ARANILLA, HANAKO S.

APRIL 17, 2020

CASE BASED ACTIVITY DR. PAREDES

1. MALE INFERTILITY

Matthew Sterile 30 y/o male ,married for 5 years to Ann De Baog who has a child
from her previous marriage. Matthew has a 10 pack year history of smoking. He is a
Corporate Executive who rides his Harley Davidson everyday. He wears tight jeans
as his uniform to work. He has had numerous girlfriends when he was a bachelor.
He once recalled having a burning sensation when he was urinating. On physical
exam he feels a lump inside his scrotum. • _
Matthew and Ann have been trying to have a baby for 5 years. *Identify and list
the possible reasons and explain.

Client’s Profile
Male, 30 married 5 years
History of Smoking -10 years
Rides Harley Davidson daily
Clothing-tight jeans
Sexual activity-numerous girlfriends bachelor days
Subjective data: Recalled “Burning sensation when urinating”

P.E.-lump inside scrotum

Possible Reasons for infertility:

1. Cigarette Smoking
Based on a study, it was found that smokers had lower seminal zinc levels than
nonsmokers, with associated decreases in sperm concentration, motility, and
morphology.

2. Exposure of scrotal area/testes to high temperatures-riding motorcycles

Optimum temperature for sperm production should be maintained at 35 degrees
celcius.

3. Tight clothing
Tight jeans exerts pressure on the testes and increases temperature, thus cold
lower sperm count.

4. STDs
The structures of the male reproductive tract, including the epididymis and
urethra, can be damaged by infection with an untreated STDs

5. Varicocele (lump inside scrotum)

A varicocele causes an increase in the temperature of the testicles, which affects
sperm development. Sperm counts decrease by an estimated 40% for every degree
the testicles rise in temperature. A low sperm count is the most common cause
of male infertility. A varicocele may cause DNA damage in sperm.
 2. OBSTRUCTION and Male Infertility

During ejaculation, two ducts carry semen from the seminal vesicles to the
urethra, where it exits the penis in the ejaculate. A blockage or obstruction
can develop in one or both of the ejaculatory ducts, preventing sperm from
getting into the ejaculate. Sometimes the ducts are blocked from birth (i.e.,
congenital) and in other cases they are acquired.

3. HORMONES and Male Infertility

The precise balance of hormones in a man’s body determines the success of the
male reproductive system. Male infertility can result if the body doesn’t produce
enough testosterone or gonadotropins, which includes follicle-stimulating hormone
(FSH) and luteinizing hormone (LH).

The development and maintenance of spermatogenesis is dependent on the

pituitary gonadotropins; FSH, and LH.

Spermatogenesis is a concerted sequence of events during maturation of

spermatogonia into spermatozoa.

The process involves differential gene-expression and cell-cell interplay regulated

by the key endocrine stimuli, i.e., follicle-stimulating hormone (FSH) and
luteinizing hormone (LH)-stimulated testosterone.

FSH affects independently and in concert with testosterone, the proliferation,

maturation and function of the supporting Sertoli cells that produce regulatory
signals and nutrients for the maintenance of developing germ cells.
 4. BENIGN PROSTATIC HYPERPLASIA

BPH gives rise to obstruction by compression as well as by distortion of the bladder

outlet. In flow dynamics, distortion causes more obstruction than compression.
Using the analogy of a garden hose, it is easier to stop the water flow by distorting
(bending) rather than compressing the hose. At the prostate, the lateral lobes tend
to compress the bladder outlet while the middle lobe tends to distort it.

The degree of Bladder Outlet Obstruction depends more on where the PA is sited
than its size. Adenoma sited at the bladder neck in the periurethral zone forming
the middle lobe would distort the bladder outlet and cause severe obstruction
even if small, while adenoma sited deep in the transitional zone forming the
lateral lobes would need to grow to a much bigger size before causing compression
of the prostatic urethra and obstruction