Male Infertility: Epididymitis

Causes of Infertility in Males

• Epididymitis
• Azoospermia
• Hydrocele
• Priapism
• Hypospadias
• Epispadias

Epididymitis

• Inflammation of the epididymis, a coiled tube at the back of the testicle that stores and transports sperm, can cause scarring and blockage.
• Scarring and blockage prevents sperm from mixing with semen.

Epididymitis Pathophysiology

• Can be caused by bacterial infections like Chlamydia trachomatis, Neisseria gonorrhoeae, and Escherichia coli.
• Also caused by trauma or urinary reflux.
• Leads to inflammation, swelling, and scarring of the epididymis, potentially blocking sperm transport

Epididymitis Diagnostic Procedures

• Urinalysis and urine culture detects infections.
• Scrotal ultrasound identifies swelling or abscess formation.
• CBC (Complete Blood Count) shows signs of infection with increased WBCs.
• STI screening detects sexually transmitted infections.

Epididymitis Nursing Interventions

• Administer prescribed antibiotics like doxycycline and ciprofloxacin.
• Educate on safe sex practices to prevent STIs.
• Apply scrotal support or elevation to reduce swelling.
• Encourage rest and ice packs to decrease inflammation.
• Monitor for complications like abscess and chronic epididymitis.

Azoospermia

• This is a condition where no sperm is present in the ejaculate.
• Can result from obstructive causes like blockages in the reproductive tract.
• Also caused by non-obstructive causes like sperm production issues due to hormonal imbalances, genetic defects, or testicular failure.

Azoospermia Pathophysiology

• May occur due to obstructive causes like blockage in the vas deferens, epididymis, or ejaculatory duct.
• Non-obstructive causes include testicular failure, hormonal imbalance, and genetic disorders like Klinefelter syndrome.
• Results in an absence of sperm in semen, leading to infertility.

Azoospermia Diagnostic Procedures

• Semen analysis confirms the absence of sperm.
• Hormonal tests, including FSH, LH, testosterone, and prolactin, evaluate endocrine function.
• Testicular biopsy determines if sperm production is present.
• Genetic testing via karyotyping or Y-chromosome microdeletion test identifies genetic causes.

Azoospermia Nursing Interventions

• Educate about assisted reproductive techniques (ARTs) like IVF with sperm retrieval.
• Provide emotional support, as infertility can be distressing.
• Assist with hormone therapy if a hormonal imbalance is the cause.
• Educate about lifestyle modifications, including avoiding heat exposure, toxins, excessive alcohol, and smoking.

Hydrocele

• Fluid accumulation around the testicle may raise scrotal temperature potentially affecting sperm production.
• Large or long-standing hydroceles may impair testicular function, but not always cause infertility.

Hydrocele Pathophysiology

• Accumulation of fluid in the tunica vaginalis surrounding the testes is caused by injury, infection, or congenital defects.
• Can increase scrotal temperature, which possibly impairs sperm production.

Hydrocele Diagnostic Procedures

• A physical examination reveals an enlarged, painless scrotum.
• Transillumination test involves shining a light through the scrotum, revealing fluid.
• Scrotal ultrasound differentiates hydrocele from other scrotal masses.

Hydrocele Nursing Interventions

• Monitor for pain or signs of testicular atrophy.
• Educate about hydrocelectomy (surgical drainage) if the hydrocele is large or persistent.
• Apply scrotal support to reduce discomfort.
• Educate patients to avoid prolonged standing or heavy lifting.

Priapism

• Prolonged and painful erection is unrelated to sexual stimulation, if not treated, can cause tissue damage and fibrosis in the penile tissues.
• Can lead to erectile dysfunction and difficulty with ejaculation.

Priapism Pathophysiology

• Prolonged erection for more than 4 hours results from venous blood trapping in the penis.
• Can be ischemic (low-flow, painful, emergency) or non-ischemic (high-flow, less painful).
• Causes include sickle cell disease, trauma, spinal cord injury, and medications like erectile dysfunction drugs or antidepressants.

Priapism Diagnostic Procedures

• Penile blood gas analysis identifies ischemic versus non-ischemic priapism.
• Doppler ultrasound evaluates blood flow in penile arteries.
• CBC and hemoglobin electrophoresis checks for sickle cell disease.

Priapism Nursing Interventions

• Administer pain relief with NSAIDs or opioids if severe.
• Apply cold compresses to reduce swelling.
• Assist with aspiration of blood from the corpus cavernosum if indicated.
• Educate patients on medication adjustments if drug-induced.
• Provide psychosocial support, as recurrent priapism can affect mental health.

Hypospadias

• Congenital condition: the urethral opening is located on the underside of the penis instead of at the tip and can cause difficulties with sperm deposition during intercourse.
• Potentially reducing the chances of fertilization.

Hypospadias Pathophysiology

• Congenital defect has the urethral opening on the underside of the penis instead of the tip.
• May impair normal ejaculation and sperm deposition in the vagina.

Hypospadias Diagnostic Procedures

• Physical examination identifies the misplaced urethral opening.
• Voiding cystourethrogram (VCUG) assesses urinary function.

Hypospadias Nursing Interventions

• Educate parents about surgical correction (urethroplasty) before school age.
• Provide preoperative and postoperative care by monitoring urinary output and pain management.
• Teach about delayed circumcision, as foreskin may be used for repair.

Epispadias

• Rare congenital condition: the urethral opening is located on the upper side of the penis and can cause difficulties with sperm delivery during intercourse.

Epispadias Pathophysiology

• Rare genetic defect which occurs on the upper side of the penis.
• Can cause urinary incontinence and impaired semen ejaculation, which affects fertility.

Epispadias Diagnostic Procedures

• A physical examination identifies abnormal urethral positioning.
• Pelvic ultrasound checks for bladder exstrophy (associated condition).
• Urodynamic studies evaluate urinary function.

Epispadias Nursing Interventions

• Educate about surgical correction (urethral reconstruction).
• Monitor for postoperative complications like infection and urinary retention.
• Provide emotional support to parents in congenital cases.

Causes of Infertility in Females (PCOS)

• Diagnostic tests
• Nursing interventions

Polycystic Ovary Syndrome (PCOS) Pathophysiology

• Hormonal Imbalance: increased luteinizing hormone (LH) and androgens (testosterone, DHEA) disrupt follicular development.
• Insulin resistance leads to increased insulin levels which stimulate the ovaries to produce excess androgens.
• Ovarian Dysfunction: follicles fail to mature and ovulate, leading to anovulation and multiple small ovarian cysts.
• Metabolic Dysregulation: insulin resistance increases the risk of obesity, type 2 diabetes, and dyslipidemia.

Polycystic Ovary Syndrome (PCOS) Diagnostic Procedures

• History and Physical Examination: irregular menstrual cycles (oligomenorrhea or amenorrhea).
• Signs of hyperandrogenism include hirsutism, acne, and alopecia along with difficulty conceiving (infertility).
• Laboratory Tests: Increased LH:FSH ratio greater than 2:1 indicates disrupted ovulation.
• There is increased total testosterone and DHEA-S, which confirms hyperandrogenism.
• Also increased fasting insulin and glucose tolerance test (OGTT) which assesses insulin resistance.
• Imaging: Pelvic ultrasound detects multiple small cysts, greater or equal to 12 follicles, 2–9 mm each in the ovaries.

Polycystic Ovary Syndrome (PCOS) Nursing Interventions

• Educating on Lifestyle Modifications: encouraging weight loss of 5-10% to improve ovulation with low-carb, high-fiber diets for insulin control and regular exercise to reduce insulin resistance.
• Medication Management: use oral contraceptives (OCPs) to regulate menstrual cycles and reduce androgen levels.
• Metformin improves insulin sensitivity and promotes ovulation.
• Clomiphene citrate or Letrozole induces ovulation for pregnancy.
• Spironolactone reduces acne and hirsutism.
• Emotional and Psychological Support is needed by providing counseling for body image concerns and infertility-related stress and encouraging support groups for women with PCOS.