A 27-year-old man presents to the emergency department with complaints of chest pain and hemoptysis. He reports a history of chronic sinusitis and recurrent pneumonias, which have required multiple hospitalizations. He also notes a history of infertility, mentioning that he and his wife have been unable to conceive despite trying for several years. During the physical examination, heart sounds are auscultated on the right side of the chest, and the patient confirms that he has situs inversus. Pulmonary function tests (PFTs) reveal a decreased FEV1/FVC ratio, consistent with obstructive lung disease. A CT scan shows dilated bronchioles with a signet-ring appearance and situs inversus. What is the most likely cause of this patient’s infertility?
