Recommended
More Related Content
What's hot
What's hot (20)
Similar to Male infertility
Similar to Male infertility (20)
More from Antima Rathore
Recently uploaded
Recently uploaded (20)
Male infertility
- 1. Dr Antima Rathore, Consultant (Infertility Specialist), Institute Of Human Reproduction, Kolkata 1
- 2. DEFINITION 2
- 3. DEFINITION âInfertility is defined as the inability of a couple to become pregnant after one year of unprotected intercourse.â ďPrimary infertility ďSecondary infertility 3
- 5. MALE INFERTILITY A Social Stigma 5
- 6. PREVALANCE INFERTILITY â 15% Male Infertility 40% Female Infertility 40% Both 10% Unexplained 10% 6
- 7. INDIA ⢠15-20 million ⢠About 40% - quantitative and qualitative decline in sperm quality J Hum Reprod Sci. 2015 Oct-Dec; 8(4): 191â196 7
- 8. 8
- 9. Causes 9
- 10. CAUSES HYPOTHALAMIC- PITUITARY DISORDERS â˘Idiopathic isolated gonadotropin defi ciency â˘Kallmann syndrome â˘Single gene mutations (e.g., Involving the gnrh receptor, fshb, lhb, or transcription â˘Factors involved in pituitary development) â˘Hypothalamic and pituitary tumors (e.g., Craniopharyngioma, macroadenoma) â˘Infi ltrative diseases (sarcoidosis, histiocytosis, transfusion siderosis, hemochromotosis) â˘Hyperprolactinemia â˘Drugs (gnrh analogs, androgens, estrogens, glucocorticoids, opiates) â˘Critical illness or injury â˘Chronic systemic illness or malnutrition â˘Infections (e.g., Meningitis) PRIMARY GONADAL DISORDERS â˘Klinefelter syndrome â˘Y chromosome deletions â˘Single gene mutations and polymorphisms (e.g., involving the androgen, estrogen, or â˘FSH receptor) â˘Cryptorchidism â˘Varicoceles â˘Infections (e.g., viral orchitis, leprosy, tuberculosis) â˘Drugs (e.g., alkylating agents, alcohol, antiandrogens, cimetidine) â˘Radiation â˘Environmental gonadotoxins (e.g., heat, smoking, metals, organic solvents, pesticides) â˘Chronic illness (renal insuffi ciency, cirrhosis, cancer, sickle cell disease, amyloidosis, â˘vasculitis, celiac disease) DISORDERS OF SPERM TRANSPORT â˘Epididymal obstruction or dysfunction â˘Congenital bilateral absence of the vas deferens (relating to CFTR mutations) â˘Infections causing obstruction of the vas deferens (e.g., gonorrhea, chlamydia, â˘tuberculosis) â˘Vasectomy â˘Kartagener syndrome (primary ciliary dyskinesia) â˘Young syndrome â˘Ejaculatory dysfunction (e.g., spinal cord disease, autonomic dysfunction) 10
- 13. CAUSES ⢠PRETESTICULAR ⢠TESTICULAR ⢠POST-TESTICULAR 13
- 14. CAUSES Varicocele 42.2% Idopathic 22.7% Obstruction 14.3% Others 20.8% Immunological 2.6% Ejaculatory Dsyfunction 1.3% Endocrinologic 1.1% Infection 0.9% Genetic 0.1% 14
- 15. 15
- 16. Evaluation 16
- 18. HISTORY 18
- 19. HISTORY ⢠FERTILITY HISTORY ⢠Duration of marriage and infertility ⢠Past conception with present and/or previous partner, ⢠Previous fertility investigations and treatments ⢠SEXUAL HISTORY ⢠Frequency of intercourse, ⢠Libido ⢠Erectile function, ⢠Ejaculation ⢠Lubricant usage 19
- 20. HISTORY ⢠MEDICAL HISTORY ⢠Diabetes ⢠Hypertension ⢠Respiratory Tract Disease ⢠Liver Diseases ⢠Neurological Diseases ⢠High Fever ⢠Medication And Duration Of Use ⢠Urinary Tract Infections ⢠STD 20
- 21. HISTORY ⢠SURGICAL HISTORY ⢠Vasectomy ⢠Testicular surgeries (varicocelectomy and hydrocelectomy) ⢠Inguinal hernia surgery, ⢠Sympathectomy ⢠Prostatectomy ⢠Bladder neck operations ⢠Urethral strictures ⢠Penile surgeries for hypospadias/epispadias 21
- 22. HISTORY ⢠DEVELOPMENTAL AND CHILDHOOD HISTORY ⢠Mumps/any other viral illness ⢠Scrotal injury ⢠Testicular torsion ⢠Treatment for testicular maldescent and age of treatment ⢠Puberty and its onset ⢠Sexual development ⢠OCCUPATIONAL AND ENVIRONMENTAL HISTORY ⢠Exposure ⢠Heat ⢠Toxins ⢠Carcinogenic dyes, tannins, etc. ⢠Substance abuse 22
- 23. HISTORY ⢠FAMILY HISTORY ⢠Infertility ⢠Recurrent Pregnancy Losses ⢠Congenital Birth Defects, ⢠Cryptorchidism ⢠Metabolic Syndrome ⢠Endocrine Disorders 23
- 24. EXAMINATION 24
- 25. EXAMINATION ⢠SCROTAL EXAMINATION ⢠Size and consistency of the testis ⢠Palpable vas deferens ⢠Presence and grade of varicoceles ⢠15-25 ML ⢠ABDOMINAL EXAMINATION ⢠Presence of scars in the inguinal area (inguinal surgery / treatment of undescended testis) 25
- 27. INVESTIGATION ď SEMEN ANALYSIS ď ENDOCRINE EVALUATION a. FSH b. SERUM TESTOSTERONE c. LH / ESTROGEN d. PROLACTIN / TSH ď GENETIC TESTING a. KARYOTYPING b. Y MICRODELETIONS c. CFTR GENE MUTATION STUDY 27
- 31. SEMEN ANALYSIS ⢠Oligospermia ⢠Asthenozoospermia ⢠Teratozoospermia ⢠OAT Syndrome ⢠AZOOSPERMIA
- 32. AZOOSPERMIA WHO 1999 No sperm seen in semen sample â Centrifuged the semen sample at 3000g for 15 minutes â THE PELLET FORMED MUST BE EXAMINED FOR PRESENCE OF ANY SPERM If no sperm is found even after centrifugation â Repeat analysis must be done after 2-4 weeks 32
- 33. DIAGNOSIS IF ANY SPERM IS FOUND IN THE PELLET â CRYPTOZOOSPERMIA 33
- 34. HORMONAL PROFILE 34 ⢠FSH > 7.6 MIU/ML â Abnormal ⢠TESTOSTERONE - > 298 ng/dl ⢠Prolactin Level - Erectile Dysfunction ⢠TSH - sign and symptoms s/o hypothyroidism
- 36. GENETIC EVALUATION ⢠Karyotype ⢠Y Chromosome Microdeletion ⢠CFTR Gene Mutation ⢠DNA Fragmentation Index 36
- 37. OTHERS ⢠SCROTAL ULTRASOUND ⢠Testicular Volume ⢠TRANSRECTAL ULTRASONOGRAPHY TESTICULAR BIOPSY â ⢠Only If The Place Has The Facility Of Sperm Cryopreservation ⢠A Trial TESA May Be Carried Out In Place Of A Biopsy Followed By Cryopreservation Of Any Sperm Retrieved ⢠TRANSABDOMINAL ULTRASOUND ⢠RULE OUT RENAL AGENESIS (UNILATERAL) 10-15 % CBAVD 37
- 38. MANAGEMENT 38
- 39. MANAGEMENT ⢠MEDICAL ⢠SURGICAL ⢠ART 39
- 40. MEDICAL MANAGEMENT ⢠ANTIBIOTICS ⢠GONADOTROPINS ⢠CC/AROMATASE INHIBITORS ⢠ANTIOXIDANTS 40
- 43. NEUTRACEUTICAL ⢠To improve count, motility and morphology of sperms ⢠Increase rates of spontaneous conception ⢠Lower rates of miscarriages due to DNA abnormalities in sperm 43
- 44. SURGICAL ⢠End to end anastomosis of epididymis ⢠Vasoepididymostomy 44
- 45. Assisted Reproductive Technology ⢠ICSI ⢠PESA ⢠TESA ⢠MICRO TESA ⢠DONOR INSEMINATION 45
- 46. THANK YOU 46