Male Infertility

A 38 year old male reported to OPD with these reports and also compalints of premature ejaculation History He has had a troublesome marriage life in past, with two wives leaving him and is under sever stress Investigations He also did semen analysis elsewhere 20days back which is also same as attached below Management My only concern is - Can a trial of clomiphene citrate 25mg one cycle + Co Q , Astaxanthin + Evion LC be given for a month on trial basis and repeat semen analysis then, before we jump upon another set of investigations like TFT,LH,FSH,PROLACTIN and scrotal sonography?

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Azoospermia with low volume semen Semen analysis for fructose will be useful to differentiate the two causes of azoospermia- 1) Congental absence of vas, seminal vesicles, or obstruction of seminal vesicle duct 2) Testicular failure. If seminal fructose is absent , it supports diagnosis of first . Need to investigate for obstruction. If seminal fructose is normal, it is in favour of testicular failure. Testicular biopsy may be needed. This is a simple test and can guide what investigations to be done.

Rule out retrograde or obstructive pathology History of any operation Color Doppler of scrotum Sos testicular biopsy Factual two sample must Come of azospermia then Investigate

Azoospermia R/o any traumatic or obstructive cause. Testicular biopsy to confirm evidence of spermatogenesis.

Azospermia 2nd set of investigations should be ordered

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Testicular biopsy is indicated in this case

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