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Male Infertility Treatment in Delhi

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SPERM DNA FRAGMENTATION


Clinical threshold value of DNA Fragmentation Index is 30%, that means 70% are normal.

Has role in deciding to go for ICSI in patients who have high fragmentation
DIAGNOSTIC CATEGORIES
After evaluation we should be able to segregate the patients into different categories depending on cause and what treatment we can offer.

Broadly we have can segregate into categories:
Medical/ Surgical treatment
Will help
May Help or improve chances of success in ART
Will not help
MEDICAL AND SURGICAL
MANAGEMENT OF
MALE INFERTILITY
MEDICAL THERAPYSPECIFIC
Endocrine Disorders
Ejaculatory Disorders
Genital Tract
Infections
EMPIRICAL THERAPY

Treatments for Idiopathic Male infertility

AROMATASE INHIBITORS
Empirical antioxidant treatment
Vitamin C and E
Carotenoids and Lycopene
Folate
Carnitine and N-acetylcysteine
Selenium
Clomiphene citrate and aromatase inhibitors

Lifestyle complimentary treatments
Environmental exposure prevention
Obesity prevention
Coital Lubricants
Eastern approaches-Acupuncture
Pyospermia: evaluate the patient for sexually transmitted diseases, penile discharge, prostatitis, or epididymitis
Coital therapy
Immunologic infertility
Corticosteroid suppression, sperm washing, IUI, IVF, and ICSI.
COMPLIMENTARY TREATMENTS
Lifestyle complimentary treatments
Environmental exposure prevention
Obesity prevention
Coital Lubricants
Eastern approaches-Acupuncture
Nonsurgical treatments
Pyospermia: evaluate the patient for sexually transmitted diseases, penile discharge, prostatitis, or epididymitis
Coital therapy
Immunologic infertility
Corticosteroid suppression, sperm washing, IUI, IVF, and ICSI.

Ejaculatory Duct obstruction

PESA-Percutaneous Epididymal Sperm Aspiration


Micro-TESE : Testicular Sperm Extraction (involves a small incision and snipping off some tissue from inside the testicle.

Micro TESE- Surgical Approach
MANAGEMENT

The management of infertility should take place in a dedicated infertility clinic staffed by an appropriately trained professional team of Andrologists with facilities for investigating and managing problems in both partners.

SCI International Hospital
M-4, Greater Kailash-1, New Delhi-110048
www.scihospital.com


Published in: Health & Medicine
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Male Infertility Treatment in Delhi

  1. 1. Dr. Vishal Dutt Gour MBBS, MS, M.Ch (Urology) Urologist and Male Infertility Specialist SCI International Hospital, New Delhi EVALUATION AND DIAGNOSIS OF MALE INFERTILITY
  2. 2. Male Infertility is common and a widespread problem in which a male is unable to make a fertile female pregnant even after unprotected intercourse for a year. Incidence rising over last few decades:  20% of infertile couples-Male infertility is the sole cause .  40-50% of cases- Male infertility is contributing factor.
  3. 3.  Sexual and Reproductive History: Timing of intercourse  Genitourinary infections: Prostatitis, Epididymitis, Orchitis  Childhood illness and development history: Delayed Puberty, Crytorchidism, Gynecomastia  Past Surgical History: Bladder Neck surgery, Hernia, Hydrocele, Testicular trauma/ torsion
  4. 4.  Systemic Medical illnesses: DM, Multiple Sclerosis, Post RT – CT, Febrile illness.  Medications, recreational drugs and gonadotoxin exposure: Anabolic Steriods, Nitrofurantoin, Chronic Alcohol and Drug Abuse, Smoking  Family History
  5. 5. General Examination  Eunoichoid appearance, Secondary Sexual Characters, gynecomastia Genital Examination  Testis-size and consistency  Epididymis rule out past evidence of infection, turgidity in obstruction  Varicocle  Vas deferens look for places of atrophy, CBAVD
  6. 6. Semen Analysis:  Cornerstone of Lab evaluation of the infertile male.  Two samples during different spermatogenic cycles.  Semen Analysis with history and physical examination guides us for future evaluation planning.
  7. 7. LOW EJACULATE VOLUME AZOOSPERMIA OLIGO ASTHENOSPERMIA NORMAL BUT INFERTILE ASTHENOSPERMIA
  8. 8. A. Medications B. Retroperitoneal or bladder neck injury C. Ejaculatory duct obstruction D. Diabetes mellitus E. Spinal cord injury F. Psychologic disturbances G. Idiopathic H. Incomplete collection
  9. 9. A. Hypogonadotropic hypogonadism 1. kallmann’s syndrome 2. pituitary tumor B. Spermatogenic abnormalities 1. chromosomal abnormalities 2. Y chromosome microdeletions 3. Gonadotoxins 4. Varicocele 5. Viral orchitis 6. Torsion 7. Idiopathic C. Ductal obstruction 1. Congenital bilateral absence of the vas deferens 2. Vasal obstruction 3. Epididymal obstruction 4. Ejaculatory duct obstruction
  10. 10. A. Varicocele B. Cryptorchidism C. Idiopathic D. Drugs, heat, toxins E. Systemic infection F. Endocrinopathy
  11. 11. A. Gynaecologic abnormality B. Abnormal coital habits C. Acrosomal defects D. Antisperm antibodies E. Unexplained
  12. 12. A. Spermatozoal structural defects B. Prolonged abstinence C. Idiopathic D. Genital tract infection E. Antisperm antibodies F. Varicocele G. Partial obstruction
  13. 13.  Identify endocrinologic disorders that affect male reproduction.  Gain prognostic information.  Done for severe oligospermia/ azoospermia and when you have clinical doubts.
  14. 14. CLINICAL STATUS FSH LH TESTOSTERONE NORMAL OR OBSTRUCTION N N N ISOLATED SPERMATOGENI C FAILURE N N TESTICULAR FAILURE N or HYPOGONADOT ROPIC HYPOGONADISM
  15. 15.  Azoospermic patients 10-15%, oligospermic 4-5% and 1% of normospermic show abnormalities  Y chromosome microdeletion and karyotyping.  Deletions in the AZFc are most frequently identified while AZF a &b have poor prognosis in sperm retrieval.
  16. 16. Scrotal Ultrasonography: Mainly to confirm varicocele TRUS: Azoospermic patient with suspicion of Ejaculatory Duct Obstruction Abdominal Ultrasonography in cases with absent vas
  17. 17.  Clinical threshold value of DNA Fragmentation Index is 30%, that means 70% are normal.  Has role in deciding to go for ICSI in patients who have high fragmentation
  18. 18.  The purpose of history, physical examination, laboratory testing, imaging, special tests help place the patient in different diagnostic classifications and plan further treatment.  Large no. of patients fall into the idiopathic category.
  19. 19. After evaluation we should be able to segregate the patients into different categories depending on cause and what treatment we can offer. Broadly we have can segregate into categories: Medical/ Surgical treatment  Will help  May Help or improve chances of success in ART  Will not help
  20. 20. SPECIFIC THERAPY EMPIRICAL THERAPY MEDICAL THERAPY Endocrine Disorders Ejaculatory Disorders Treatments for Idiopathic Male infertility Genital Tract Infections ANTIOXIDANTS AROMATASE INHIBITORS
  21. 21. Empirical antioxidant treatment  Vitamin C and E  Carotenoids and Lycopene  Folate  Carnitine and N-acetylcysteine  Selenium  Clomiphene citrate and aromatase inhibitors
  22. 22.  Lifestyle complimentary treatments  Environmental exposure prevention  Obesity prevention  Coital Lubricants  Eastern approaches-Acupuncture
  23. 23.  Pyospermia: evaluate the patient for sexually transmitted diseases, penile discharge, prostatitis, or epididymitis  Coital therapy  Immunologic infertility  Corticosteroid suppression, sperm washing, IUI, IVF, and ICSI.
  24. 24. Microsurgical Varicocelectomy Transurethral resection of the ejaculatory ducts Surgical sperm retrieval Reconstructive surgery Obstructive-PESA Non Obstructive-Micro TESE VEA-Vasoepididymostomy VVA- Vasovasostomy
  25. 25. Higher success rate- Disappearance of Varicocele. Lower complication rate- No hydrocele formation.
  26. 26. Incision
  27. 27. Transurethral resection of the ejaculatory ducts
  28. 28. Micro TESE- Surgical Approach Micro-TESE : Testicular Sperm Extraction (involves a small incision and snipping off some tissue from inside the testicle.
  29. 29. VEA-Vasoepididymostomy
  30. 30.  VVA-Vasovasostomy
  31. 31. The management of infertility should take place in a dedicated infertility clinic staffed by an appropriately trained professional team of Andrologists with facilities for investigating and managing problems in both partners.
  32. 32. SCI International Hospital M-4, Greater Kailash-1, New Delhi-110048 www.scihospital.com

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