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
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. 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. 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. 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. 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. 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.
9. 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
10. 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
13. A. Spermatozoal structural defects
B. Prolonged abstinence
C. Idiopathic
D. Genital tract infection
E. Antisperm antibodies
F. Varicocele
G. Partial obstruction
14. Identify endocrinologic disorders that
affect male reproduction.
Gain prognostic information.
Done for severe oligospermia/
azoospermia and when you have
clinical doubts.
16. 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.
17. Scrotal Ultrasonography: Mainly to
confirm varicocele
TRUS: Azoospermic patient with
suspicion of Ejaculatory Duct
Obstruction
Abdominal Ultrasonography in cases
with absent vas
18. 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
19. 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.
20. 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
24. Empirical antioxidant treatment
Vitamin C and E
Carotenoids and Lycopene
Folate
Carnitine and N-acetylcysteine
Selenium
Clomiphene citrate and aromatase
inhibitors
36. 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.