male infertility , infertility, female infertility , problems of infertility, treatment of male infertility, ART techniques

2. INTRODUCTION
• Successful pregnancy requires the union of a mature ovum & a sperm – fertilization and
its subsequent implantation in the uterus
• This process can be disturbed at several stages resulting in infertility
• INFERTILITY: Failure to conceive within one or more years of regular unprotected coitus.
• PRIMARY INFERTILITY :
Patients who have never conceived
• SECONDARY INFERTILITY :
Previous pregnancies but failure to conceive subsequently

3. • Infertility affects about 10 % of couples of childbearing age
• Infertility is not just a woman's concern. About one third of infertility can be
attributed to male alone factors & about one third to female alone factors.
• 35 % of infertility is related to male factor problems
1.structural abnormalities
2.sperm production disorders
3.ejaculatory disturbance
4.immunologic disorders

4. CAUSES OF INFERTILITY IN
FEMALE
• Ovulatory failure, due to hyposecretion of gonadotrophic hormones from the
anterior pituitary
• Non functional or uterus absent
• Damaged or non-functional fallopian tubes
• Non functional or ovaries absent
• Damage of the cervix
• Improper development of the external genetalia
• Ventral diseases like syphilis, gonorrhea
• The hymen may be rigid & prevent the entry of penis

5. RISK FACTORS FOR MEN
REGARDING INFERTILITY
• Precocious puberty – puberty occurring at a young age
• Delayed puberty - puberty occurring at an older age
• Exposure to toxic substances like Lead, Cadmium, Mercury, Ethylene oxide, Vinyl
chloride, radioactivity & X-ray.
• Cigarettes, Tobacco or Marijuana smoke
• Heavy alcohol consumption
• Exposure of the genitals to high temperatures especially workers near furnaces,
soaking in hot water bath for a long time everyday.
• Surgical injury to vas especially after inguinal hernia repair on both sides
• Undescended testicles.

6. CAUSES OF MALE INFERTILITY
1. Sperm production problem
2. Blockage of sperm transport
3. Sexual problem ( erection & ejaculatory problems )
4. Hormonal problems
5. Sperm antibodies

7. SPERM PRODUCTION PROBLEM
1. Chromosomal genetic problems
2. Undescended testis ( failure of the testes to descend at birth )
3. Infections
4. Torsion ( twisting of the testis in scrotum )
5. Varicocele ( varicose veins in the testis )
6. Medicines & chemicals
7. Radiation damage
8. Unknown causes

8. BLOCKAGE OF SPERM
TRANSPORT
1. Infections
2. Prostate related problems
3. Absence of vas deferens
4. vasectomy

9. SEXUAL PROBLEM ( ERECTION &
EJACULATORY PROBLEMS )
1. Retrograde or premature ejaculation
2. Failure of ejaculation
3. Erectile dysfunction
4. Infrequent intercourse
5. Spinal cord injury
6. Prostate surgery
7. Damages to nerves
8. Some medicines

11. HORMONAL PROBLEMS
1. Pituitary tumors
2. Congenital lacks of LH/FSH ( pituitary problem from birth )

12. SPERM ANTIBODIES
1. Vasectomy
2. Injury or infection in the epididymis
3. Unknown cause
Sperm antibodies found in one in 16 infertile men.in most men sperm antibodies
will not affect the chance of a pregnancy but in some men sperm antibodies
reduce fertility.

13. PRIMARY GONADAL DISORDERS
Y chromosome deletions:
20% men with infertility
Severe oligospermia & azoospermia
Genetic counselling offered before ICSI, as these deletions are transmitted to sons.
Single gene mutations & polymorphism:
No. of CAG repeats inversely proportional to sperm concentration & fertility
Epididymal dysfunction:
Intrauterine exposure to Diethylstilbestrol (DES) is a synthetic form of the female
hormone estrogen . Causes isolated asthenospermia

14. Cryptorchidism:
Failure of testicular descent.
An androgen dependent process.
FSH levels raised. LH normal
Risk of tumors
Varicoceles:
Dilatation of pampiniform plexus of spermatic veins.
More common on left side.
No causal relationship with infertility
CBAVD:
Congenital bilateral absence of the vas deferens related to CFTR gene mutations.
1-2% of infertile men

15. NORMAL REFERENCE VALUES
(WHO)
Volume 1.5-5 ml
pH >7.2
Viscosity < 3 (scale 0-4)
Sperm concentration >20 million/ml
Total sperm number >40million/ejaculate
Percent motility > 50%
Forward progression >2 (scale 0-4)
Normal morphology >50%, >30%, >14%
Round cells < 5 million/ml
Sperm agglutination <2 (scale 0-3)

16. SPERM CONCENTRATION & TOTAL
SPERM
COUNT
Azoospermia
Complete absence of sperm on standard microscope examination in ejaculate.
1-3 % of male population 10-15 % male infertility
Oligospermia
Sperm density less than 20 million/ ml. sever when less than five million/ml

18. • Asthenospermia
Poor sperm motility
• Teratospermia
Greaterthan 70 % abnormal morphology
• Neurospermia
Dead sperm

20. MALE INFERTILITY EVALUATION
• Physical evaluation
1.examination of penis, location of urethra
2.size of testis
3.secondary sexual characters
• Semen analysis
to examine number, shape & movement of sperm
• Blood test --- to check the levels of hormones that control sperm production
• Genetic investigations & testicular biopsy are sometimes done.

21. SPECIALIZED TEST
• Sperm autoantibodies (PCT)
• Sperm penetration assay
• Human zona binding assay
• Computer assisted sperm analysis
• Acrosome reaction
• Biochemical test
• Sperm chromatin structure & DNA
• Renal scan
• Testis biopsy in a azoospermic men
• vasogram

22. MALE INFERTILITY TREATMENT
• One in eight infertile men has a treatable condition.
• ART ( Assisted reproductive technologies)
1.IVF-ET (invitro fertilization & embryo transfer )
2.GIFT ( gamete intra fallopian transfer )
3.ZIFT ( Zygote intra fallopian transfer )
4.POST (peritoneal oocyte & sperm transfer )
5.TET ( tubal embryo transfer zone )
6.SUZI (subzonal insemination )
7.ICSI (intra cytoplasmic sperm injection)
8.AH ( Assisted hatching)

23. • TESE ( testicular sperm extraction )
• Micro – TESE (microdissection testicular sperm extraction)
• MESA ( microsurgical epididymal sperm aspiration
• PESA ( percutaneous epididymal sperm aspiration )

24. PREVENTION OF MALE
INFERTILITY
• Avoid cigarette smoking, excess alcohol consumption
• Sexually transmitted infections
• Heat stress from tight fitting underwear
• Anabolic steroids (taken for body building or sporting purpose)

26. REFERENCE
• Men’s Health – male factor infertility
university of Utah heath science Centre 2007-11-21
• Male factor infertility
medical clinics of north America
• Male subfertility –Hirsha
BMJ -327
• Developmental biology reproductive biology teratology
Dr.Boby Jose – manjusha publication

27. THANK YOU