Male Infertility - Physical Examination

A complete examination of the infertile male is important to identify general health issues associated with infertility. For example, the patient should be adequately virilized; signs of decreased body hair or gynecomastia may suggest androgen deficiency.

The scrotal contents should be carefully palpated with the patient standing. As it is often psychologically uncomfortable for young men to be examined, one helpful hint is to make the examination as efficient and as matter of fact as possible. Two features should be noted about the testis: size and consistency. Size is assessed by measuring the long axis and width; as an alternative, an orchidometer can be placed next to the testis for volume determination (Figure 42-5). Standard values of testis size have been reported for normal men and include a mean testis length of 4.6 cm (range 3.6-5.5 cm), a mean width of 2.6 cm (range 2.1-3.2 cm), and a mean volume of 18.6 mL (± 4.6 mL) (Figure 42-6). Consistency is more difficult to assess but can be described as firm (normal) or soft (abnormal). A smaller or softer than normal testis usually indicates impaired spermatogenesis.

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