Expenence with 3,520 Infertile Male Patients and A Clinical Perspective

Abstract

The author's experience with a total of 3,520 infertile male patients during the period from 1955 to 1984 were reviewed based on the pathophysiology, etiology, evaluation and management. These infertile males corresponded to 4.2% of total male outpatients of the Department. Duration of barren marital life was 4.5 years. Completion of spermatogenesis from spermatogonium to spermatozoon requires 74±5 days. Causes of male infertility were faulty sperm production in 33%, faulty sperm transportation in 35%, faulty semen composition in 7%, faulty ejaculation in 3%, and idiopathic cause which is an eponym for ignorance in 22%. Normal testicular size of Korean males is 19m!. A man with a testicular size of 10 ml or less should be suspected as suffering from faulty spermatogenesis. Normal spermiogramme of our series reveals that volume is 2.6 ml; counts, 120 X 106/ml; motility, 60%; viability, 64%; activity grade, 3; motility index, 180; and morphology, 80%. Medical treatment was attempted to 723 subfertile males using 12 different pharmacological compounds for average of 6 months (2 treatment courses). Semen parameters improved in 28% and pregnancy resulted in 14% after the pharmacotherapy. Surgical therapy was applied to 1,119 patients. In vasovasostomy group (699 patients), anatomical success rates were 90% and functional success rates, 51% by microsurgical anastomosis technique. In epididymovasostomy group (281 patients), patency rates were 37% and pregnancy rates, 20% by microsurgery. In varicocelectomy group, spermiogramme improved in 30% and pregnancy occurred in 20% of the patients who had the varicocelectomy. However, 33% of the patients with varicocele who did not have varicocelectomy could impregnate their wives. The author is quite confident that the urologist who is skilled in andrology can provide better and more rational care for these infertile males.