For Medical students

1. MALE INFERTILITY
LT COL SM SHAHADAT HOSSAIN
MCPS,FCPS( Surgery),FCPS(Thoracic Surgery)
Adv Trg on Thoracoscopy,CNUH,South Korea
CMH ,Bogra

2. INTRODUCTION
INFERTILITY -inability to become pregnant after one
year of intercourse without contraception involving a
male and female partner.
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.

3. SPERMATOGENSIS

4. SPERMATOGENSIS
 Approximately 300 thousand
spermatogonia in each gonad.
 Each undergoes mitotic division, and by
puberty 600 million in each testis.
 Spermatogenesis takes about 70 days.
 Adult males produce 100-200 million
sperm each day.

5. A.Head B.Neck C.Mid piece D.Principal piece E.Tail

6. PHYSIOLOGY OF SEMEN AFTER EJACULATION
1. Liquefaction
2. Capacitation
3. Acrosome reaction
4. Cortical reaction

7. Relative prevalence of the etiologies of
infertility

8. SEMEN ANALYSIS

9. SEMEN ANALYSIS

10. SEMEN ANALYSIS

11. PRE-REQUISITE
 Abstinence for 2-3 days (Not less than 2
days & not more than 7 days)
 Semen specimen should be collected in a
clean container.
 Semen sample should be examined within
an hour after collection.

12. SEMEN ANALYSIS

13. ABNORMALITIES OF SPERM
 Oligozoospermia - reduced sperm count.
 Asthenozoospermia – reduced sperm
motility.
 Teratozoospermia- increased abnormal
sperms.
 Azoospermia- no sperm in semen.
 Aspermia – no ejaculate.
 Leucocytospermia – increased WBC.

14. CAUSES OF MALE INFERTILITY
 Hypothalamic pitutary disorders (12%)
 Primary gonadal disorders (30-40%)
 Disorders of sperm transport (10-20%)
 Idiopathic (40-50%).

15. HYPOTHALAMIC PITUTARY DISORDERS
 Idiopathic isolated gonadotropin deficiency
 Kallmann syndrome
 Hypothalamic and pitutary tumours
 Hyperprolactinemia
 Drugs
 Chronic systemic illness and malnutrition
 Infections
 Obesity

16. PRIMARY GONADAL DISORDERS
 Klinefelter syndrome
 Y chromosome deletions
 Cryptorchidism
 Varicoceles
 Infections
 Drugs
 Radiation
 Environmental gonadotoxins

17. DISORDERS OF SPERM TRANSPORT
 Epididymal obstruction or dysfunction
 Infections causing obstruction to vas
deferens
 Vasectomy
 Kartagener syndrome (situs inversus, chronic
sinusitis, and bronchiectasis).
 Ejaculatory dysfunction.

18. EVALUATION OF MALE INFERTILITY
 HISTORY
 PHYSICAL EXAMINATION
 INVESTIGATIONS

19. HISTORY
 Duration of infertility and previous infertility
 Coital frequency and sexual dysfunction
 Childhood illness
 Previous surgery, systemic medical illness
 History of exposure to STD, environmental
toxins
 Occupational exposure to tobacco, alcohol
and other drugs.

20. PHYSICAL EXAMINATIONS
 Examination of penis
 Palpation of testes and their size
 Presence and consistency of both vasa
and epididymides
 Presence of varicocele
 Secondary sexual characteristics, hair
distribution, and breast development.

21. OTHER INVESTIGATIONS
 Endocrine evaluation - FSH, LH,
Testosterone
 Transurethral or transcrotal USG
 Renal ultrasonography
 Testis biopsy- azoospermia
 Vasography

22. TREATMENT
MEDICAL:
 GnRh
 Testosterone
 Clomiphene citrate
 Hyperprolactaemia: Dopamine agonists
 Erectile dysfunction; Sildenafil
 Retrograde ejaculation: Imipramine

23. SURGICAL
1. Vasovasotomy
2. Vasoepididymostomy
3. Varicocele repair

24. ASSISTED REPRODUCTIVE TECHNOLOGY
 ICSI;
 PESA;
 TESA;
 MICRO TESA;
 DONOR INSEMINATION;

25. ASSISTED REPRODUCTIVE TECHNOLOGY
1. ICSI; Intracytoplasmic Sperm Injection
2. MESA;
Microsurgical Epididymal Sperm Aspiration:
3. Micro-TESE;
Microdissection Testicular Sperm Extractio
n
4. PESA;Percutaneous Epididymal Sperm Aspir
ation
5. TESA;Testicular Sperm Aspiration
6. TESE;Testicular Sperm Extraction

26. ASSISTED REPRODUCTIVE TECHNOLOGY