Male Infertility Review 2011 By Paul J. Turek MD FACS, FRSM, Director of The Turek Clinic and Former Professor and Endowed Chair, University of California San Francisco (UCSF)
Lecture written and presented by Paul J. Turek MD FACS, FRSM. Dr. Turek is the Director of the The Turek Clinic in San Francisco and Former Professor and Endowed Chair at the University of California San Francisco (UCSF).
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Male Infertility Review 2011 By Paul J. Turek MD FACS, FRSM, Director of The Turek Clinic and Former Professor and Endowed Chair, University of California San Francisco (UCSF)
1. Male Infertility
Review 2011
Paul J. Turek MD FACS, FRSM
Director, The Turek Clinic, San Francisco, CA
Former Professor and Endowed Chair, UCSF
5. Embryology-Testis
Gonocytes Testosterone
• Inactive until puberty • 1st surge in utero
• Meiosis inhibited by MIS • 2nd surge in neonatal period
• Pubertal testosterone meiosis • 3rd rise at puberty; peaks in
2nd to 3rd
decade
Testosterone (ng/dL)
600
400
200
100
0
Adult Senescence
9. Embryology-Mesonephric Duct Abnormalities
Congenital Absence of the Vas Deferens (CAVD)
• Unilateral: most azoospermic
• Bilateral: all azoospermic
• Any segment of Wolffian duct
• If ipsilateral kidney also absent:
No CFTR mutations
• If ipsilateral kidney is present:
80% have CFTR mutations
CF results in: Pneumonia, pancreatic
insufficiency, bowel obstruction, sinusitis,
nasal polyps, and death by 35 years of age.
10. Embryology-Questions
When does meiosis begin in the human male? Puberty
What hormone is responsible for regression of MIS
female internal genitalia?
What gene is responsible for male sexual SRY, (SOX-9)
differentiation?
What gene mutation should be examined CFTR=cystic
in men with idiopathic ejaculatory fibrosis trans-
duct obstruction? membrane
regulatory gene
How many testosterone peaks have occurred by 3-First trimester,
the time a man reaches age 30?
neonatal and adult
11. (caput)
10 days
4 x 3 cm Rete testis
(20mL)
(corpus)
80
64 days %ge
rm
600
10-15 cells
(cauda) million
lobules
sperm
Need 3 months to make and ejaculate sperm.
Soft, small testes imply a sperm production problem
25. H-P-G Axis: Testosterone
• Testosterone comes in several forms.
• Only free and albumin (weakly bound) are “active.”
• SHBG-bound is inactive.
Free/unbound
Albumin bound 1-2%
SHBG bound
60% 40%
SHBG-T
Total Free T
Testosterone Bioavailable
Testosterone
Albumin-T