MSFinals-6780

A 35-year-old healthy man presents because he and his wife have been repeatedly unsuccessful in achieving pregnancy, even after three years of actively attempting to conceive. They are not using any method of contraception. The wife has been tested and determined to be fertile. The husband’s past medical history is significant for being treated for repeated upper respiratory tract infections and ear infections, as well as him stating ‘they told me my organs are all reversed’. He also complains of a decreased sense of smell. His prostate is not enlarged on examination. His blood test results are within normal limits.
Which of the following is the most likely cause of the patient’s infertility?