Secondary Infertility Associated with Intra-testicular Schistosomiasis in an Endemic Area: A Case Report

Abstract

Background: Schistosomiasis remains a significant public health problem in low- and middle-income countries, including Yemen. Although the disease primarily affects the urinary and intestinal systems, involvement of the male genital tract—particularly the testes—is rare and often underrecognized. Testicular schistosomiasis can cause chronic inflammation and granulomatous damage that may lead to male infertility, including secondary infertility.

Case presentation: We report a case of a 30-year-old man with a ten-year history of secondary infertility and progressive deterioration of sperm parameters, culminating in azoospermia. Testicular histopathological examination revealed focal granulomatous inflammation with schistosome ova. Notably, clinical exam, imaging, and repeated stool, urine, and semen analyses showed no bilharzial ova.

Conclusions: This case highlights the importance of considering testicular schistosomiasis in the differential diagnosis of male infertility in endemic areas, even when clinical and laboratory findings are unremarkable. Early recognition and treatment may prevent irreversible testicular damage and preserve fertility.