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PREVENTION OF MALE INFERTILITY

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PREVENTION OF MALE INFERTILITY

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PREVENTION OF MALE INFERTILITY

  1. 1. PREVENTION OF MALE INFERTILITY Aboubakr Elnashar Benha university hospital, Egypt ABOUBAKR ELNASHAR
  2. 2. 1. INTRODUCTION  Prevention Better than cure. An ounce of prevention is worth a pound of cure Of infertility: neglected Important in developing countries developed countries. {Infertility tt including ARTs are expensive and their availability is limited} ABOUBAKR ELNASHAR
  3. 3. Significant proportion of infertility could be prevented through (WHO, 2011) Standard public health measures Prevention of infections Prevention of iatrogenic infertility (Schoysman R and Segal L, 1989) ABOUBAKR ELNASHAR
  4. 4. Iatrogenic infertility infertility caused by a physician’s actions: prescribed drugs, medical or surgical procedure (Serour et al, , 1997) . In Western Europe: 5% (Schoysman R and Segal L, 1989) In Egypt: 15.5% (Serour et al, 2002) ABOUBAKR ELNASHAR
  5. 5. 1. High prevalence of folk methods of infertility 2. High rates of medical malpractice 3. Unregulated private practices offer considerable potential for making large profits from infertile women, and this can attract doctors who are more interested in wealth than ‘good practice’ 4. lack of proper training of doctors in new techniques (Serour et al, 2002) ABOUBAKR ELNASHAR
  6. 6. Level Definition Example Primary Methods to avoid occurrence of disease by 1. eliminating disease agents 2. increasing resistance to disease. 1. Immunization 2. Healthy diet 3. Exercise 4. Avoiding smoking Secondary Methods to detect and address an existing disease prior to the appearance of symptoms. 1. TT of hypertension(risk factor for CVD) 2. Cancer screenings Tertiary Methods to reduce negative impact of symptomatic disease: disability or death, through rehabilitation and tt. Surgical procedures that halt the spread or progression of disease  Levels of prevention ABOUBAKR ELNASHAR
  7. 7. 2. PREVENTION OF MALE FACTOR INFERTILITY 1. Environmental pollutants (oestrogens): increasing rates Cryptorchidism Hypospadias Germ cell tumours Decline in sperm concentrations over the past 20–50 years. Increase in maternal beef consumption inversely related to sperm count. ABOUBAKR ELNASHAR
  8. 8. ABOUBAKR ELNASHAR
  9. 9. 2. Undescended testes 40% rate of epididymal and vasal abnormalities, compared with 0.5%–1% in the normal population. Unilateral: most are fertile but with a reduced sperm count. Bilateral: very poor prognosis for fertility. Carcinoma in situ Testicular germ cell cancer Early orchidopexy, before the age of 5 y: decrease this risk. Retractile testes IM (hCG): descend but not the cryptorchid testis ABOUBAKR ELNASHAR
  10. 10. 3. Orchidopexy Prevent recurrent testicular torsion. 4. Surgery in the inguinal region: avoid injury of: vas deferens or testicular vessels ABOUBAKR ELNASHAR
  11. 11. 5. Prophylactic Mumps, Measles, Rubella Vaccination  Protects against the development of mumps orchitis: significantly affect spermatogenesis. Chickenpox: severe orchitis. ABOUBAKR ELNASHAR
  12. 12. 6. Orchitis  Minimise testicular atrophy {raised intratesticular pressure}. Steroids (prednisoone at 40–60 mg/d): No response: surgery to relieve pressure necrosis by placing incisions in the tunica albuginea. ABOUBAKR ELNASHAR
  13. 13. 7. Sexually Transmitted Diseases Gonorrhoea: irreversible obstruction of the spermatic ducts Chlamydia trachomatis: urethritis and epididymitis condoms ABOUBAKR ELNASHAR
  14. 14. 8. Trauma to the testes: Permanent damage Increase production of antisperm antibodies. Men wear appropriate protection when participating in contact sports. ABOUBAKR ELNASHAR
  15. 15. 9. Varicocele Ligation In male infertility: Controversy In childhood or adolescence: No justification for prophylactic ligation ABOUBAKR ELNASHAR
  16. 16. 10. Occupational Factors Toxic to spermatogenesis. Metals: Lead, cadmium and mercury Pesticides: dibromochloropropane, chlordecone and ethylene dibromide Inks, paint and adhesives: Glycol ethers ABOUBAKR ELNASHAR
  17. 17. 11. Drugs Reversible effects Permanent effects Sulfasalazine Azulfidine (used in tt of inflammatory bowel disease). Alternative: Olsalazine (Dipentum) β-blockers, methyldopa, captopril: impotence Alternative: calcium channel blockers ABOUBAKR ELNASHAR
  18. 18. 12. Before Chemotherapy and Radiotherapy Alkylating agents cyclophosphamide, procarbazine and cisplatin Freezing sperm Cryopreservation of spermatogenic stem cells taken from the testes of prepubertal boys with cancer: controversial {difficulties in taking informed consent} ABOUBAKR ELNASHAR
  19. 19. CONCLUSIONS Prevention of male infertility 1.Reduce estrogenic pollutants 2.Early orchidopexy for undescended testis 3.Orchidopexy for recurrent testicular torsion. 4.Surgery in the inguinal region: avoid injury to the vas deferens or testicular vessels 5.Prophylactic Mumps, Measles, Rubella Vaccination: Protects against the development of mumps 6.TT of Orchitis ABOUBAKR ELNASHAR
  20. 20. 7. TT of STD 8. Avoid trauma to the testes 9. No justification for prophylactic ligation in childhood or adolescence 10. Avoid Occupational Factors 11. Avoid Drugs affecting spermatgenesis 12. Sperm storage before Chemotherapy and Radiotherapy ABOUBAKR ELNASHAR

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