Male Infertility: Medical History

Medical history (history of illness) represents an important component in the diagnosis of male infertility. Family history

  • Is there any history of involuntary infertility in your family?
  • Are there any hereditary diseases in your family?
  • Are there any tumor diseases in your family (germ cell tumor, prostate or breast cancer).

Social history

  • What is your profession?
  • Are you exposed to harmful working substances in your profession?
  • Do you work in areas with increased ambient temperature (work on blast furnace, bakery)?
  • Is there any evidence of psychosocial stress or strain due to your family situation?

Current medical history/systemic history (somatic and psychological complaints).

  • How long have you been trying to conceive a child with your partner?
  • Has there been a pregnancy in the past? If yes:
    • With this or a previous partner?
    • Was the pregnancy carried to term or did an abortion (miscarriage) occur?
  • Was your puberty normal or delayed?
  • Sexual history
    • How long has your partnership existed?
    • Age of the partner?
      • Pre-existing conditions of the partner?
    • Partnership disorders?
      • How do you feel about the desire to have children?
      • What is your partner’s attitude to the desire to have children?
    • What is your libido (desire for sex)?
    • How often do you have sexual intercourse per week/month?
    • Do you have erectile dysfunction?
      • Indicate what type this erectile dysfunction is: partner-related?, situation-related?, act-related?
      • Is the erectile dysfunction permanent?
      • Do you have morning erections?
    • Other questions if you have erectile dysfunction:
      • Do you have premature or delayed ejaculation?
      • Do you have aspermia (failure to ejaculate with or without sperm (semen) despite orgasm)?

Vegetative anamnesis including nutritional anamnesis.

  • Are you overweight / underweight? Please tell us your body weight (in kg) and height (in cm).
  • Do you eat a balanced or wholesome diet?
  • Do you do a lot of (excessive) sports?
  • Do you regularly go to the sauna?
  • Do you use the heated seats in the car?
  • Do you like to drink coffee, black and green tea? If so, how many cups per day?
  • Do you drink other or additional caffeinated beverages? If so, how much of each?
  • Do you smoke? If yes, how many cigarettes, cigars or pipes per day?
  • Do you drink alcohol? If yes, what drink(s) and how many glasses per day?
  • Do you use drugs? If yes, which drugs (cannabis1+3, morphine3, opiates3) and how often per day or per week?

Self-history

  • Pre-existing conditions (diabetes mellitus, hormonal disorders, genitourinary tract diseases (urethritis/urethritis, prostatitis/prostatitis, epididymitis/epididymitis), testicular damage (e.g., maldescensus testis (defective descent of the testis into the scrotum) testicular injuries (e.g. Testicular torsion/rotation of testis and epididymis with interruption of blood circulation), mumps, tendency to respiratory diseases (cystic fibrosis), autoimmune diseases, renal diseases, cardiovascular diseases, liver diseases, renal dysfunction, neurological diseases (multiple sclerosis), psychiatric or psychosomatic diseases, infectious diseases (here: Febrile diseases in the past 3 months because of temporary influence on spermatogenesis), malignancies (chemotherapy, radiotherapy), venereal diseases, thyroid diseases, trauma (injuries), especially in the genital, pelvic and cranial areas).
  • Operations (undescended testis, inguinal hernia (inguinal hernia)).
  • Radiotherapy (in the area of the pelvis or reproductive organs or head).
  • Allergies
  • Environmental anamnesis (see below “Environmental pollution – Intoxications”).

Medication history

  • Antibiotics1
    • Anthracyclines
    • Cotrimoxazole
    • Gentamycin
    • Nitrofurantoin
    • Sulfonamides
  • Antihypertensives (may lead to impaired spermatogenesis (spermatogenesis)).
    • Alpha-1 receptor blockers2 (doxazosin, prazosin, terazosin).
    • Beta blockers (beta receptor blockers)3 – (atenolol, betaxolol, bisoprolol, carvedilol, celiprolol metoprolol, nadolol, nebivolol, oxprenolol, pindolol, propranolol )
    • Reserpine3
  • Antidepressants
    • Selective serotonin reuptake inhibitors (SSRIs) – citalopram2, fluoxetine2, sertraline2
    • Tricyclic antidepressants (nonselective monoamine reuptake inhibitors, NSMRIs) – doxepin2, opipramol2
    • Serotonin-norepinephrine reuptake inhibitors (SNRIs) – duloxetine2, venlafaxine2
  • Antiepileptic drugs (pregabalin2, primidone3).
  • Anxiolytics2
  • Calcium channel antagonist (calcium channel blocker) – amlodipine (effect on fertility potential).
  • H2 blockers – cimetidine4, famotidine4, ranitidine4
  • Hair restorer (finasteride3)
  • Hormones
    • Glucocorticoids3
    • Testosterone preparations3 (testosterone, anabolic steroids)
  • Ketoconazole (androgen biosynthesis disorders)3
  • Non-steroidal anti-inflammatory drugs (NSAIDs) – ibuprofen (testosterone/LH ratio as a function of Leydig cell ↓).
  • Prostate drugs2 (dutasteride, finasteride).
  • Rauwolfia3
  • Cytostatic drugs1 (substances that inhibit cell growth or division) – e.g., busulfan, chlorambucil, cisplatin, cyclophosphamide, methotrexate (MTX).

1Oligozoospermia (< 20 million spermatozoa per milliliter) or impaired spermatogenesis (spermatogenesis)2Ejaculatory disorders including decreased ejaculate volume3Diminished testosterone production4Effects on hormone secretionDrugs that can cause erectile dysfunction can be found under the disease “Erectile Dysfunction (ED) or Erectile Dysfunction”. Environmental stress – intoxications (poisonings).

  • Ionizing radiation (electric fields?).
  • Overheating of the testicles – work at the blast furnace, bakery, frequent sauna sessions; heated seats in the car: long and frequent driving with heated car seats can reduce the ability to conceive. Sperm become fewer in number (oligozoospermia), slower (asthenozoospermia) and are more often malformed (teratozoospermia) [oligo-astheno-teratozoospermia, OAT syndrome].
  • Air pollutants: particulate matter – particulate matter (PM2.5) in the air; increase in particulate matter concentration by 5 µg/m3 each time.
    • Decrease in sperm with normal shape and size by 1.29 percent
    • Proportion of sperm in the lowest tenth of sperm morphology increased by 26 percent
    • Slight increase in sperm concentration
  • Environmental toxins (occupational substances, environmental chemicals):
    • Bisphenol A (BPA)
    • Organochlorines (e.g. dichlorodiphenyltrichloroethane (DDT), dioxins, polychlorinated biphenyls* , PCBs).
    • Solvents (e.g. glycol ether; carbon disulfide).
    • Non-ionic surfactants (e.g. alkyl phenols).
    • Pesticides, herbicides (e.g. dibromochloropropane (DBCP), ethylene dibromide).
    • Heavy metals (lead, mercury compounds).
    • Sunscreens such as 4-methylbenzylidene camphor (4-MBC), plasticizers di-n-butyl phthalate (DnBP), the antibacterial triclosan (e.g. in toothpaste and cosmetics).
    • Plasticizers (phthalates* )

* belong to the endocrine disruptors (synonym: xenohormones), which even in the smallest amounts can damage health by altering the hormonal system.