Assessing Testicular Output Dr Anand K. Shinde M.D (OBGYN) Center for Assisted Reproduction Andrology OPD At Deenanath Mangeshkar Hospital, Pune - 4 Tel: 4023395
Assessing Testicular Output Dr Anand K.Shinde What is the need?B. 1 in 20 male has Infertility problemC. Besides Fertility issue he may have problems related to i) Androgen Deficiency ii) Infections including tuberculosis, HIV, STD’s iii) Impotence, Rapid ejaculation
Assessing Testicular Output Dr Anand K.ShindeHow to Assess ?3. History4. Physical Examination5. Lab Semen tests Blood tests7. USG8. Other - Ct scan - scrotal explorations etc
Assessing Testicular Output Dr Anand K. ShindeClinical history of male partner• Length of Infertility• Any previous conception ?• P/H medical – mumps, MAGI etc P/H Surgical – Orchiopexy, Hernia, etc• Occupation – exposure to heat/ toxins / radiation• Drugs – Antihypertensives, salazopyrine etc• Sexual history
Assessing Testicular Output Dr Anand K.ShindePhysical Examination of the male • Height, Weight • Adiposity, Sec. Sexual Characteristics • Penis • Testes • Epididymes • Vasa • Variococoele + -
Semen Analysis W.H.O Manuals 2000 Reference ValuesVolume 2.0ml or morePh 7.2 or moreSperm Conc. 20 x 106 sp/ml or moreTotal sperm count 40 x 106 sperm/ejaculate or moreMotility 50% or more with progressive motility or 25% or more with rapid linear progressionMorphology upto 70% abnormalVitality 75% or more liveWBCs less than 1 x 106/mlImmuno bead test less than 50% motile sperms with beads attachedMAR test less than 50% with particles attached
Control of Testicular OutputPositive LoopFSH stimulates SpermatogenesisLH stimulates TestosteroneNegative LoopTestosterone levels suppress GnRHLH Inhibin suppresses FSH levels.
Interlinking Two CompartmentsSertoli Cells : Nourish gametogenesis : Produce Inhibin : Produce Androgen Binding Protein (ABP)Both FSH & high testosterone levels necessary forSpermatogenesisThin basement membrane of the tubules & presence ofABP allow 100 times more build-up of Testosterone in theS. tubules.Disturbances in the above harm sperm output