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Sperm count, motility, Clidton and scrotum scan.Question

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I am 32 years old male, married for 4 years now. I have been suffering from weak erections and early ejaculation, and long refractory period after ejaculating once; for almost 6 years now. Also for past 2 years we are unsuccessfully trying for children. All reports of my wife are fine which indicates problems with me. Recently I met a urologist and then got following tests done;

1) Urine test routine dated 21-JUN-2014 -- All was fine as mentioned by report and urologist
Below are details;

PHYSICAL EXAMINATION
---------------------------------------------------------------------------
a) Color :: Pale Yellow b) Tranparency :: Clear
c) Odour :: Aromatic d) Specific Gravity :: 1012

CHEMICAL EXAMINATION
---------------------------------------------------------------------------
a) Reaction :: Acidic b) Protein (Albumin) :: NIL
c) Sugar :: NIL d) Bile Salt :: NIL
e) Bile Pigment :: NIL f) Orthotolidin(OBT) :: NEGATIVE

MICROSCOPICAL EXAMINATION : per H.P.F.
---------------------------------------------------------------------------
a) Epithelial Cells :: A Few b) Pus ells :: 0-1
c) RBC :: NIL d) Casts :: NIL
e) Crystals :: NIL f) Micro Organisms :: MOD. NO.
g) Parasites :: NIL h) Yeast Cells :: MOD. NO.
i) Other :: NIL


2) Stool test routine dated 21-JUN-2014 -- All was fine as mentioned by report and urologist
Below are details;

PHYSICAL & CHEMICAL EXAMINATION
---------------------------------------------------------------------------
a) Color :: Brown b) Reaction :: Acidic
c) Consistency :: Soft d) Odour :: Offensive
e) Mucus :: Trace f) Blood :: Not Visible
g) OBT :: NEGATIVE

MICROSCOPICAL EXAMINATION : per H.P.F.
---------------------------------------------------------------------------
a) Veg. Cell Residue :: MOD. NO. b) Cellulose Fibres :: MOD. NO.
c) Split Fat :: A Few d) Unsp. Fat Globules :: Occasional
e) Pus Cell :: NIL f) Starch Granules :: MOD. NO.
g) RBC :: NIL h) Parasite :: NIL
i) Cyst :: NIL j) OVA :: NIL
k) Mucus Plaques :: NIL

Con. Method :: OVA not found

3) X-Ray KUB dated 20-JUN-2014-- No abnormalities detected in abdominal area was conclusion
4) VDRL Tet/ rapid Reagin Test dated 20-JUN-2014 -- NEGATIVE was conclusion
5) Blood Glucose Fasting dated 20-JUN-2014 -- 91 (Again this was considered normal considering normal range as 70-110 mg%)
6) Blood Glucose 2 hours after meal dated 21-JUN-2014 -- 86 (Again this was considered normal considering normal range as 70-140 mg%)
7) Prostatic Smear dated 20-JUN-2014 -- Below are the details;
Gram's Stain :
--------------
Occasional Pus Cells and Leucocytes
No Gram Positive or Gram Negative
Micro Organisms seen

=======================================

Also I must mention two test reports which I got done in 2012;

1) Semen Analysis dated 30-AUG-2012 -- Below are the details;

PARAMETER
---------------------------------------------------------------------------
a) Time of collection :: 9:40 AM b) Place of collection :: Laboratory
c) Time of liquification :: 15 mins d) Abstinence :: 03 days

PHYSICAL EXAMINATION
---------------------------------------------------------------------------
a) vOLUME :: 3.0 ml b) Color :: Greyish White
c) PH :: Alkaline

MICROSCOPIC EXAMINATION
---------------------------------------------------------------------------
a) Sperm Count :: 32.2 Million/ml

MOTILITY
---------------------------------------------------------------------------
a) Progressively Motile :: 70% b) Non Progressively Motile :: 20%
c) Non Motile :: 10%

OTHERS
---------------------------------------------------------------------------
a) Epithelial Cells :: Occasional b) Pus Cells :: 1-2/hpf
c) RBC :: Occasional

MORPHOLOGY
---------------------------------------------------------------------------
a) Normal :: 75% b) Abnormal :: 25%

CHEMICAL EXAMINATIONS
---------------------------------------------------------------------------
a) Fructose :: Present

2) Hormone Test dated 6-SEP-2012 -- Below are the details;
a) Testosterone :: 499.50 ng/dl (Again this was considered normal considering reference normal range as 241-827 ng/dl)
b) Prolactin :: 19.67 ng/dl (It was considered slightly high since for males its < 15 ng/dl)

=======================================

Finally I must mention one test reports which I got done in 2014;

1) Semen Analysis dated 29-APR-2012 -- Below are the details;

PARAMETER
---------------------------------------------------------------------------
a) Time of collection :: 10:15 AM b) Place of collection :: Laboratory
c) Time of liquification :: 25 mins d) Abstinence :: 03 days

PHYSICAL EXAMINATION
---------------------------------------------------------------------------
a) vOLUME :: 3.0 ml b) Color :: Greyish White
c) PH :: Alkaline

MICROSCOPIC EXAMINATION
---------------------------------------------------------------------------
a) Sperm Count :: 15.0 Million/ml

MOTILITY
---------------------------------------------------------------------------
a) Progressively Motile :: 70% b) Non Progressively Motile :: 20%
c) Non Motile :: 10%

OTHERS
---------------------------------------------------------------------------
a) Epithelial Cells :: Occasional b) Pus Cells :: 1-2/hpf
c) RBC :: Occasional

MORPHOLOGY
---------------------------------------------------------------------------
a) Normal :: 75% b) Abnormal :: 25%

CHEMICAL EXAMINATIONS
---------------------------------------------------------------------------
a) Fructose :: Present

=======================================

After studying all these reports, doctor suggested me that there was no issues with my prostrate and this is also not case of diabetes. But my sperm count has clearly gone down from 32.2 to 15.0 Million/ml over period of 2 years. And my problems of weak erections, early ejaculation, and long refractory period after ejaculating once is still there. I pointed him to high prolactin level, though he suggested its not important for me.

Medicines suggested by him are;
1) Udzire 100
2) Duralast
3) Mayoza I -- 3 times a day for 3 months
4) Clidton 600 -- 3 times a day for 3 months
5) Evion 300 -- 3 times a day for 3 months

I also dont smoke, though I drink very occasionaly. I was also never a patient of any depression and didnt had any physological issues. Shall I go for some more tests, may be to get my blood circulation levels to ensure my artries are ot clogged or some other heart issues. Also please suggest if I shall get scrotum scan done to check any injuries to my testicles. I strongly suspect high prolactin levels to be culprit. Please suggest me further course of action/recommendations. Also suggest me side effects of medicines suggested to me.

Regards,
Tushar


Category: Urologist

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Category: Sexually Transmitted Diseases(STD)Specialist
Dr. Rajiv Goel is online now

Expert:  Dr. Rajiv Goel replied 4 Days.

Thanks for choosing Doctorspring.com
Dear Sir,

I Shall first discuss your erection problem. The medication, Udezire is good for providing you with erection and having sexual intercourse. From your history it seems that you are suffering from vascular causes of erectile dysfunction and you should consider treatment with low intensity shockwave therapy. It shall improve your erections and may be even cure erectile dysfunction. It is very new treatment and is available at only limited places. You prolactin levels are marginally high and shall not cause the problems. No test shall inform conclusively about clogged blood vessels. You should certainly get lipid profile. USG scrotum is of no use and shall not contribute to your management.

Regarding your infertility, semen analysis reports change every day and hence a single report is never conclusive. However, I am pretty happy with your latest report also. Since you have been actively trying since long to conceive there is a possibility that your wife has antisperm antibodies and the treatment for that is intrauterine insemination (IUI). You should see your gynecologist and seriously consider IUI.

All the best.

Sincerely


Patient replied :

Thanks for providing your valuable insight sir, so tow I am assuming that Prolactin factor is not that important for my case. I want to ensure if my ED problem is due to any vascular disease as you suggested. Can you recommend me some tests which will tell if blood flow to my penis and testicles is normal or arteries are not clogged, or any other clinical tests which will indicate towards vascular problems. I know its difficult to diagnose this with conviction, but I want to give a try. Apart from that I will also go for lipip profile test as recommended.
Regards,
Tushar


Expert:  Dr. Rajiv Goel replied 3 Days.

Dear sir,
Kindly undertake Penile Doppler study. This will determine blood flow to the penis and testicles.
Take care.
Sincerely,
Dr. Rajiv Goel.


Dr. Rajiv Goel
Category: Sexually Transmitted Diseases(STD)Specialist
Experience: 
MCh(urology) Medical Council of India
Fellow, Laparoscopic urology, Germany
Fellow, Urooncology and Robotic urology, Australia
DNB - NBE
Felloship - MCH, Urology/Genito-Urinary Surgery, AIIMS, 2004
Residency - MS, Master of Surgery, AIIMS, 2001
Medical School - MBBS, Bachelor of Medicine and Bachelor of Surgery, AIIMS, 1998
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