I think this question is sort of misleading with that whole introduction about the patient's confusion about his work: "Could it be my work? I've heard that high temperatures cause infertility" and that he works in a boiler room.
Excessive testicular temperature is the cause of infertility in cryptorchidism, the failure of one or both testes to descend into the scrotum, and bilateral varicoceles. Optimal spermatogenesis occurs at a temperature several degrees lower than that of the body core, which is achieved when the testes have descended into the scrotum. The dilated veins of the varicocele also cause the temperature of the scrotum to rise. (Recall that varicocele most often happens on the left side because of increased resistance to flow from left gonadal vein drainage into the left renal vein (because the left spermatic vein enters the left renal vein at a 90ยบ angle, flow is less laminar than on the right and left pressure > right venous pressure, the right renal vein is a direct branch of the IVC). Renal cell carcinoma can invade the renal vein and develop a varicocele if left-sided.)
The real answer is given by the lab values of a decreased FSH and LH (which are inhibited by his exogenous testosterone).
Maybe the point is to trust the lab values but also keep in mind the patient's concerns?
submitted by โshak360(20)
I think this question is sort of misleading with that whole introduction about the patient's confusion about his work:
"Could it be my work? I've heard that high temperatures cause infertility"and that he works in a boiler room.Excessive testicular temperature is the cause of infertility in cryptorchidism, the failure of one or both testes to descend into the scrotum, and bilateral varicoceles. Optimal spermatogenesis occurs at a temperature several degrees lower than that of the body core, which is achieved when the testes have descended into the scrotum. The dilated veins of the varicocele also cause the temperature of the scrotum to rise. (Recall that varicocele most often happens on the left side because of increased resistance to flow from left gonadal vein drainage into the left renal vein (because the left spermatic vein enters the left renal vein at a 90ยบ angle, flow is less laminar than on the right and left pressure > right venous pressure, the right renal vein is a direct branch of the IVC). Renal cell carcinoma can invade the renal vein and develop a varicocele if left-sided.)
The real answer is given by the lab values of a decreased FSH and LH (which are inhibited by his exogenous testosterone).
Maybe the point is to trust the lab values but also keep in mind the patient's concerns?