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542 Infertility, Male

• Scrotal hyperthermia (due to fever, Initial Database Asthenozoospermia:
obesity with increased intrascrotal fat, • Physical exam, including palpation of • Radiography of the thorax, biopsy and
VetBooks.ir • Toxin exposure or exogenous drug admin- • Semen collection and libido evaluation tory epithelium or spermatozoal mid-
hydrocele, hematocele, scrotal edema, or
the scrotal contents, spermatic cords, and
electron microscopy of nasal or respira-
prostate
neoplasia)
pieces for evaluation for primary ciliary
istration: glucocorticoids, anabolic steroids
dyskinesia
(human estrogen or testosterone patches or • Semen evaluation (including volume, motil- • Exam of ejaculate for pH and/or presence of
ity, concentration, and morphology)
creams), other steroid hormones, chronic • Seminal and prostatic fluid cytologic analysis urine crystals, indicating urine contamination
nonsteroidal antiinflammatory drug (NSAID) and culture (p. 1153) • Collection directly into semen extender at
usage, gonadotropin-releasing hormone • CBC, serum biochemistry panel, urinalysis body temperature, with fractionation of
(GnRH) agonist/antagonists, chemothera- • Serologic titers, as appropriate: B. canis, feline ejaculate
peutic agents coronavirus/FIP Teratozoospermia:
• Testicular degeneration (primary or • Detailed morphologic exam using special
secondary) Advanced or Confirmatory Testing staining (i.e., Spermac, toluidine blue,
• Immune mediated (lymphocytic thyroiditis All categories: Coomassie blue) and microscopic techniques
or spermatozoal autoantibodies) • Scrotal and prostatic ultrasonography for (i.e., phase-contrast, differential interference
• Unilateral or partial epididymal or tubular structural lesions contrast, or electron microscopy).
obstruction (granuloma, spermatocele) • Endocrine testing: baseline testosterone, Oligozoospermia:
• Congenital estradiol, follicle-stimulating hormone • Urinalysis after ejaculation to assess for
Additional causes (specific to individual concentrations and/or prolactin retrograde ejaculation. Sample may be
categories): • Endocrine stimulation testing obtained by cystocentesis or catheterization.
• Primary ciliary dyskinesia with abnor- ○ Administer 2.2-3.3 mcg/kg GnRH IM or • Seminal plasma alkaline phosphatase concen-
mal spermatozoal midpiece formation 44 IU/kg human chorionic gonadotropin trations to confirm that ejaculation actually
(asthenozoospermia) (hCG) IM in dogs with baseline testoster- occurred with azoospermia.
• Prostatic disease: benign prostatic hyperplasia, one and luteinizing hormone (LH) and
prostatitis, or squamous metaplasia (oligo- then sample for LH (10 minutes after TREATMENT
zoospermia, asthenozoospermia) injection) and testosterone (1 hour after
• Neoplasia (oligozoospermia, teratozoospermia) injection) Treatment Overview
• Hyperadrenocorticism (oligozoospermia) ○ 250-500 IU hCG IM or IV or 25 mcg • Increase the number of total sperm, the
GnRH IM in toms with baseline testos- number of total motile cells, and/or the
DIAGNOSIS terone and post-stimulation samples taken number of normal cells per ejaculate.
2 and 4 hours later for hCG or 1 hour • Manage use of the male to maximize fertility.
Diagnostic Overview after GnRH
Diagnosis is based on history (generally of ○ Normal response: minimum of a twofold Acute General Treatment
suboptimal fertility), physical exam findings, to fourfold increase in testosterone All:
semen evaluation, and cultures of semen or concentrations • Bacterial infections should be treated with
prostatic fluid in many cases. Remainder ○ Negligible or inappropriate response appropriate antibiotics based on culture
may require more advanced diagnostic indicates a primary testicular lesion or and sensitivity and on ability of drug to be
testing. a lesion of the hypothalamic-pituitary effective in target tissue (e.g., blood-prostate
axis, resulting in failed feedback loop barrier [p. 1443]). Individuals positively
Differential Diagnosis mechanisms. confirmed to be infected with brucellosis
Asthenozoospermia: • Testicular aspirate or biopsy should be neutered or culled and all ken-
• Contaminated or improperly washed ejacu- • Advanced semen diagnostics: sperm chro- nelmates tested.
late collection equipment (e.g., disinfectant matin structure assay, electron microscopy, • Hemicastration for unilateral inflammatory,
residues) in vitro functional assays, flow cytometry obstructive, or neoplastic conditions
• Excessive use of lubricants
• Prolonged exposure of ejaculate to latex, heat,
or cold
• Urine contamination of the ejaculate
• Infrequent ejaculate/collection, with accu-
mulation of dead sperm in the epididymis
and/or vas deferens
Teratozoospermia:
• Poor handling of semen after collection
(especially if coiled tails or detached heads
are present)
• Improper microscopic interpretation
• Prolonged sexual abstinence (increase in
detached heads) or overuse, pubertal and
geriatric patients (increases in cytoplasmic
droplets)
Oligozoospermia: A B
• Retrograde ejaculation
• Fear or apprehension of mating (e.g., pres- INFERTILITY, MALE Sperm morphology slides were made with an eosin-nigrosin (viability) stain (A) or
Romanowsky (Diff-Quik) (B). With the viability stain, sperm that have damaged cell membranes (dead) stain
ence of dominant female, timid male, first red (pink), whereas sperm with normal cell membranes (live) do not take up the eosin and therefore appear
time breeding) white. With the Romanowsky stain, increased incubation time (at least 5 minutes for each stain instead of the
• Overuse of males, resulting in depletion of typical 10 dips in the stain jar) is required for the sperm cells to take up adequate amounts of stain to determine
epididymal sperm reserves morphology. Cytoplasmic droplets are not evident with Romanowsky stain.

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