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Related Concept Videos

Infertility in Males01:23

Infertility in Males

Male infertility affects millions of couples worldwide, arising from various factors that impact different stages of the reproductive process. An endocrine imbalance resulting from conditions like hypogonadism, Klinefelter syndrome, or pituitary disorders can disrupt hormone levels and reduce sperm production. Testicular defects, such as tumors, cryptorchidism, atrophic testes, abnormal sperm morphology, and low sperm count or motility, may arise due to genetic factors, structural...

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Prolactinoma presenting as a failed vasectomy reversal.

Adam W Templeton1, Kwabena K Pobi, John Turco

  • 1Dartmouth Medical School, Hanover, New Hampshire, USA.

Fertility and Sterility
|June 15, 2007
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Summary

This case report highlights a prolactinoma causing infertility after vasectomy reversal. Effective treatment of hyperprolactinemia improved semen parameters, though assisted reproductive technologies were ultimately needed for conception.

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Area of Science:

  • Reproductive Endocrinology
  • Andrology
  • Neuroendocrinology

Background:

  • Vasectomy reversal is a common procedure for male infertility.
  • Hyperprolactinemia, often caused by pituitary adenomas, can lead to hypogonadism and impaired spermatogenesis.
  • Failed vasectomy reversal necessitates thorough investigation into underlying causes of infertility.

Observation:

  • A 46-year-old male presented with severe oligospermia and zero motility post-vasectomy reversal.
  • Endocrine evaluation revealed significantly elevated prolactin levels (650 ng/mL) indicative of a pituitary adenoma.
  • Initial semen analysis showed low volume (0.65 mL) and severe oligospermia (16 sperm).

Findings:

  • Treatment with bromocriptine and subsequently carbegoline normalized prolactin levels (16.9 ng/mL) and improved testosterone and FSH.
  • Semen analysis showed improvement in volume (4.5 mL) and concentration (15 million/mL), but motility remained low (1%).
  • Despite improved semen parameters, intracytoplasmic sperm injection and testicular sperm extraction were unsuccessful due to antisperm antibodies and oligoasthenospermia; donor sperm was used.

Implications:

  • This case demonstrates prolactinoma as a rare but significant cause of infertility mimicking failed vasectomy reversal.
  • It underscores the importance of comprehensive endocrine evaluation in cases of unexplained infertility after vasectomy reversal.
  • Early diagnosis and management of hyperprolactinemia can potentially improve male fertility outcomes.