SlideShare a Scribd company logo
1 of 35
MALE INFERTILITY
1
CONTENTS
 Introduction
 Spermatogenesis
 Causes
 Evaluation
 Management
 What’s new in male infertility
2
INTRODUCTION
 INFERTILITY - one year of unprotected intercourse
without conception
 SUBFERTILITY- couples who exhibit decreased
reproductive efficiency
 FECUNDABILITY - probability of achieving
pregnancy within a single menstrual cycle
 FECUNDITY - probability of achieving live birth
within a cycle.
Speroff 15th ed.
3
SPERMATOGENSIS
• During embryogensis, there are approximately
300 thousand spermatogonia in each gonad.
• Each undergoes mitotic division, and by
puberty 600 million in each testis.
4
 Sperm production takes place in seminiferous
tubules within testis.
 Spermatogenesis takes about 70 days
 Adult males produce 100-200 million sperm
each day.
 Leydig cells produce testosterone (which along
with FSH, stimulates spermatogenesis).
 Maturation of sperms takes place in epididymis.
 Transport of sperms – vas deferens
Speroff 15th 5
1.Plasma membrane
2.Outer acrosomal membrane
3.Acrosome
4.Inner acrosomal membrane
5.Nucleus
6.Proximal centriole
7.Rest of the distal centriole
8.Thick outer longitudinal fibers
9.Mitochondrion
10.Axoneme
11.Anulus
12.Ring fibers
A.Head
B.Neck
C.Mid piece
D.Principal piece
E.Tail
6
SPERM STRUCTURE
Physiology of Semen after
Ejaculation
1. Liquefaction
2. Capacitation
3. Acrosome reaction
4. Cortical reaction
7
Relative prevalence of the
etiologies of infertility
Percentage
Male Factor 20-30
Both male & Female 10-40
Female Factor 40-55
Unexplained Infertility 10-20
8
SEMEN ANALYSIS
• Abstinence for 2-3 days (Not less than 2 days & not
more than 7 days)
• Abnormal sperm count - analysis at least after 4
weeks. 9
 Short intervals of abstinence- decreases the
sperm density and semen volume.
 Longer abstinence intervals - increase in the
proportion of dead, immotile and
morphologically abnormal sperms.
 Semen specimen should be collected in a clean
container.
 Semen can also be collected in a silastic
condom, which does not contain any
antispermicidal agents.
 Semen sample should be examined within an
hour after collection
10
11
Parameters Normal Reference Values Lower Reference Limits
Volume 1.5-5.0 mL 1.5 (1.4-1.7) mL
P H >7.2
Viscosity <3
Sperm
Concentration
>20 million/mL 15 (12-16) million/mL
Total sperm
number
>40 million/ejaculate 39 (33-46) million/ejaculate
Percent motility >50% 40 (38-42)%
Forward
progression
>2 (scale 0-4) 32 (31-34)%
Normal
morphology
>15,30,50% normal 4(3-4)%
Round cells <5 million/mL
Sperm
agglutination
<2 (Scale 0-3)
12
Semen analysis
Ejaculate volume and pH:
• Low or absent – CBAVD, ejaculatory duct
obstruction, hypogonadism, retrograde
ejaculation.
• High volume (>5ml)- Inflammation of
accessory gland
 Seminal vesicle secretions are alkaline and
contains fructose.
 EDO- semen is acidic (prostrate secretions),
and has no sperm or fructose. 13
Sperm concentration and total sperm count:
1. Azoospermia, Oligospermia
2. OBSTRUCTIVE: blockage in ductal system (
CBAVD, scrotal or inguinal surgery)
3. NON OBSTRUCTIVE: primary testicular failure,
endocrinopathies that suppress
spermatogenesis.
4. Endocrine and genetic evaluation indicated in
men with severe oligospermia.
5. Total sperm count is the product of multiplying
semen volume and sperm concentration. 14
Abnormalities of sperm
 Oligozoospermia - reduced sperm count
 Asthenozoospermia – reduced sperm
motility
 Teratozoospermia- increased abnormal
sperms
 Oligoasthenoteratozoospermia – sperm
variables are subnormal
 Azoospermia- no sperm in semen
 Aspermia – no ejaculate
 Leucocytospermia – increased WBC
 Necrozoospermia – all sperms are 15
Causes of Male Infertility
 Hypothalamic pitutary disorders (1-
2%)
 Primary gonadal disorders (30-40%)
 Disorders of sperm transport (10-20%)
 Idiopathic (40-50%)
16
Hypothalamic pitutary
disorders
 Idiopathic isolated gonadotropin deficiency
 Kallmann syndrome
 Single gene mutations
 Hypothalamic and pitutary tumours
 Infiltrative disease
 Hyperprolactinemia
 Drugs
 Chronic systemic illness and malnutrition
 Infections
 Obesity
17
Primary gonadal disorders
 Klinefelter syndrome
 Y chromosome deletions
 Cryptorchidism
 Varicoceles
 Infections
 Drugs
 Radiation
 Environmental gonadotoxins
 Chronic illness
18
Disorders of sperm transport
 Epididymal obstruction or dysfunction
 Infections causing obstruction to vas
deferns
 Vasectomy
 Kartagener syndrome
 Ejaculatory dysfunction
 Young syndrome
19
CAUSES
PRE TESTICULAR TESTICULAR POST
TESTICULAR
ENDOCRINE:
• Hypogonadotropic
hypogonadism
• Hypothyroidism
•
Hyperprolactinaemia
• Diabetes
COITAL DISORDERS:
• Erectile dysfunction
• Ejaculatory failure
GENETIC:
• Klinefelter syndrome
• Y chromosome
deletion
• Immotile cilia
syndrome
CONGENITAL:
• Cyptorchidism
• Infective
• Antispermatogenic
agents
heat, irradiation,
drugs, chemotherapy
VASCULAR :
Torsion
Varicocele
IMMUNOLOGICAL
OBSTRUCTIVE:
Epdidymal
congenital
infective
Vasal
Genetic: cystic
fibrosis.
Accquired:
Vasectomy
Ejaculatory duct
obstruction
Accessory gland
infection
Immunological
Idiopathic
post vasectomy
20
Evaluation of male infertility
 To Identify and correct specific cause
 To identify the individuals whose fertility
cannot be corrected but could be over
come by IUI and ART.
 To identify- Genetic abnormality
 To identify any medical condition that
requires specific attention
 To identify the individuals whose infertility
can neither be corrected or overcome with
ART, in whom adoption or donor sperm are
considered.
21
HISTORY
 Duration of infertility and previous infertility
 Coital frequency and sexual dysfunction
 Any previous evaluation or treatment of
infertility
 Childhood illness and developmental history
 Previous surgery and its outcome, systemic
medical illness
 History of exposure to STD
 Exposure to environmental toxins
 Current medications and allergies
 Occupational exposure to tobacco, alcohol
and other drugs 22
Physical examinations
 Examination of penis,
 Palpation of testes and measurement of
their size
 Presence and consistency of both vasa
and epididymides
 Presence of any varicocele
 Secondary sexual characteristics, hair
distribution, and breast development
 Digital rectal examination
23
Other investigations
Absence of fructose: Congenital absence of
seminal vesicle, Partial duct obstruction.
 Semen culture (If pus cells in microscopy)
 Urologic evaluation
 Endocrine evaluation - FSH, LH,
Testosterone.
 Transurethral or transcrotal USG
 Renal ultrasonography
 Testis biopsy- azoospermia
 Vasography
24
Endocrine evaluation:
Indications:
Abnormal semen analysis
Serum FSH,LH and testosterone
 Hypogonadotropic gonadism-
FSH,LH,testosterone low
 Abnormal spermatogenesis- FSH
normal/increased, LH& testosterone normal
 Testicular failure- high FSH and LH, low /normal
testosterone
25
Genetic evaluation
1) Mutations within cystic fibrosis
transmembrane conductance regualtor
(CTFR gene)
2) Chromosomal anomalies resulting
testicular dysfunction – klinefelter
syndrome
3) Y chromosome deletions associated
with abnormalities of spermatogeneis.
26
 Transrectal ultrasonography: less
invasive
indicated in diagnosis severe
oligospermia or azoospermia.
 Renal ultrasonography: unilateral or
bilateral vasal agenesis.
 Trans scrotal ultrasonography: To
confirm physical findings. Detect non
palpable varicocele. 27
 Testis biopsy :
diagnostic purpose in azoospermic
men.
when the testicular biopsy shows
normal spermatogenesis obstruction to the
vas deferens is suspected.
28
Drugs that impair male
infertility
29
Treatment
 Hypogonadotropic hypogonadism:
Pulsatile GnRh, hCG, hMG, Testosterone,
Clomiphen citrate, Tamoxifen
 Hypergonadotropic hypogonadism:
1. IVF/ICSE, Donor sperm, Adaptation
2. Androgen, FSH, Clomiphen
3. Hyperprolactinemia-Dopamine agonists
4. Strict control of DM, Hypothyroid
30
Pretesticular
 Erectile dysfunction-
PDE5 Inhibitor (Sildenafil)
 For ejaculatory problems(Retrograde
ejaculation):
Imipramine ,
Pseudoephedrine/Ephedrine ,
Phenylpropalamine
 Retrograde ejaculation, Neurogenic
impotence, Severe Hypospadias
Intrauterine insemination (IUI)
31
Post testicular
 Prior vasectomy (most common cause)-
microsurgical vasovasostomy (better if less
than 5 years)
 Epididymal or vasal obstruction
 MESA
 PESA
 TESE
 TESA/FNA
 ICSI
32
Surgical treatment for male
infertility
 Vasovasotomy
 Vasoepididymostomy
 Transurethral resection of ejaculatory ducts
 Varicocele repair
 Orchiopexy
 Vibratory stimualtion and electro ejacualtion
33
surgical management
 Cryptorchidism-
Orchidopexy at 2-3 year of age
 Varicocele-
High ligation of internal spermatic vein
 Gonadal failure-
Surgical retrieval of spermatozoa, followed by
ICSI
34
THANK YOU

More Related Content

What's hot

Female infertility (2)
Female infertility (2)Female infertility (2)
Female infertility (2)obgymgmcri
 
Male infertility by Dr. Preksha Jain
Male infertility by Dr. Preksha JainMale infertility by Dr. Preksha Jain
Male infertility by Dr. Preksha JainDr. Preksha Jain
 
Abnormal Uterine Bleeding
Abnormal Uterine BleedingAbnormal Uterine Bleeding
Abnormal Uterine BleedingIna Irabon
 
Amenorrhea.warda
Amenorrhea.wardaAmenorrhea.warda
Amenorrhea.wardaOsama Warda
 
Male Infertility
Male InfertilityMale Infertility
Male InfertilityEko indra
 
Evaluation of male infertility
Evaluation of male infertilityEvaluation of male infertility
Evaluation of male infertilityAboubakr Elnashar
 
Diagnostic evaluation of the infertile female
Diagnostic evaluation of the infertile femaleDiagnostic evaluation of the infertile female
Diagnostic evaluation of the infertile femaleAsaad Hashim
 
Primary amenorrhea
Primary amenorrheaPrimary amenorrhea
Primary amenorrheaNahry Omer
 
medical management of infertility,think before surgery!!!!
medical management of infertility,think before surgery!!!!medical management of infertility,think before surgery!!!!
medical management of infertility,think before surgery!!!!ShitalSavaliya1
 
Premature ovarian failure
Premature ovarian failurePremature ovarian failure
Premature ovarian failureShambhu N
 
Abnormal uterine bleeding
Abnormal uterine bleedingAbnormal uterine bleeding
Abnormal uterine bleedingdrmcbansal
 

What's hot (20)

Female infertility (2)
Female infertility (2)Female infertility (2)
Female infertility (2)
 
Low sperm count (oligospermia)
Low sperm count (oligospermia)Low sperm count (oligospermia)
Low sperm count (oligospermia)
 
Male infertility by Dr. Preksha Jain
Male infertility by Dr. Preksha JainMale infertility by Dr. Preksha Jain
Male infertility by Dr. Preksha Jain
 
Male infertility
Male infertility Male infertility
Male infertility
 
Induction of ovulation
Induction of ovulationInduction of ovulation
Induction of ovulation
 
Abnormal Uterine Bleeding
Abnormal Uterine BleedingAbnormal Uterine Bleeding
Abnormal Uterine Bleeding
 
Amenorrhea.warda
Amenorrhea.wardaAmenorrhea.warda
Amenorrhea.warda
 
Male Infertility
Male InfertilityMale Infertility
Male Infertility
 
Endometriosis
EndometriosisEndometriosis
Endometriosis
 
Evaluation of male infertility
Evaluation of male infertilityEvaluation of male infertility
Evaluation of male infertility
 
Diagnostic evaluation of the infertile female
Diagnostic evaluation of the infertile femaleDiagnostic evaluation of the infertile female
Diagnostic evaluation of the infertile female
 
Primary amenorrhea
Primary amenorrheaPrimary amenorrhea
Primary amenorrhea
 
Tubal factor infertility
Tubal factor infertilityTubal factor infertility
Tubal factor infertility
 
Male factor infertility
Male factor infertilityMale factor infertility
Male factor infertility
 
medical management of infertility,think before surgery!!!!
medical management of infertility,think before surgery!!!!medical management of infertility,think before surgery!!!!
medical management of infertility,think before surgery!!!!
 
Premature ovarian failure
Premature ovarian failurePremature ovarian failure
Premature ovarian failure
 
Male infertility treatment
Male infertility treatmentMale infertility treatment
Male infertility treatment
 
Abnormal uterine bleeding
Abnormal uterine bleedingAbnormal uterine bleeding
Abnormal uterine bleeding
 
adenomyosis
adenomyosisadenomyosis
adenomyosis
 
Amenorrhea
AmenorrheaAmenorrhea
Amenorrhea
 

Viewers also liked

The reproductive system
The reproductive systemThe reproductive system
The reproductive systemhscteacher04
 
Robert Oates, M.D. - Genetic Evaluation and Testing
Robert Oates, M.D. -  Genetic Evaluation and TestingRobert Oates, M.D. -  Genetic Evaluation and Testing
Robert Oates, M.D. - Genetic Evaluation and Testinghooksheather
 
Evaluation of infertile male
Evaluation of infertile maleEvaluation of infertile male
Evaluation of infertile maleSarabjeet Singh
 
Management of Male Infertility
Management of Male InfertilityManagement of Male Infertility
Management of Male InfertilitySandro Esteves
 
Poster on clinical significance of sperm morphology assessment a lekshmi
Poster on clinical significance of sperm morphology assessment a lekshmiPoster on clinical significance of sperm morphology assessment a lekshmi
Poster on clinical significance of sperm morphology assessment a lekshmiAiswarya Lekshmi
 
NURSING ASSESSMENT – HISTORY AND PHYSICAL ASSESSMENT OF MALE REPRODUCTIVE SYS...
NURSING ASSESSMENT – HISTORY AND PHYSICAL ASSESSMENT OF MALE REPRODUCTIVE SYS...NURSING ASSESSMENT – HISTORY AND PHYSICAL ASSESSMENT OF MALE REPRODUCTIVE SYS...
NURSING ASSESSMENT – HISTORY AND PHYSICAL ASSESSMENT OF MALE REPRODUCTIVE SYS...ANILKUMAR BR
 
Causes of Infertility - Genetic Factors
Causes of Infertility - Genetic FactorsCauses of Infertility - Genetic Factors
Causes of Infertility - Genetic FactorsDr. Sami David
 
Sperm DNA Fragmentation
Sperm DNA FragmentationSperm DNA Fragmentation
Sperm DNA Fragmentationsasicrea
 
Advanced EMS Assessment - Reproductive System
Advanced EMS Assessment - Reproductive SystemAdvanced EMS Assessment - Reproductive System
Advanced EMS Assessment - Reproductive SystemEdward Stern
 
SEMEN ANALYSIS (WHO 2010)
SEMEN ANALYSIS (WHO 2010)SEMEN ANALYSIS (WHO 2010)
SEMEN ANALYSIS (WHO 2010)Ashish Jawarkar
 

Viewers also liked (15)

The reproductive system
The reproductive systemThe reproductive system
The reproductive system
 
Subfertility
SubfertilitySubfertility
Subfertility
 
Robert Oates, M.D. - Genetic Evaluation and Testing
Robert Oates, M.D. -  Genetic Evaluation and TestingRobert Oates, M.D. -  Genetic Evaluation and Testing
Robert Oates, M.D. - Genetic Evaluation and Testing
 
Infertility
InfertilityInfertility
Infertility
 
Evaluation of infertile male
Evaluation of infertile maleEvaluation of infertile male
Evaluation of infertile male
 
Management of Male Infertility
Management of Male InfertilityManagement of Male Infertility
Management of Male Infertility
 
Causes of infertility
Causes of infertilityCauses of infertility
Causes of infertility
 
Poster on clinical significance of sperm morphology assessment a lekshmi
Poster on clinical significance of sperm morphology assessment a lekshmiPoster on clinical significance of sperm morphology assessment a lekshmi
Poster on clinical significance of sperm morphology assessment a lekshmi
 
NURSING ASSESSMENT – HISTORY AND PHYSICAL ASSESSMENT OF MALE REPRODUCTIVE SYS...
NURSING ASSESSMENT – HISTORY AND PHYSICAL ASSESSMENT OF MALE REPRODUCTIVE SYS...NURSING ASSESSMENT – HISTORY AND PHYSICAL ASSESSMENT OF MALE REPRODUCTIVE SYS...
NURSING ASSESSMENT – HISTORY AND PHYSICAL ASSESSMENT OF MALE REPRODUCTIVE SYS...
 
Causes of Infertility - Genetic Factors
Causes of Infertility - Genetic FactorsCauses of Infertility - Genetic Factors
Causes of Infertility - Genetic Factors
 
Sperm DNA Fragmentation
Sperm DNA FragmentationSperm DNA Fragmentation
Sperm DNA Fragmentation
 
Advanced EMS Assessment - Reproductive System
Advanced EMS Assessment - Reproductive SystemAdvanced EMS Assessment - Reproductive System
Advanced EMS Assessment - Reproductive System
 
History and investigation in male infertilty
History and investigation in male infertiltyHistory and investigation in male infertilty
History and investigation in male infertilty
 
infertility
infertility infertility
infertility
 
SEMEN ANALYSIS (WHO 2010)
SEMEN ANALYSIS (WHO 2010)SEMEN ANALYSIS (WHO 2010)
SEMEN ANALYSIS (WHO 2010)
 

Similar to Male infertility (2)

Seminar on male infertility
Seminar on male infertilitySeminar on male infertility
Seminar on male infertilityeshna gupta
 
Approach to infertility by dr.bagasi
Approach to infertility by dr.bagasiApproach to infertility by dr.bagasi
Approach to infertility by dr.bagasiAbdulaziz Bagasi
 
Recent advances in male infertility
Recent advances in male infertilityRecent advances in male infertility
Recent advances in male infertilityJaya Kore Tulaskar
 
Azoospermia how to manage azoospermia.pptx
Azoospermia how to manage azoospermia.pptxAzoospermia how to manage azoospermia.pptx
Azoospermia how to manage azoospermia.pptxKarimElattar4
 
male infertility causes, management .pptx
male infertility causes, management .pptxmale infertility causes, management .pptx
male infertility causes, management .pptxzamurdabbas
 
Nanda pri. and secondary infertility
Nanda pri. and secondary infertilityNanda pri. and secondary infertility
Nanda pri. and secondary infertilityDrnrseervi Kantalia
 
Woman Health 2023 PPT.pdf
Woman Health 2023 PPT.pdfWoman Health 2023 PPT.pdf
Woman Health 2023 PPT.pdfWafa sheikh
 
Panel Discussion Problems of MALE INFERTILITY & Management of Oligo Astheno T...
Panel Discussion Problems of MALE INFERTILITY & Management of Oligo Astheno T...Panel Discussion Problems of MALE INFERTILITY & Management of Oligo Astheno T...
Panel Discussion Problems of MALE INFERTILITY & Management of Oligo Astheno T...Lifecare Centre
 
Infertility and Sperm analysis
Infertility and Sperm analysisInfertility and Sperm analysis
Infertility and Sperm analysisVikash Prasad
 
Male Infertility- How a Gynaecologist can Manage?
Male Infertility-How a Gynaecologist can Manage?Male Infertility-How a Gynaecologist can Manage?
Male Infertility- How a Gynaecologist can Manage?Sujoy Dasgupta
 

Similar to Male infertility (2) (20)

Seminar on male infertility
Seminar on male infertilitySeminar on male infertility
Seminar on male infertility
 
Infertility.pptx
Infertility.pptxInfertility.pptx
Infertility.pptx
 
Approach to infertility by dr.bagasi
Approach to infertility by dr.bagasiApproach to infertility by dr.bagasi
Approach to infertility by dr.bagasi
 
Recent advances in male infertility
Recent advances in male infertilityRecent advances in male infertility
Recent advances in male infertility
 
Male infertility 2 2018)
Male infertility 2 2018)Male infertility 2 2018)
Male infertility 2 2018)
 
Azoospermia how to manage azoospermia.pptx
Azoospermia how to manage azoospermia.pptxAzoospermia how to manage azoospermia.pptx
Azoospermia how to manage azoospermia.pptx
 
Infertility
Infertility Infertility
Infertility
 
Male Infertility
Male InfertilityMale Infertility
Male Infertility
 
Intersex presentation
Intersex presentationIntersex presentation
Intersex presentation
 
male infertility causes, management .pptx
male infertility causes, management .pptxmale infertility causes, management .pptx
male infertility causes, management .pptx
 
Male Infertility
Male InfertilityMale Infertility
Male Infertility
 
Workshop d1
Workshop d1Workshop d1
Workshop d1
 
Pri. and secondary infertility
Pri. and secondary infertilityPri. and secondary infertility
Pri. and secondary infertility
 
Nanda pri. and secondary infertility
Nanda pri. and secondary infertilityNanda pri. and secondary infertility
Nanda pri. and secondary infertility
 
Woman Health 2023 PPT.pdf
Woman Health 2023 PPT.pdfWoman Health 2023 PPT.pdf
Woman Health 2023 PPT.pdf
 
Panel Discussion Problems of MALE INFERTILITY & Management of Oligo Astheno T...
Panel Discussion Problems of MALE INFERTILITY & Management of Oligo Astheno T...Panel Discussion Problems of MALE INFERTILITY & Management of Oligo Astheno T...
Panel Discussion Problems of MALE INFERTILITY & Management of Oligo Astheno T...
 
Infertility and Sperm analysis
Infertility and Sperm analysisInfertility and Sperm analysis
Infertility and Sperm analysis
 
Male infertility
Male infertilityMale infertility
Male infertility
 
Male Infertility- How a Gynaecologist can Manage?
Male Infertility-How a Gynaecologist can Manage?Male Infertility-How a Gynaecologist can Manage?
Male Infertility- How a Gynaecologist can Manage?
 
Disorders of gonads
Disorders of gonadsDisorders of gonads
Disorders of gonads
 

More from obgymgmcri

Heart disease in pregnancy
Heart disease in pregnancyHeart disease in pregnancy
Heart disease in pregnancyobgymgmcri
 
Premalignant lesion of vulva
Premalignant lesion of vulvaPremalignant lesion of vulva
Premalignant lesion of vulvaobgymgmcri
 
Preterm labour dr seeteshviii&amp;ix_
Preterm labour dr seeteshviii&amp;ix_Preterm labour dr seeteshviii&amp;ix_
Preterm labour dr seeteshviii&amp;ix_obgymgmcri
 
Endoscopy in gynaecology
Endoscopy in gynaecologyEndoscopy in gynaecology
Endoscopy in gynaecologyobgymgmcri
 
Obstructed labour
Obstructed labourObstructed labour
Obstructed labourobgymgmcri
 
Breech presentation
 Breech presentation Breech presentation
Breech presentationobgymgmcri
 
Endomtriosis seetesh mgmcri
Endomtriosis  seetesh mgmcriEndomtriosis  seetesh mgmcri
Endomtriosis seetesh mgmcriobgymgmcri
 
Complications of third stage of labour
Complications of third stage of labourComplications of third stage of labour
Complications of third stage of labourobgymgmcri
 
Fibroid uterus
Fibroid uterusFibroid uterus
Fibroid uterusobgymgmcri
 
Antepartum haemorrhage i
Antepartum haemorrhage iAntepartum haemorrhage i
Antepartum haemorrhage iobgymgmcri
 
Abnormalities of-placenta-and-cordppt
Abnormalities of-placenta-and-cordpptAbnormalities of-placenta-and-cordppt
Abnormalities of-placenta-and-cordpptobgymgmcri
 
Prenatal diagnosis
Prenatal diagnosisPrenatal diagnosis
Prenatal diagnosisobgymgmcri
 
Genital tract fistula
Genital tract fistulaGenital tract fistula
Genital tract fistulaobgymgmcri
 
Anemia in Pregnancy
Anemia in PregnancyAnemia in Pregnancy
Anemia in Pregnancyobgymgmcri
 
Diabetes in pregnancy 2
Diabetes in pregnancy 2Diabetes in pregnancy 2
Diabetes in pregnancy 2obgymgmcri
 
Female infertility - 1
Female infertility - 1Female infertility - 1
Female infertility - 1obgymgmcri
 
Physiological changes in pregnancy (part 1)
Physiological changes in pregnancy (part 1)Physiological changes in pregnancy (part 1)
Physiological changes in pregnancy (part 1)obgymgmcri
 

More from obgymgmcri (20)

Heart disease in pregnancy
Heart disease in pregnancyHeart disease in pregnancy
Heart disease in pregnancy
 
Premalignant lesion of vulva
Premalignant lesion of vulvaPremalignant lesion of vulva
Premalignant lesion of vulva
 
Preterm labour dr seeteshviii&amp;ix_
Preterm labour dr seeteshviii&amp;ix_Preterm labour dr seeteshviii&amp;ix_
Preterm labour dr seeteshviii&amp;ix_
 
Endoscopy in gynaecology
Endoscopy in gynaecologyEndoscopy in gynaecology
Endoscopy in gynaecology
 
Obstructed labour
Obstructed labourObstructed labour
Obstructed labour
 
Breech presentation
 Breech presentation Breech presentation
Breech presentation
 
Endomtriosis seetesh mgmcri
Endomtriosis  seetesh mgmcriEndomtriosis  seetesh mgmcri
Endomtriosis seetesh mgmcri
 
Complications of third stage of labour
Complications of third stage of labourComplications of third stage of labour
Complications of third stage of labour
 
Fibroid uterus
Fibroid uterusFibroid uterus
Fibroid uterus
 
Prolapse - 1
Prolapse - 1Prolapse - 1
Prolapse - 1
 
Antepartum haemorrhage i
Antepartum haemorrhage iAntepartum haemorrhage i
Antepartum haemorrhage i
 
Abnormalities of-placenta-and-cordppt
Abnormalities of-placenta-and-cordpptAbnormalities of-placenta-and-cordppt
Abnormalities of-placenta-and-cordppt
 
Prenatal diagnosis
Prenatal diagnosisPrenatal diagnosis
Prenatal diagnosis
 
Genital tract fistula
Genital tract fistulaGenital tract fistula
Genital tract fistula
 
Anemia in Pregnancy
Anemia in PregnancyAnemia in Pregnancy
Anemia in Pregnancy
 
HRT
HRTHRT
HRT
 
Diabetes in pregnancy 2
Diabetes in pregnancy 2Diabetes in pregnancy 2
Diabetes in pregnancy 2
 
Female infertility - 1
Female infertility - 1Female infertility - 1
Female infertility - 1
 
Vbac
VbacVbac
Vbac
 
Physiological changes in pregnancy (part 1)
Physiological changes in pregnancy (part 1)Physiological changes in pregnancy (part 1)
Physiological changes in pregnancy (part 1)
 

Recently uploaded

Russian Call Girls Ajmeri Gate | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Ajmeri Gate | 9711199171 | High Profile -New Model -Availa...Russian Call Girls Ajmeri Gate | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Ajmeri Gate | 9711199171 | High Profile -New Model -Availa...sandeepkumar69420
 
Call Girls South Delhi 9999965857 Cheap and Best with original Photos
Call Girls South Delhi 9999965857 Cheap and Best with original PhotosCall Girls South Delhi 9999965857 Cheap and Best with original Photos
Call Girls South Delhi 9999965857 Cheap and Best with original Photosparshadkalavatidevi7
 
『澳洲文凭』买莫道克大学毕业证书成绩单办理澳洲Murdoch文凭学位证书
『澳洲文凭』买莫道克大学毕业证书成绩单办理澳洲Murdoch文凭学位证书『澳洲文凭』买莫道克大学毕业证书成绩单办理澳洲Murdoch文凭学位证书
『澳洲文凭』买莫道克大学毕业证书成绩单办理澳洲Murdoch文凭学位证书rnrncn29
 
Call Girl Bangalore Aashi 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Aashi 7001305949 Independent Escort Service BangaloreCall Girl Bangalore Aashi 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Aashi 7001305949 Independent Escort Service Bangalorenarwatsonia7
 
Call Girls Delhi 9873940964 Elite Escort Service Available 24/7 Hire
Call Girls Delhi 9873940964 Elite Escort Service Available 24/7 HireCall Girls Delhi 9873940964 Elite Escort Service Available 24/7 Hire
Call Girls Delhi 9873940964 Elite Escort Service Available 24/7 HireCall Girls Delhi
 
Hi,Fi Call Girl In Whitefield - [ Cash on Delivery ] Contact 7001305949 Escor...
Hi,Fi Call Girl In Whitefield - [ Cash on Delivery ] Contact 7001305949 Escor...Hi,Fi Call Girl In Whitefield - [ Cash on Delivery ] Contact 7001305949 Escor...
Hi,Fi Call Girl In Whitefield - [ Cash on Delivery ] Contact 7001305949 Escor...narwatsonia7
 
2025 Inpatient Prospective Payment System (IPPS) Proposed Rule
2025 Inpatient Prospective Payment System (IPPS) Proposed Rule2025 Inpatient Prospective Payment System (IPPS) Proposed Rule
2025 Inpatient Prospective Payment System (IPPS) Proposed RuleShelby Lewis
 
Russian Escorts Delhi | 9711199171 | all area service available
Russian Escorts Delhi | 9711199171 | all area service availableRussian Escorts Delhi | 9711199171 | all area service available
Russian Escorts Delhi | 9711199171 | all area service availablesandeepkumar69420
 
2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology Insights2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology InsightsHealth Catalyst
 
Call Girls Laxmi Nagar 9999965857 Cheap and Best with original Photos
Call Girls Laxmi Nagar 9999965857 Cheap and Best with original PhotosCall Girls Laxmi Nagar 9999965857 Cheap and Best with original Photos
Call Girls Laxmi Nagar 9999965857 Cheap and Best with original Photosparshadkalavatidevi7
 
Biology class 12 assignment neet level practise chapter wise
Biology class 12 assignment neet level practise chapter wiseBiology class 12 assignment neet level practise chapter wise
Biology class 12 assignment neet level practise chapter wiseNAGKINGRAPELLY
 
independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...
independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...
independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...narwatsonia7
 
Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...
Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...
Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...Call Girls Delhi
 
Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...satishsharma69855
 
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment BookingRussian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Bookingnarwatsonia7
 
Gurgaon Sector 86 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...
Gurgaon Sector 86 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...Gurgaon Sector 86 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...
Gurgaon Sector 86 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...ggsonu500
 
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near MeBook Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Menarwatsonia7
 
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...satishsharma69855
 

Recently uploaded (20)

Russian Call Girls Ajmeri Gate | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Ajmeri Gate | 9711199171 | High Profile -New Model -Availa...Russian Call Girls Ajmeri Gate | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Ajmeri Gate | 9711199171 | High Profile -New Model -Availa...
 
Call Girls South Delhi 9999965857 Cheap and Best with original Photos
Call Girls South Delhi 9999965857 Cheap and Best with original PhotosCall Girls South Delhi 9999965857 Cheap and Best with original Photos
Call Girls South Delhi 9999965857 Cheap and Best with original Photos
 
『澳洲文凭』买莫道克大学毕业证书成绩单办理澳洲Murdoch文凭学位证书
『澳洲文凭』买莫道克大学毕业证书成绩单办理澳洲Murdoch文凭学位证书『澳洲文凭』买莫道克大学毕业证书成绩单办理澳洲Murdoch文凭学位证书
『澳洲文凭』买莫道克大学毕业证书成绩单办理澳洲Murdoch文凭学位证书
 
Call Girl Bangalore Aashi 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Aashi 7001305949 Independent Escort Service BangaloreCall Girl Bangalore Aashi 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Aashi 7001305949 Independent Escort Service Bangalore
 
Call Girls Delhi 9873940964 Elite Escort Service Available 24/7 Hire
Call Girls Delhi 9873940964 Elite Escort Service Available 24/7 HireCall Girls Delhi 9873940964 Elite Escort Service Available 24/7 Hire
Call Girls Delhi 9873940964 Elite Escort Service Available 24/7 Hire
 
Hi,Fi Call Girl In Whitefield - [ Cash on Delivery ] Contact 7001305949 Escor...
Hi,Fi Call Girl In Whitefield - [ Cash on Delivery ] Contact 7001305949 Escor...Hi,Fi Call Girl In Whitefield - [ Cash on Delivery ] Contact 7001305949 Escor...
Hi,Fi Call Girl In Whitefield - [ Cash on Delivery ] Contact 7001305949 Escor...
 
2025 Inpatient Prospective Payment System (IPPS) Proposed Rule
2025 Inpatient Prospective Payment System (IPPS) Proposed Rule2025 Inpatient Prospective Payment System (IPPS) Proposed Rule
2025 Inpatient Prospective Payment System (IPPS) Proposed Rule
 
Russian Escorts Delhi | 9711199171 | all area service available
Russian Escorts Delhi | 9711199171 | all area service availableRussian Escorts Delhi | 9711199171 | all area service available
Russian Escorts Delhi | 9711199171 | all area service available
 
2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology Insights2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology Insights
 
Call Girls Laxmi Nagar 9999965857 Cheap and Best with original Photos
Call Girls Laxmi Nagar 9999965857 Cheap and Best with original PhotosCall Girls Laxmi Nagar 9999965857 Cheap and Best with original Photos
Call Girls Laxmi Nagar 9999965857 Cheap and Best with original Photos
 
Biology class 12 assignment neet level practise chapter wise
Biology class 12 assignment neet level practise chapter wiseBiology class 12 assignment neet level practise chapter wise
Biology class 12 assignment neet level practise chapter wise
 
independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...
independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...
independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...
 
Russian Call Girls South Delhi 9711199171 discount on your booking
Russian Call Girls South Delhi 9711199171 discount on your bookingRussian Call Girls South Delhi 9711199171 discount on your booking
Russian Call Girls South Delhi 9711199171 discount on your booking
 
Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...
Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...
Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...
 
Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...
 
Kidney Transplant At Hiranandani Hospital
Kidney Transplant At Hiranandani HospitalKidney Transplant At Hiranandani Hospital
Kidney Transplant At Hiranandani Hospital
 
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment BookingRussian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
 
Gurgaon Sector 86 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...
Gurgaon Sector 86 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...Gurgaon Sector 86 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...
Gurgaon Sector 86 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...
 
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near MeBook Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
 
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
 

Male infertility (2)

  • 2. CONTENTS  Introduction  Spermatogenesis  Causes  Evaluation  Management  What’s new in male infertility 2
  • 3. INTRODUCTION  INFERTILITY - one year of unprotected intercourse without conception  SUBFERTILITY- couples who exhibit decreased reproductive efficiency  FECUNDABILITY - probability of achieving pregnancy within a single menstrual cycle  FECUNDITY - probability of achieving live birth within a cycle. Speroff 15th ed. 3
  • 4. SPERMATOGENSIS • During embryogensis, there are approximately 300 thousand spermatogonia in each gonad. • Each undergoes mitotic division, and by puberty 600 million in each testis. 4
  • 5.  Sperm production takes place in seminiferous tubules within testis.  Spermatogenesis takes about 70 days  Adult males produce 100-200 million sperm each day.  Leydig cells produce testosterone (which along with FSH, stimulates spermatogenesis).  Maturation of sperms takes place in epididymis.  Transport of sperms – vas deferens Speroff 15th 5
  • 6. 1.Plasma membrane 2.Outer acrosomal membrane 3.Acrosome 4.Inner acrosomal membrane 5.Nucleus 6.Proximal centriole 7.Rest of the distal centriole 8.Thick outer longitudinal fibers 9.Mitochondrion 10.Axoneme 11.Anulus 12.Ring fibers A.Head B.Neck C.Mid piece D.Principal piece E.Tail 6 SPERM STRUCTURE
  • 7. Physiology of Semen after Ejaculation 1. Liquefaction 2. Capacitation 3. Acrosome reaction 4. Cortical reaction 7
  • 8. Relative prevalence of the etiologies of infertility Percentage Male Factor 20-30 Both male & Female 10-40 Female Factor 40-55 Unexplained Infertility 10-20 8
  • 9. SEMEN ANALYSIS • Abstinence for 2-3 days (Not less than 2 days & not more than 7 days) • Abnormal sperm count - analysis at least after 4 weeks. 9
  • 10.  Short intervals of abstinence- decreases the sperm density and semen volume.  Longer abstinence intervals - increase in the proportion of dead, immotile and morphologically abnormal sperms.  Semen specimen should be collected in a clean container.  Semen can also be collected in a silastic condom, which does not contain any antispermicidal agents.  Semen sample should be examined within an hour after collection 10
  • 11. 11
  • 12. Parameters Normal Reference Values Lower Reference Limits Volume 1.5-5.0 mL 1.5 (1.4-1.7) mL P H >7.2 Viscosity <3 Sperm Concentration >20 million/mL 15 (12-16) million/mL Total sperm number >40 million/ejaculate 39 (33-46) million/ejaculate Percent motility >50% 40 (38-42)% Forward progression >2 (scale 0-4) 32 (31-34)% Normal morphology >15,30,50% normal 4(3-4)% Round cells <5 million/mL Sperm agglutination <2 (Scale 0-3) 12
  • 13. Semen analysis Ejaculate volume and pH: • Low or absent – CBAVD, ejaculatory duct obstruction, hypogonadism, retrograde ejaculation. • High volume (>5ml)- Inflammation of accessory gland  Seminal vesicle secretions are alkaline and contains fructose.  EDO- semen is acidic (prostrate secretions), and has no sperm or fructose. 13
  • 14. Sperm concentration and total sperm count: 1. Azoospermia, Oligospermia 2. OBSTRUCTIVE: blockage in ductal system ( CBAVD, scrotal or inguinal surgery) 3. NON OBSTRUCTIVE: primary testicular failure, endocrinopathies that suppress spermatogenesis. 4. Endocrine and genetic evaluation indicated in men with severe oligospermia. 5. Total sperm count is the product of multiplying semen volume and sperm concentration. 14
  • 15. Abnormalities of sperm  Oligozoospermia - reduced sperm count  Asthenozoospermia – reduced sperm motility  Teratozoospermia- increased abnormal sperms  Oligoasthenoteratozoospermia – sperm variables are subnormal  Azoospermia- no sperm in semen  Aspermia – no ejaculate  Leucocytospermia – increased WBC  Necrozoospermia – all sperms are 15
  • 16. Causes of Male Infertility  Hypothalamic pitutary disorders (1- 2%)  Primary gonadal disorders (30-40%)  Disorders of sperm transport (10-20%)  Idiopathic (40-50%) 16
  • 17. Hypothalamic pitutary disorders  Idiopathic isolated gonadotropin deficiency  Kallmann syndrome  Single gene mutations  Hypothalamic and pitutary tumours  Infiltrative disease  Hyperprolactinemia  Drugs  Chronic systemic illness and malnutrition  Infections  Obesity 17
  • 18. Primary gonadal disorders  Klinefelter syndrome  Y chromosome deletions  Cryptorchidism  Varicoceles  Infections  Drugs  Radiation  Environmental gonadotoxins  Chronic illness 18
  • 19. Disorders of sperm transport  Epididymal obstruction or dysfunction  Infections causing obstruction to vas deferns  Vasectomy  Kartagener syndrome  Ejaculatory dysfunction  Young syndrome 19
  • 20. CAUSES PRE TESTICULAR TESTICULAR POST TESTICULAR ENDOCRINE: • Hypogonadotropic hypogonadism • Hypothyroidism • Hyperprolactinaemia • Diabetes COITAL DISORDERS: • Erectile dysfunction • Ejaculatory failure GENETIC: • Klinefelter syndrome • Y chromosome deletion • Immotile cilia syndrome CONGENITAL: • Cyptorchidism • Infective • Antispermatogenic agents heat, irradiation, drugs, chemotherapy VASCULAR : Torsion Varicocele IMMUNOLOGICAL OBSTRUCTIVE: Epdidymal congenital infective Vasal Genetic: cystic fibrosis. Accquired: Vasectomy Ejaculatory duct obstruction Accessory gland infection Immunological Idiopathic post vasectomy 20
  • 21. Evaluation of male infertility  To Identify and correct specific cause  To identify the individuals whose fertility cannot be corrected but could be over come by IUI and ART.  To identify- Genetic abnormality  To identify any medical condition that requires specific attention  To identify the individuals whose infertility can neither be corrected or overcome with ART, in whom adoption or donor sperm are considered. 21
  • 22. HISTORY  Duration of infertility and previous infertility  Coital frequency and sexual dysfunction  Any previous evaluation or treatment of infertility  Childhood illness and developmental history  Previous surgery and its outcome, systemic medical illness  History of exposure to STD  Exposure to environmental toxins  Current medications and allergies  Occupational exposure to tobacco, alcohol and other drugs 22
  • 23. Physical examinations  Examination of penis,  Palpation of testes and measurement of their size  Presence and consistency of both vasa and epididymides  Presence of any varicocele  Secondary sexual characteristics, hair distribution, and breast development  Digital rectal examination 23
  • 24. Other investigations Absence of fructose: Congenital absence of seminal vesicle, Partial duct obstruction.  Semen culture (If pus cells in microscopy)  Urologic evaluation  Endocrine evaluation - FSH, LH, Testosterone.  Transurethral or transcrotal USG  Renal ultrasonography  Testis biopsy- azoospermia  Vasography 24
  • 25. Endocrine evaluation: Indications: Abnormal semen analysis Serum FSH,LH and testosterone  Hypogonadotropic gonadism- FSH,LH,testosterone low  Abnormal spermatogenesis- FSH normal/increased, LH& testosterone normal  Testicular failure- high FSH and LH, low /normal testosterone 25
  • 26. Genetic evaluation 1) Mutations within cystic fibrosis transmembrane conductance regualtor (CTFR gene) 2) Chromosomal anomalies resulting testicular dysfunction – klinefelter syndrome 3) Y chromosome deletions associated with abnormalities of spermatogeneis. 26
  • 27.  Transrectal ultrasonography: less invasive indicated in diagnosis severe oligospermia or azoospermia.  Renal ultrasonography: unilateral or bilateral vasal agenesis.  Trans scrotal ultrasonography: To confirm physical findings. Detect non palpable varicocele. 27
  • 28.  Testis biopsy : diagnostic purpose in azoospermic men. when the testicular biopsy shows normal spermatogenesis obstruction to the vas deferens is suspected. 28
  • 29. Drugs that impair male infertility 29
  • 30. Treatment  Hypogonadotropic hypogonadism: Pulsatile GnRh, hCG, hMG, Testosterone, Clomiphen citrate, Tamoxifen  Hypergonadotropic hypogonadism: 1. IVF/ICSE, Donor sperm, Adaptation 2. Androgen, FSH, Clomiphen 3. Hyperprolactinemia-Dopamine agonists 4. Strict control of DM, Hypothyroid 30
  • 31. Pretesticular  Erectile dysfunction- PDE5 Inhibitor (Sildenafil)  For ejaculatory problems(Retrograde ejaculation): Imipramine , Pseudoephedrine/Ephedrine , Phenylpropalamine  Retrograde ejaculation, Neurogenic impotence, Severe Hypospadias Intrauterine insemination (IUI) 31
  • 32. Post testicular  Prior vasectomy (most common cause)- microsurgical vasovasostomy (better if less than 5 years)  Epididymal or vasal obstruction  MESA  PESA  TESE  TESA/FNA  ICSI 32
  • 33. Surgical treatment for male infertility  Vasovasotomy  Vasoepididymostomy  Transurethral resection of ejaculatory ducts  Varicocele repair  Orchiopexy  Vibratory stimualtion and electro ejacualtion 33
  • 34. surgical management  Cryptorchidism- Orchidopexy at 2-3 year of age  Varicocele- High ligation of internal spermatic vein  Gonadal failure- Surgical retrieval of spermatozoa, followed by ICSI 34