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Male infertility
Male infertility
Male infertility
Male infertility
Male infertility
Male infertility
Male infertility
Male infertility
Male infertility
Male infertility
Male infertility
Male infertility
Male infertility
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Male infertility

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  • 1. Male Infertility Where to go?
  • 2. Case
    • A 37 years old man married since 1.5 years and his wife is 31 years old.
    • Semen analysis : moderate athenozoospermia on several analyses ( count :7-13 million/ml/ progressive motility 10%, 80% abnormal forms )
    • By examination : no palpable varicocele , Duplex : grade II varicocele
  • 3. What to do!!!
    • WAIT & SEE??
    • Clomid/ L-carnitine, royal gelly
    • varicocelectomy
    • IUI
    • IVF
  • 4. Wait & See
    • Wife age 31ys
    • Fecundability decreases with age
    • Sharply decreases after 37 ys old
  • 5. Wait & See strategy
    • Stop smoking—Nicotine reduces seminal plasma antioxidants
    • Have frequent intercourse—Increases output of non-senile spermatozoa
    • avoid hot baths—Heat suppresses spermatogenesis
    • Avoid pesticides, herbicides, heat, and radiation at work—All impair spermatogenesis
  • 6. What doesn't work
    • Abstaining from coitus until ovulation does not improve the semen or likelihood of conception.
  • 7. Medical???
    • Mostly empirical
    • Pregnancy, the most relevant outcome parameter of fertility, was reported in only a few studies
  • 8. Medical
    • no clear benefit of using any medication in these patients.
    • Moreover, androgens should not be used because they may actually suppress spermatogenesis
  • 9. Varicocelectomy
    • Varicoceles occur in 15% of men in general and in 30% of subfertile men. Varicoceles probably impair spermatogenesis by increasing the temperature in the scrotum.
  • 10. Varicocelectomy
    • no evidence that treatment of varicoceles in men from couples with otherwise unexplained subfertility improves the couple's chance of conception. (Evers et al, 2009)
  • 11. IUI
    • Improve pregnancy rate?
    • Should be repeated ?? 6 times
  • 12.
    • Data from the literature suggest that gonadotropin treatment of male infertility can lead to a significant increase in pregnancy rates, however larger studies are needed to confirm such findings (Attia et al, 2008)
  • 13. reproductive medicine seems to be promising
    • IVF
    • If duration of marriage more than 3 years
    • If woman above 35 years old
    • If IUI failed more than 4 times (Clinical Evidence, 2008)

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