A REVIEW ON MALE INFERTILITY IS PRESENTED BY N.PAVAN ,4TH B.PHARMACY,CHILKUR BALAJI COLLEGE OF PHARMACY,HYDERABAD,TELANGANA

1. A REVIEW ON MALE
INFERTILITY
Presented by:
N. Pavan
IVth B-Pharmacy
13GD1R0016
Under the guidance of:
P. Kishore Kumar
Assistant professor
CHILKUR BALAJI COLLEGE OF PHARMACY
(Affiliated to JNTU Hyderabad-500008)

2. DEFINITION:
Infertility primarily refers to the biological inability of a person to contribute to
conception (or) Infertility may also refer to the state of a woman who is unable to carry a
pregnancy to full term.
INTRODUCTION:
There are many biological causes of infertility, some which may be bypassed with medical
intervention. Male infertility is a reasonably common problem. Being infertile has nothing to do
with male sexual prowess (virility), but rather with the absence of healthy sperm in the semen
that are capable of travelling to meet the ovum.

3. MALE REPRODUCTIVE SYSTEM:
 For reproduction to occur, both the female reproductive and male systems are essential. While both the
female and male reproductive systems are involved with producing, nourishing and transporting either the
egg or sperm, they are different in shape and structure.
 The male has reproductive organs, or genitals, that are both inside and outside the pelvis, while the female
has reproductive organs entirely within the pelvis.
Structure of male Reproductive system

4. Parts of male Reproductive system:
1. Testes
2. Scrotum
 Dartos muscle
 Cremaster muscle
3. Interstitial cells (cells of Leydig)
4. Sertoli Cells

5. 5. Efferent ductules
6.. Epididymis
7.Ductus Deferens

6. 8. Blood supply
9. Seminal Vesicles
10. Ejaculatory Ducts
11. Prostate gland
12. Bulbourethral glands
13. Penis
14. Urethra

7. SPERM PRODUCTION:
The word spermatozoon or spermatozoan taken from the Greek word which means living being
and more commonly known as a sperm cell, is the haploid cell that is the male gamete.
A mature human Spermatozoon contains Spermatagonia which divides several times during the
process of sperm development. The entire process of sperm formation and maturation takes about
9-10 weeks.
The separate divisions are:
First division: First division mitosis, and ensures a constant supply of Spermatocytes, number of
chromosomes.
Second division: Spermatocytes then undergo a series of two cell divisions during meiosis to
become secondary Spermatocytes.
Third division: Secondary Spermatocytes finally become spermatids. Spermatids, which are
haploid cells, mature slowly to become the male gametes, or sperm.
 The sperm is the main reproductive cell in males. The females differ in males that they carry a
X gene, while the male sperm carry Y gene.

8.  The sperm contains head and tail part. The spermatozoan stream lines are straight and parallel.
The tail flagellates propels the sperm cell in a circular motion.
 During fertilization, the sperm’s mitochondria gets destroyed by the egg cell, mitochondrial
DNA can be recombinant.
 Sperms are produced in the seminiferous tubules of the testes in a process called
spermatogenesis. Round cells called Spermatagonia divide and differentiate eventually to
become spermatozoa.
 During copulation the vagina is inseminated, the spermatozoa move through chemotaxis to the
ovum inside a Fallopian tube or uterus.

9. SPERM PATHWAY:
Spermatogenesis takes place inside a male’s testes, specifically in the walls of the seminiferous
tubules.
 The epididymis is a tortuously coiled structure topping the testis; it receives immature sperm
from the testis and stores it for several days.
 When ejaculation occurs, sperm is forcefully expelled from the tail of the epididymis into the
ductus deferens.
 Sperm travels through the ductus deferens and up the spermatic cord into the pelvic cavity,
over the urethra to the prostate behind the bladder.
Sperm cells become even more active when they begin to interact with the fertilizing layer of an
egg cell.
Hyper Activation:
Sperms faster and their tail movements become more forceful and erratic. This behaviour is
called "hyper activation.”
 The flagellum of the sperm is composed of ion channels formed by proteins called
“CatSper.”

10. o The sudden rise in calcium levels causes the flagellum to form deeper bends, propelling
the sperm more forcefully through the viscous environment. Acrosome reaction on a Sea
Urchin cell the sperm uses their tails to push them into the epididymis.
o It takes sperm about 4 to 6 weeks to travel through the epididymis. The sperm then move
to the vas deferens, or sperm duct. The seminal vesicles and prostate gland produce a
whitish fluid called seminal fluid, which mixes with sperm to form semen when a male is
sexually stimulated.
o The penis, which usually hangs limp, becomes hard when a male is sexually excited.
Tissues in the penis fill with blood and it becomes stiff and erects (an erection).
o The rigidity of the erect penis makes it easier to insert into the female's vagina during
sexual intercourse, and the extended length allows it to reach deeper into the female's
oviduct, the passage from the ovaries to the outside of the body.
o When the erect penis is stimulated to orgasm, muscles around the reproductive organs
contract and force the semen through the duct system and urethra. Semen is pushed out of
the male's body through his urethra - ejaculation.

11. PUBERTY:
In addition to producing sperm, the male reproductive system also produces sex hormones, which
help a boy develop into a sexually mature man during puberty.
As a new-born FSH and LH levels are high and after a few weeks levels drop to extremely low.
When puberty begins, usually between the ages of 10 and 14, the pituitary gland - which is
located in the brain - secretes hormones that stimulate the testicles to produce testosterone.
Stages of Puberty:
•First stage: The scrotum and testes grow larger, the apocrine glands develop.
•Second stage: The penis becomes longer, and the seminal vesicles and prostate gland grow. Hair
begins to grow in the pubic region. Reproductive capacity has usually developed by this stage.
•Third stage: Hair begins to appear on the face and underarms. During this time, a male's voice
also deep Fertility continues to increases

12. INFERTILITY:
Infertility is of four types as follows. Those are
1. Infertility
2. Sub fertility
3. Primary fertility
4. Secondary fertility
Epidemiology:
Approximately 15-20% of couples attempting to achieve pregnancy in the United States each
year face difficulties with fertility. Of those couples, a pure "female factor" is responsible for
about 35-40% of cases. About another 35% of cases are pure "male factor." Couples with a
combination of male and female factors account for the remaining 25-30% of cases.
Therefore, a male infertility factor plays a part for more than 50% of couples unable to
conceive on their own. These numbers stress the need for appropriate male factor evaluation and
treatment options.
Causes of infertility:
More than 90% of male infertility cases are due to low sperm counts, poor sperm quality, or both.

13. The remaining cases of male infertility can be caused by a number of factors including them are:
 Environmental pollutants,
 Exposure to high heat for prolonged periods,
 Genetic abnormalities.
 Heavy use of alcohol, marijuana, or cocaine, smoking.,
 Hormone deficiency or taking too much of a hormone,
 Impotence,
 Infections of the testes or epididymis,
 Older age,
 Previous chemotherapy,
 Previous scarring due to infection,
 trauma or surgery,
 Radiation exposure,
 Retrograde ejaculation,
 Use of prescription drugs,
 spironolactone, and nitrofurantoin

14. 1. Sperm Abnormalities:
Sperm abnormalities can be caused by a range of factors, including congenital birth defects,
disease, chemical exposure, and lifestyle habits. In many cases, the causes of sperm
abnormalities are unknown. Sperm abnormalities are categorized by whether they affect sperm
count, sperm movement, or sperm shape them include:
a. Low Sperm Count (Oligospermia)
b. Poor Sperm Motility (Asthenospermia)
c. Abnormal Sperm Morphology (Teratospermia)
2. Retrograde Ejaculation
Retrograde ejaculation occurs when the muscles of the bladder wall do not function properly
during orgasm and sperm are forced backward into the bladder instead of forward out of the
urethra. Sperm quality is often impaired. Retrograde ejaculation can be the consequence of
several conditions:

15. 3. Genetic Disorders:
Certain inherited disorders can impair fertility. Examples include:
 Cystic fibrosis can cause missing or obstructed vas deferens.
 Polycystic kidney disease, a relatively common genetic disorder that causes large cysts to
form on the kidneys and other organs during adulthood, may cause infertility as the first
symptom if cysts develop in the reproductive tract.
 Klinefelter syndrome is marked by two X and one Y chromosomes, which leads to the
destruction of the lining of the seminiferous tubules in the testicles during puberty, although
most other male physical attributes are unimpaired.
 Kartagener syndrome, a rare disorder that is associated with a reversed position of the
major organs, also causes impaired sperm motility.
Surgery to the lower part of the bladder or prostate (the most common cause of retrograde
ejaculation), Diseases such as diabetes and multiple sclerosis, Spinal cord injury or surgery,
Medications such as tranquilizers, certain antipsychotics, or blood pressure medications also
may cause temporary retrograde ejaculation, Aging.

16. Risk factors:
1.Varicocele
2. Age
3. Sexually transmitted diseases
4. Lifestyle factors
5. Emotional Stress
6. Testicular Overheating
7. Substance abuse
8. Smoking
9. Laptops
10. Environmental Factors

17. DIABETES INDUCED MALE INFERTILITY:
Sperm+ Sugar= Infertility
Now a day’s diabetic mellitus is the most complicatory disease in the world. India one
of the leading country suffering with diabetes. More number of complications will arise with
diabetic mellitus e.g.: diabetic infertility. Infertility is the most causative disease which
affects the reproductive organs of both male and female persons. Diabetes in men has a
direct effect on fertility at a molecular level. In diabetes sperm RNA was significantly
altered, once altered their ability to repair sperm DNA is collapsed and once this is damaged
it cannot be restored.

18.  DIAGNOSIS OF INFERTILITY IN MALE:
Infertility can be diagnosed by several methods:
1. Semen analysis
2. Sperm morphology
a. Anatomic site of the defect:
b. Primary versus secondary defects:

19. 3. Sperm Count 4.Sperm motility
Diagram showing sperm
count, Sperm motility and
Sperm morphology
Grades of Sperm count

20. TREATMENT
Non surgical /Medication Therapy Medication Surgery
Varicocele
ligation
Prevention
of
male
infertility
Hormone
deficiency
treatments
Clomiphene
citrate
(Clomid,
Serophene)
Spinal Cord
Injury
(SCI)
Treatments
Electro ejaculation
Therapy
(EET)
Transurethral
Resection of
Ejaculatory
Duct
Sperm Retrieval
Techniques

21. CONCLUSION:
Pharmacologic therapy is only effective in a handful of known causes of male infertility. The
Pathophysiology behind these specific causes of male infertility is relatively well-defined and
understood, which allowed for the development of specific pharmacologic agents to correct the
problem. More research is needed to delineate the Pathophysiology behind idiopathic male
infertility in order to develop specific therapies. Based on current data, hormonal therapies in
general are a poor choice for idiopathic male infertility due to questionable efficacy and
restrictive cost. At present, anti-oxidants appear to be the best pharmacologic choice for empirical
treatment of idiopathic male infertility due to their low cost, high availability, good safety profile,
and modest efficacy.

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