Sperm count, motility, Clidton and scrotum scan.Question

Resolved question:
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

Submitted: 4 Days
Category: Urologist

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