Male inferility

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Male inferility

  1. 1. Male InfertilityMale Infertility Dr. Waleed DawoodDr. Waleed Dawood
  2. 2. DefinitionDefinition • inability to conceive after 1 year of unprotected sexual intercourse. • 15% of couples. 40%: male; 40%: female; 20%: both
  3. 3. Hypothalamic- Pituitary- Gonadal AxisHypothalamic- Pituitary- Gonadal Axis
  4. 4. SpermatogenesisSpermatogenesis • Sertoli cell: tight junction. The strongest intercellular barriers in the body: blood-testis barrier; nurse cells • Germ cells: spermatogonia; primary spermatocytes; secondary spermatocytes, spermatid. Mitosis and meiosis
  5. 5. cyclescycles • within the human testis, 60 days; sperm maturation: 10-15 days
  6. 6. FertilizationFertilization • Middle of the female menstrual cycle, the cervical mucus changes • Acrosome reaction, zona reaction
  7. 7. Diagnosis of male infertilityDiagnosis of male infertility History • Duration of infertility; earlier pregnancies • Sexual history, timing and frequency, lubricants • Medical and surgical history • fever, acute infection, surgical procedure of bladder, retroperitoneum, pelvis, hernia • Childhood diseases: mumps, cryptorchidism • Medication, pesticides, radiation, tobacco, cocaine, marijuana, androgenic steroids, hot tubs or saunas • Family history
  8. 8. Physical examinationPhysical examination • Virilization: body hair, gynecomastia • Scrotal contents • Testis: size and consistency • Epididymis; vas deferens; varicocele • Other abnormalities
  9. 9. Laboratory testsLaboratory tests • Urinalysis • Semen analysis • Semen collection: 48-72 hours of sexual abstinence. • Seminal fructose and postejaculate urinalysis • Fructose: derived from the seminal vesicle • Hormone assessment • FSH and testosterone
  10. 10. Adjunctive testsAdjunctive tests • semen leukocyte analysis; • antisperm antibody test; • hypoosmotic swelling test; • sperm penetration assay; • sperm chromatin structure; • chromosomal studies; • genetic analysis
  11. 11. • Radiologic testing • scrotal ultrasound, transrectal ultrasound • CT scan or MRI of the pelvis • Testis biopsy & vasography • Fine-needle aspiration ‘mapping’ of the testes • Semen culture
  12. 12. Mapping of testesMapping of testes
  13. 13. Causes of male infertilityCauses of male infertility • Pretesticular • Testicular • posttesticular
  14. 14. Pretesticular causes of infertilityPretesticular causes of infertility
  15. 15. Testicular causes of infertilityTesticular causes of infertility
  16. 16. Medications associated with infertilityMedications associated with infertility • Ketoconazole, spironolactone, alcohol inhibit T synthesis • Cimetidine: androgen antagonist • Marijuana, heroin: lower T levels • Pesticides, estrogen like activity • Chemotherapy • Calcium channel blockers; sulfasalazine; colchicine; allopurinol; alpha-blockers; nitrofurantoin; antipsychotics; antidepressants
  17. 17. varicocelevaricocele Normal: 15%; infertility: 40%
  18. 18. Posttesticular causes of infertilityPosttesticular causes of infertility
  19. 19. Posttesticular causes of infertilityPosttesticular causes of infertility
  20. 20. Treatment of male infertility (SurgicalTreatment of male infertility (Surgical treatments)treatments) • Varicocele: • Vasovasostomy or epididymovasostomy • Ejaculatory duct obstruction: TURED • Electroejaculation spinal cord injury; pelvic or retroperitoneal surgery injured the pelvic sympathetic nerves. • Sperm aspiration: vas deferens, epididymis, or testicle. • Orchidopexy: within two years of age • Testicular torsion; the unaffected, contralateral testis can become infertile after torsion of its mate. Sympathetic orchidopathia, immunologic in nature. • Pituitary ablation • Elevated serum prolactin levels stemming from a pituitary adenoma can be treated medically and surgically.
  21. 21. Surgical management of maleSurgical management of male infertilityinfertility • Testis biopsy
  22. 22. Surgical management of maleSurgical management of male infertilityinfertility • Vasography:
  23. 23. • Vasography Surgical management of maleSurgical management of male infertilityinfertility
  24. 24. Surgical management of maleSurgical management of male infertilityinfertility • Vasovasostomy
  25. 25. Surgical management of maleSurgical management of male infertilityinfertility • Vasovasostomy
  26. 26. Surgical management of maleSurgical management of male infertilityinfertility • Vasoepididymostomy
  27. 27. Surgical management of maleSurgical management of male infertilityinfertility • Transurethral resection of the ejaculatory ducts
  28. 28. Treatment of male infertility (NonsurgicalTreatment of male infertility (Nonsurgical treatments)treatments) • Pyospermia: evaluate the patient for sexually transmitted diseases, penile discharge, prostatitis, or epididymitis • Coital therapy • Immunologic infertility • Corticosteroid suppression, sperm washing, IUI, IVF, and ICSI.
  29. 29. Medical therapyMedical therapy • Hyperprolactinemia; hypothyroidism; congenital adrenal hyperplasia; testosterone excess/ deficiency: Kallmann syndrome, HCG, FSH • Empiric medical therapy • clomiphene citrate: antiestrogen, increase secretion of GNRH, FSH, and LH. Low sperm count • antioxidant therapy: vit E
  30. 30. Assisted reproductive technologiesAssisted reproductive technologies • Intrauterine insemination (IUI): Cervical factors; low sperm quality, immunologic infertility, poor sperm delivery. At least 5-40 million motile sperm in the ejaculate • In Vitro Fertilization and Intracytoplasmic sperm injection • IVF: controlled ovarian stimulation and ultrasound-guided transvaginal egg retrieval from the ovaries before normal ovulation. 500,000 to 5 million sperms are required • ICSI: one viable sperm • Eliminate many natural selection barriers that exist during natural fertilization, genetic defects that caused the infertility are expected to be passed on to offspring unabated. • Preimplantation genetic diagnosis
  31. 31. ICSI IUIIVF

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