Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Male infertility


Published on

Published in: Health & Medicine
  • Be the first to comment

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>