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Urology


Answer 1
  1. Repeat semen analysis. Variability in semen analysis from the same patient can occur secondary to multiple factors, such as duration of abstinence and efficiency of collection. Due to this inconsistency, initial laboratory analysis should include at least 2 to 3 semen analyses. If low volume continues, then postejaculatory urinalysis should be performed to rule out retrograde ejaculation. Scrotal ultrasonography should not be used to screen infertile men but rather as a tool to assist in the diagnosis of testicular tumors or varicoceles. Endocrine disorders are responsible for fewer than 3% of cases of male infertility. The current screening recommendations include a serum FSH and testosterone levels for men with suggestive history, physical examination, or sperm density less than 10 million/mL. Further testing with repeat testosterone, LH, and prolactin levels are indicated with abnormalities in the initial serum FSH or testosterone levels. For couples in which the woman is approaching age 40 years, aggressive management should begin at the initial presentation.

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