to treat them.
5. Select appropriate diagnostic treatment codes to get the best reimbursements.