April 22, 1983

Evaluation of Infertility-Reply

Author Affiliations

Harbor-UCLA Medical Center UCLA School of Medicine Torrance, Calif

JAMA. 1983;249(16):2175-2176. doi:10.1001/jama.1983.03330400027007

In Reply.—  Dr Schwarzstein has raised a number of interesting points in his letter in response to our article, "Evaluation of the Male Partner of an Infertile Couple: An Algorithmic Approach."We are of common mind regarding the importance of a careful history and physical examination. The article focused on laboratory testing, since it was published as part of a series in The Journal entitled TOWARD OPTIMAL LABORATORY USE. The history should, of course, include questions regarding cryptorchidism and genital infections. Physical examination includes careful palpation of the epididymis, vas deferens, and spermatic veins with the Valsalva maneuver, as indicated in several places in the article. We have used the Doppler stethoscope in an attempt to detect subclinical varicoceles with mixed success. Spermatic venography carries considerable expense to the patient and probably should be reserved for those with a high degree of suggestion of nonpalpable varicoceles, ie, increased number of

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