Editing Infertility: Epidemiology and Etiology (section)

=== Post-testicular ===
* '''<span style="color:#ff0000">Ejaculatory dysfunction</span>'''
** '''<span style="color:#ff0000">Ductal obstruction</span>'''
** '''<span style="color:#ff0000">Retrograde ejaculation</span>'''
***Partial retrograde ejaculation may exist concurrently with partial antegrade ejaculation. If the antegrade specimen is sufficient for reproduction either naturally or with medical assistance, no treatment may be necessary. However, if the antegrade ejaculate is poor and a substantial RE is present as demonstrated by post-ejaculatory urinalysis, various therapies may be required.
***'''Causes[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5002007/table/t1/]'''
****Pharmacological
*****Alpha-adrenergic blockers
*****Psychotropic medications
****Neurogenic
*****Spinal cord injuries
*****Lumbar sympathectomy
*****Retroperitoneal lymph node dissection (RPLND)
*****Aorto-iliac vascular surgery
*****Abdominoperineal resection
*****Diabetic autonomic neuropathy
*****Multiple sclerosis
*****Myelodysplasia
*****CVA
****Anatomical
*****Congenital
******Posterior urethral valves
******Utricular cysts
******Extrophy
*****Acquired
******Transurethral bladder neck incision
******Transurethral resection of prostate
***'''Management'''
****'''May be treated with [https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''
****#'''Sympathomimetics and alkalinization of urine with or without urethral catheterization'''
****#'''Induced ejaculation'''
****#'''Surgical sperm retrieval'''
** '''<span style="color:#ff0000">Anejaculation</span>'''
*** Causes
**** Spinal cord injury
**** Demyelinating neuropathies (multiple sclerosis)
**** Diabetes
**** Iatrogenic (RPLND, pelvic surgery)
**** Transverse myelitis
**** Congenital neural tube defects
* '''<span style="color:#ff0000">Sexual History</span>'''
** '''<span style="color:#ff0000">Lubricants impair sperm motility</span>'''.
*** '''Pre-seed is a lubricant that does not decrease motility.'''
** Saliva is toxic to sperm

* '''<span style="color:#ff0000">Other syndromes associated with infertility</span>'''
** '''<span style="color:#ff0000">Kartagener syndrome</span>'''
*** '''Also known as primary ciliary dyskinesia'''
*** '''Associated with infertility and respiratory pathology due to absence of ciliary movement'''
**'''<span style="color:#ff0000">Cystic Fibrosis</span>'''
*** '''Inheritance: autosomal recessive'''
****One defective allele must be inherited from each parent for a child to be affected
****Individuals with only one mutation are carriers but do not harbor the disease.
***Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) 
****Gene responsible for cystic fibrosis
****Regulates anion transport and fluid secretion in the excurrent ducts
****The mutations more likely to cause obstructive azoospermia may be different than those that cause cystic fibrosis[https://pubmed.ncbi.nlm.nih.gov/33295257/]
***Characterized by 
***#Pulmonary obstruction and infection
***#Exocrine pancreatic insufficiency
***#Obstructive azoospermia
***#Dental carries
***'''<span style="color:#ff0000">Mutations in the CFTR gene can lead to vasal and seminal vesicle agenesis/atresia</span>[https://pubmed.ncbi.nlm.nih.gov/33295257/]'''
****Thought that dysregulation of proper fluid dynamics leads to obstruction and/or atrophy in the epididymis and vas deferens during embryogenesis
*****'''<span style="color:#ff0000">Mutations in the CFTR gene are present in up to</span>''' 
******'''<span style="color:#ff0000">80% of men with congenital bilateral absence of the vas deferens (CBAVD)</span>'''
******'''<span style="color:#ff0000">20% of men with CUAVD</span>'''
******21% of men with idiopathic epididymal obstruction
*******While vasal abnormalities are apparent on physical examination, epididymal obstruction may only be diagnosed at the time of surgical exploration. As such, ''CFTR'' testing may necessarily occur after surgical treatment in some men.
****'''<span style="color:#ff0000">Not all cystic fibrosis patients have vasal agenesis</span>'''
***Some men with otherwise idiopathic genital tract obstruction are found to harbor mutations in the ''CFTR'' gene
[[File:Male Infertility.png|center|thumb|1316x1316px|Male Infertility. Source: Wikipedia]]