Androlog of the Fertility and Sterility Dialog

Low volume oligospermia

Started about 2 years ago

I have a problem patient. 38 year old male with 2ndary infertility. History of acoustic neuroma 2018. Recent SA revealed volume 0.21 cc ( didn’t miss) concentration 5.18 million/cc TMC 9.46. Zero percent motile. pH 6.4. Hormone profile WNL. Has Gr111 varicocele. With the low pH, I was wondering about EDO and a cyst but TRUS showed nothing. Am awaiting the second SA. Labs temporarily closed still. Any other things I may be missing?  So far it has been suggested on Twitter to perm a post ejaculatory urine and to consider a partial EDO and perform a TURED.

Any other suggestions?

Can you be more specific around the hormonal profile? Did you calculate bioavailable testosterone? And what do you mean by "TRUS showed nothing"? What did the seminal vesicles measure out to be?

TRUS was normal. No ejaculatory duct cyst. 2nd SA pending with PEU. Also for clarification. It was 0% morphology. 

Hormones specially FSH 5.9. LH 4.0. Total testosterone 23 nmol/L. PRL 12. TSH 3.12.   I didn’t get an SHBG. TT was done at 8 am. Although the SV were not measured, it was commented on that they were not dilated. I measured them at 7.9 and 6.5 mm across.