A 41-year-old man comes to your office with his wife...


 







A 41-year-old man comes to your office with his wife because she has been unable to conceive with him. He is married for the first time. His wife has two children by her previous marriage. The patient is well with no risk factors for heart disease. As a child, he had the usual communicable diseases, including chickenpox and mumps, and as an adult he received the recommended schedule of immunizations. The likely site of his infertility is



a. Pretesticular
  

b. Testicular
  

c. Posttesticular
  

d. Idiopathic
The answer is b.  

  

Mumps virus infection can directly affect the testicles, producing an orchitis, often very painful, and consequently infertility. Posttesticular causes are those that affect sperm transport, and pretesticular causes are those that affect the hormones that stimulate the testicles.
A.  I think your analysis of the situation is correct. Your husband’s fears about not being able to perform are bigger than his concern for his 21 year marriage. Imagine how big those fears must be! The doctors who were trying to help weren’t helpful in that they treated the physical problem without taking into account the emotional message of their interventions. I wish they had talked to him about how normal it is for a man who is under lots of pressure to have trouble performing. I wish they had included you in the discussions.


You probably can’t help him understand that he is running away. At this point, he’s had 10 years of believing that whatever is wrong can’t be fixed. For that reason, I think it would be more helpful for you to start going to a therapist yourself — not because I think you are the patient here but because your relationship is in trouble. When one member of a couple has a problem, the couple has a problem. When one member of a couple starts to go to [therapy](https://psychcentral.com/psychotherapy/) and starts learning new ways to manage stress, it shows. Often that makes the other member of the couple willing to give it a try. Work with a therapist who can hear your whole story and who can give you suggestions about how to approach your husband in new ways. 



You’ve done what you can on your own. Your husband is a lucky man indeed to have a wife who is as understanding and as willing to help as you are. But both you and your husband are missing out on the intimacy that is a special part of a long marriage. For that reason, I encourage you to make an appointment and get started with therapy. 


I wish you well.  

Dr. Marie


Work as Avoidance Technique dear bubu<br/><br/>generally ovarian cysts do not cause infertility. however if your gynaecologist says that you have a condition called polycystic ovarian syndrome which has multiple small ovarian cysts-like structures then that condition certainly causes infertility because it normally causes anovulation. i don’t think that this is the situation in your particular case because you have regular menstrual periods. then there are cyst caused by a condition called endometriosis and these cysts have fluid in it that looks like dark blood. the condition can certainly cause infertility. the need for laparoscopy surgery for an ovarian cyst will depend on the size of the cyst, nature and position of the cyst and your gynaecologist would be the best physician to suggest if it is required or not. <br/><br/>answered by: dr y.m. dasoo<br/> you may have an infection, or a problem with ovulating on time. the first sign of early menopause is the alteration of the menstrual cycle and the absence of periods. also, if you are trying to get pregnant without success, the cause of infertility may be related to ovarian failure.

to confirm whether a woman really suffers from early menopause, it will be necessary to have a gynecological check-up and a hormonal examination. sorry about your diagnosis. i too was given the diagnosis of pof this past february, after a failed ivf cycle. i was told that my only chance to have a successful ivf cycle would be to use donor eggs. so that is what my husband and i are doing next month. i have regular monthly periods though, apparently unlike you. if you truly have a diagnosis of pof, there are not any fertility medications that will make it possible for you to create a genetic family. sorry. it's a fact. you can use the strongest fertility stim meds at the highest doses, and it won't do you any good. furthermore, having a period does not mean that you're ovulating...which is exactly the point of having pof. there is no pharmaceutical way, nor technological way available right now to provide the opportunity for a woman who has pof to have her own eggs retrieved. perhaps you were mistaken with what your diagnosis was? i would ask your re again. best of luck to you. if you have any further questions, please feel free to email me. i am here to provide support for you as well.
addtl info: i just realized that you stated that you aren't able to get into an re until june 2nd. so who gave you the diagnosis of pof? i suppose your gyn? not meaning to knock your doctor, but the reality is that a gyn is simply not educated enough nor specialized enough to make this diagnosis. coming to the conclusion of pof is made via blood work and exams. also, it usually is made only after a round of stim meds fails miserably. i suggest you get a real diagnosis when you see an re. you probably simply will find that you just need a some clomid to help "kick start" your period. but that's a far cry from actually having pof. Hello Miilla,



  

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The difficulty of couples in having a baby can be caused by fertility problems in women and men. Fertility disorders in men often occur due to lack of quality and quantity of sperm cells. Therefore, sperm analysis is one of the most frequently performed examinations in cases like this.



  

Various indicators will be assessed in sperm analysis, including sperm cell concentration, motility and morphology, semen liquid volume, acidity level, time of liquefaction, as well as fructose levels. Ideally, sperm analysis checks are indeed carried out on direct examination from the examining doctor. If it is needed, this examination can be done independently on the examination of the patient. However, given the interpretation of the results of the analysis of sperm cell analysis must also be done directly by a doctor, then you should continue to consult a doctor or a specialist in urology surgery. With his competence, after checking your general health condition, he certainly understands more whether it is necessary for you to undergo a sperm analysis examination or not.



  

To take the examination specimen, the doctor will generally invite you to ejaculate in a special place, then then collect the ejaculation fluid that comes out in a container. In some conditions, you can also do this ejaculation at home, that is by masturbating or ejaculating during sexual intercourse that is accommodated in a special condom (not just any counselor). However, even if it is done at home, this ejaculatory fluid must be stored at room temperature and taken directly to the doctor in less than 1 hour to be examined. Before taking a specimen, to get accurate results, you need to delay sexual intercourse and masturbation for 2 to 3 days in order. Also avoid consuming alcohol, caffeinated minerals, drugs, or any supplements without first consulting a doctor. So that the results are right, this examination can also be repeated 2 to 3 times in 2-3 weeks.



  

Hope this helps ... but your pregnancy needs monitered very carefully and be prepared if an incompatibility shows itself. see more... the cause would really be determined by the levels of your other hormones. it may be that you are not ovualating. early menopause is also a cause, but the diagnosis cannot be made just on the oestrogen levels.<br><br>best wishes yes, if you marry this dude and no one ever cheats. but still, why not protect yourself? get the vaccine so you are totally safe. i hope your boyfriend is always faithful but you never know, things happen. this vaccination is supposed to be given before the age of 25 years, i think. i do not know of a test for hpv for men anyway at this time. it is very very contageous and running rampid. my step-daughter was not promiscuous and she found out she had hpv after she was married. who really knows where her husband got it? and it doesn't matter they have a good marriage. anyway, he has no symptoms but she has had to have surgery. i wish we would have known about this vaccine or it would have been available when she was younger. i would have made sure she got the vaccine when she was in my care as a teenager. then, she would not have ever had to suffer. she has a daughter and will make sure she is vaccinated. the vaccination is a blessing and only provides protection. be thankful it is available and get it.

ok valid answer - here is a copy of an article and if you are 26 you can still get it:
 
human papillomavirus, a disease that causes 70 percent of cervical cancer cases and 90 percent of genital warts cases, is most common for people in their late teens and early twenties, according to the centers for disease control and prevention web site.

"if i were a 26-year-old who had never had intercourse or had never been exposed to the virus, i'd get the vaccine," said dr. roger yandell in the department of obstetrics and gynecology at the texas tech health sciences center. "it definitely has more impact on younger girls, though. the cervix changes during menarche, a girl's first period. that's when it's most susceptible to the virus, so we try to start the vaccine just before that takes place." 

the advisory committee on immunization practices consists of 15 experts - selected by the secretary of the u.s. department of health and human services - who provide advice and guidance to the cdc. the committee recommends women through age 26 years old receive catch-up vaccinations, according to the cdc web site.

"you have to look at what we're trying to treat," yandell said. "cervical cancer is really what we're talking about here, and on a lesser scale, genital warts. this is the most common disease for causing either of those." most people do both, but obstetricians deal with pregnancy and gynaecologists with non-pregnancy female problems.<br/><br/>best wishes