Male infertility

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Male infertility

  1. 1. Male Infertility Where to go?
  2. 2. Case <ul><li>A 37 years old man married since 1.5 years and his wife is 31 years old. </li></ul><ul><li>Semen analysis : moderate athenozoospermia on several analyses ( count :7-13 million/ml/ progressive motility 10%, 80% abnormal forms ) </li></ul><ul><li>By examination : no palpable varicocele , Duplex : grade II varicocele </li></ul>
  3. 3. What to do!!! <ul><li>WAIT & SEE?? </li></ul><ul><li>Clomid/ L-carnitine, royal gelly </li></ul><ul><li>varicocelectomy </li></ul><ul><li>IUI </li></ul><ul><li>IVF </li></ul>
  4. 4. Wait & See <ul><li>Wife age 31ys </li></ul><ul><li>Fecundability decreases with age </li></ul><ul><li>Sharply decreases after 37 ys old </li></ul>
  5. 5. Wait & See strategy <ul><li>Stop smoking—Nicotine reduces seminal plasma antioxidants </li></ul><ul><li>Have frequent intercourse—Increases output of non-senile spermatozoa </li></ul><ul><li>avoid hot baths—Heat suppresses spermatogenesis </li></ul><ul><li>Avoid pesticides, herbicides, heat, and radiation at work—All impair spermatogenesis </li></ul>
  6. 6. What doesn't work <ul><li>Abstaining from coitus until ovulation does not improve the semen or likelihood of conception. </li></ul>
  7. 7. Medical??? <ul><li>Mostly empirical </li></ul><ul><li>Pregnancy, the most relevant outcome parameter of fertility, was reported in only a few studies </li></ul>
  8. 8. Medical <ul><li>no clear benefit of using any medication in these patients. </li></ul><ul><li>Moreover, androgens should not be used because they may actually suppress spermatogenesis </li></ul>
  9. 9. Varicocelectomy <ul><li>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. </li></ul>
  10. 10. Varicocelectomy <ul><li>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) </li></ul>
  11. 11. IUI <ul><li>Improve pregnancy rate? </li></ul><ul><li>Should be repeated ?? 6 times </li></ul>
  12. 12. <ul><li>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) </li></ul>
  13. 13. reproductive medicine seems to be promising <ul><li>IVF </li></ul><ul><li>If duration of marriage more than 3 years </li></ul><ul><li>If woman above 35 years old </li></ul><ul><li>If IUI failed more than 4 times (Clinical Evidence, 2008) </li></ul>

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