Your SlideShare is downloading. ×
0
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Azoospermia
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Azoospermia

3,077

Published on

This Presentation about Azoospermia by Dr. Khaled Mokhtar - Assistant Professor of Urology Ain-Shams University - Cairo , Egypt

This Presentation about Azoospermia by Dr. Khaled Mokhtar - Assistant Professor of Urology Ain-Shams University - Cairo , Egypt

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
3,077
On Slideshare
0
From Embeds
0
Number of Embeds
9
Actions
Shares
0
Downloads
109
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. History ofAzoospermia in Era of ART Khaled Mokhatr MD Urology Ain Shams University
  • 2. History of infertility Ancient Egyptian papyri (2000 BC)“Man is the source of life, through his seeds and woman is a reservoir of these seeds”.
  • 3. History of infertility  Leonardo Da Vinci (1500 AC):  Anatomy of genital systemNetherland MRI 2002 DaVinci 1500
  • 4. History of infertility Anton Leeuwenhoek (1632-1723), discovered the sperms (Animalcules).I am sending a letter to show my observation, you may consider it as scientific discovery or HOAX.
  • 5. History of infertility Franzy Leydig, german Zoologist, (1850):discovered Leydig cell
  • 6. History of infertility Enrico Sertoli, Italin Anatomist, (1865): discovered Sertoli cell
  • 7. Spermist vs Ovist 1600 till 1700 Spermist  Ovist  ovum is harboring small fetous and it just need to contact the male fluid to be released
  • 8. Only in 1779 Italian, Lazzaro Spallanzani, Scientific proof that the sperm fertilizes the ovum To produce pregnancy was first available (Spallanzani).
  • 9. History of infertility Robert Dicknson (BJM, 1921) IUI Stepto& Edward First Test-Tube Baby - Louise Brown (Lancet, 1977) IVF
  • 10. History of infertility Palermo et al (Lancet, 1992) ICSI. Devroey et al (Hum. Reprod., 1995) TESE/ICSI
  • 11. “Infertile men, whereverthey live, should have achance to become geneticfathers” Westlander J (Human Reprod. 2000)
  • 12. Azoospermia 1% of all men 10% of infertile men Azoo spermic Infertile fertile
  • 13. Introduction Azoospermia is an absolute barrier against spontaneous pregnancy. Until recently, men with azoospermia have little or even no hope to be biologic father. Recent advances in microsurgery and reproductive technology have allowed many azoospermic men to father children. Pregnancy rate is a real reflection of all these advances
  • 14. ObstructiveAzoospermia
  • 15. Obstructive Azoospermia Obstructive azoospermia (OA) are potentially correctable with the aid of microsurgery (VE) or endoscopic (TURED). Irreparable OA e.g. CBAVD, requires sperm retrieval (PESA.MESA) combined with IVF/ICSI.
  • 16. Obstructive Azoospermia: Sperm Retrieval Optionsè Epididymis  MESA (microsurgical epididymal sperm aspiration)  PESA (percutaneous epididymal sperm aspiration)
  • 17. Obstructive Azoospermia: Sperm Retrieval OptionsTestis TESA (testicular sperm aspiration) TESE (testicular sperm extraction - therapeutic testis biopsy)
  • 18. Obstructive Azoospermia: Results with IVF/ICSI (Experienced Centres) Epididymal TesticularSperm Retrieval ~100% ~100%Fertilization rates 50-70% 40-70%Clin. Pregnancy rates 30-50% 30-50%Live birth rate 30-40% 20-40% Palermo et al, Hum Reprod 1999 Devroey et al, Hum Reprod 1996 De Croo et al, Hum Reprod 2008
  • 19. Non ObstructiveAzoospermia..Testicular failureIt is not an absolute failure
  • 20. NOA Non Obstructive Azoospermia (NOA), recently, have been granted the hope to father their children after testicular extraction and ICSI (Devroey et al, Hum Rprod, 1995) .
  • 21. New concept. +ve sperm identification in failed testes 20% to 70% of non obstructed azoospermia still harbor foci of active spermatogenesis with mature spermatozoa that could be retrieved and the only way to use it is ICSI
  • 22. Testicular histology in testicular failure 56454035 20 SCO n=4430 14 Mat. Arrest n=1525 10 Hypo n=820 Mixed n=111510 5 0 NOA
  • 23. Distribution of spermatogenesis in OA Vs NOA There must be at least 4 sperms per tubule as a minimum quantitative threshold of spermatogenesis to reach the ejaculate. Mapping of spermatogenesis in NOA testes shows that Spermatogenesis is diffuse rather than regional.Silber et al, Hum Reprod 2000
  • 24. Non-Obstructive Azoospermia: Sperm Retrieval Options TESE (testicular sperm extraction)  Singlevs multiple open biopsies  Microdissection- microTESE TESA (testicular sperm aspiration) is not recommended Silber et al, Hum Reprod 1997 Schlegel et al, Hum Reprod 2004
  • 25. Non-Obstructive Azoospermia: Sperm Retrieval: Microdissection Small areas of spermatogenesis may be distinguished from areas of Sertoli cell-only by microscopic examination Microdissection enhances sperm yield and reduces volume of tissue excised Schlegel et al, Hum Reprod 1999
  • 26. Micro. TESE
  • 27. Doctor patient Minimally invasive procedure Minimally invasive for a Doctor is not Minimally invasive for patients
  • 28. The only way to use retrieved sperms is via ICSI
  • 29. Non-Obstructive Azoospermia (NOA): Results with IVF/ICSI (Experienced Centres) NOA OATestic. Sperm Retrieval 20-80% ~100% *Fertilization rates 40-60% 40-70%Clin. Pregnancy rates 30-40% 30-50%Live birth rate 20-30% 20-40% Nagy et al, Fertil Steril 1995 Devroey et al, Hum Reprod 1996 Kahraman et al, Hum Reprod 1996 Palermo et al, Hum Reprod 2002
  • 30. In Egypt..We are different
  • 31. In Egypt.. We are different, why? More prevalent of NOA > OA Low incidence of CF mutation gene Misdiagnosis of active spermatogenesis by many pathologists. However, we do not have good statistical reports of true incidence of any of theses
  • 32. CONCLUSION OA can be effectively and successfully managed with microsurgery. non-constructible OA, (CBAVD) sperm retrieval combined with IVF/ICSI can be highly effective in achieving pregnancy. NOA has been recently revolutionized by successful TESE/ICSI with resultant successful pregnancy. The high cost compared to pregnancy outcome is a considerable limiting factor against the popularization of TESE/IVF-ICSI.
  • 33. The future In vitro maturation of oocyte (IVM) In vitro spermatogenesis (Tesarik et al.,Lancet, 1998) Tissue culture system fortified with RFSH, T. spermatogenesis could be completed in vitro with an unusual speed, but the resulting gametes are morphologically abnormal.
  • 34. Design Final Touch:Ahmad Al-Sabbagh March 2012*

×