IntroductionOld men preparing themselves for marriage late in their lives might face infertility. Infertility in this group of men should be considered from a wider perspective, as they face any age–related health troubles that include, but are not limited to, androgen deficiency and psychological disorders that impede early conception. This review aims to shed light on the proper approach to this minority of secondarily infertile men.Material and methodsA comprehensive electronic English literature search was conducted, using various medical websites and books, for the factors that cause infertility in senior fathers. The physiology of geriatric males, together with their common comorbidities, were discussed.ResultsOld men presenting with secondary infertility should be approached differently. Aging, itself, has a significant impact on male sexual function, sperm parameters, and fertility; all of which contribute to poor fecundability, decreased fertilizing capacity, increased time to pregnancy, increased rate of DNA damage, high abortion rates and increased prevalence of fetal developmental failures. The complexity and the unknowns of the aging male physiology, together with the interaction of obstinate diseases the patient might have, make the issue very difficult to tackle.ConclusionsManagement should include the conventional way of treating young sufferers and further target the underlying causes, if known, along with the provision of geriatric, psychologic, and andrologic support.
A 37‐year‐old man was first seen on 20 March 1997 for a 5‐year history of widespread, persistent, and intensely pruritic skin lesions on all the extremities. Two years following the appearance of prurigo nodularis (PN), the patient developed a major depressive disorder for which he was given antidepressant agents (amitriptyline and clonazepam) by the psychiatrist. His past history also revealed hepatitis B virus infection. Examination revealed numerous, excoriated, erythematous papules and nodules on all extremities of variable size (ranging from 1 to 3 cm), accompanied by secondary pigmentary changes and scars (Fig. 1). Investigations revealed normal complete blood count (CBC), urea, creatinine, and liver enzymes. Hepatitis B surface antigen was positive. 1 Lesions prior to treatment. Numerous nodules at different locations in the upper and lower extremities The patient was treated with several modalities, including antihistamines and topical and intralesional corticosteroids, but with no significant improvement. His depressive symptoms failed to respond and he continued to deteriorate such that he started to exhibit suicidal gestures. On assumption that the continuous itching caused by PN was a major factor in his depression and with the risk of suicide, the decision was made to start thalidomide. On 20 July 1997, thalidomide was started at a dose of 100 mg twice a day after normal baseline work‐up, which included a nerve conduction study, CBC, urea, creatinine, and liver function tests. Because of the history of hepatitis B infection, ultrasound of the liver was performed and was reported to be normal. All topical corticosteroids and antihistamines were discontinued and the patient was allowed to use emollient. On 10 August 1997, pruritus had decreased, but with no change in the skin lesions. The patient tolerated thalidomide, and the dose was increased to 100 mg every morning and 200 mg every evening. On 22 March 1998, there was no pruritus, and skin examination revealed the clearance of most of the lesions and flattening of others (Figs 2 and 3). Central nervous system examination revealed mild sensory loss over both ankles. These changes were seen after a cumulative dose of 79 g. The dose was reduced to 100 mg orally twice a day. A nerve conduction study in May 1998 of three nerves (medial, perennial and surreal) confirmed the clinical findings of mild sensory neuropathy. Because of his very extensive and still active disease, the failure of previous therapeutic modalities, and history of suicidal gestures, full discussion concerning thalidomide side‐effects was carried out with the patient and the neurologist, and the decision was made to taper his thalidomide gradually and to monitor for a worsening of neuropathy. 2 Lesions after 4.5 months of treatment. Flattening of the nodules can be seen 3 Lesions after 8 months of treatment. The disappearance of most lesions and flattening of others can be seen with very obvious secondary hypo‐ and hyperpigmentation and scars During the last 3 months prior t...
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