Infertility is an increasingly common problem in urological practice today, and some urological conditions such as erectile dysfunction, reduced libido, problems related to ejaculation, changes in body hair, intermittent testicular pain can be associated with infertility. Some of these symptoms can be related to other conditions such as those of the testicle or even hormonal ones, directly or indirectly influencing fertility.

A recent study by Shirasishi and Matsuyama (Effects of medical comorbidity on male infertility and comorbidity treatment on spermatogenesis - Koji Shiraishi, Hideyasu Matsuyama - https://pubmed.ncbi.nlm.nih.gov/30396536/ found that 21.7% of patients suffering from infertility also suffered from other related conditions undiagnosed until that time. The two researchers observed that treating newly diagnosed comorbidities led to improvement in sperm quality. The conclusion of this study was that patients should be referred to the general practitioner, a valid recommendation for systems of health where primary care is well organized.

Moreover, according to a guide published by PubMed in 2019 (Reasons that should prompt a referral to a reproductive urologist: guidelines for the gynecologist and reproductive endocrinologist - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6853630 /#), gynecologists are often the first to contact those couples who have fertility problems, playing a key role in directing partners to more thorough investigations that can culminate in treatments that improve sperm values, thus increasing the success rate of fertility procedures. assisted human reproduction.

In general, according to this guide, if changes in the spermogram are detected such as azoospermia, motility disorders, premature death of spermatozoa, numerous leukocytes in high quantity in the ejaculate, the partner must be referred to a urological examination which, in addition to a thorough urological history, must it also includes a careful clinical examination and an ultrasound of the prostate and testicles. As a result of these investigations, related conditions can be discovered, by removing which sperm quality can be improved, according to the two Japanese researchers mentioned above.

For example, the presence of an asymptomatic varicocele in the conditions of a modified spermogram can be highlighted only through an Echo-Doppler, its removal clearly improving the result of the spermogram. In the case of oligospermia, the suspicion of partial or total retrograde ejaculation can be raised following a careful anamnesis, and the identification can only be done through an ultrasound examination of the prostate. Epididymal cysts or sequelae of epididymitis also belong to the same category, which can only be diagnosed by ultrasound when they are small in size and escape the clinical examination.

Through this brief presentation, I try to draw the attention of fellow gynecologists to the importance of the most complete diagnosis of men affected by infertility, with the aim of creating a collaboration between our specialties that will be reflected in better results for the treatment of couple's infertility.