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torchidism (dysgenesis), Y chromosome microdeletions;

  • acquired – after orchitis, testicular torsion, testicular

tumour, systemic illness, cytotoxic therapy.

Hypogonadotrophic hypogonadism (deficient FSH/LH) Low levels of gonadotrophins due to dysfunction of the pituitary gland or hypothalamus are rare and may occur as a result of:

  • congenital anomalies – idiopathic hypogonadotrophic hypogonadism, Kallmann syndrome (accompanied by anosmia);

  • acquired anomalies – acquired hypothalamic/pituitary gland diseases (tumour, granulomatous illness, hyperprol- actinemia);

  • exogenous factors – drugs (anabolic steroids, obesity, irra- diation).

If unexplained hypogonadotrophic hypogonadism is present, the medical examination should include magnetic resonance imaging (MRI) or a computed tomography (CT) scan of the pituitary gland.

Microbiological assessment Indications for microbiological assessment include abnormal urine samples, urinary tract infections, ‘male accessory gland infections’ (MAGI), and sexually transmitted diseases (STDs). The clinical implications of white blood cells detected in a semen sample are as yet undetermined. However, in com- bination with a small ejaculate volume, this may point to a (partial) obstruction of the ejaculatory ducts caused by a (chronic) infection of the prostate or seminal vesicles.

Male Infertility 161

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