ANDROLOGY  Andrology • Habard Siebke first used the term andrology in 1951, and the field first emerged from dermatology in Germany. • However, urology, gynecology, and endocrinology have a greater impact on modern andrology. • At least 15% of couples throughout the world experience andrological issues, which have become both a prevalent and significant problem. • Male infertility, male contraception, hypogonadism, erectile dysfunction, and male senescence are among the main issues addressed by andrology. • Andrology encompasses a variety of conditions, including testicular cancer, prostate disorders like benign prostatic hyperplasia and carcinoma, delayed puberty, family planning and contraception, cryopreservation of semen and testicular tissue, hormone replacement therapy, forensic paternity issues, and aging in men. Symptomatology of male infertility • TYPE I – erection problems (0,3-7%) • TYPE II – azoospermia (0,9%-16%) • TYPE III – immunological infertility (3,4%-25%) • TYPE IV – abnormal seminal quality (23%-48%) • TYPE V – idiopathic sperm dysfunction (0-25%)  Diagnosis • General examination • Semen analysis • Other diagnostic tests: • USG • Hormonal diagnostic • Diagnostic tests for Assisted Reproductive Technology  TYPE I – erection problems (0,3-7%) • Normal ejaculation • Hypospermia (semen volume < 2,0 ml) – chronic prostatitis • Impotence • Retrograde ejaculation • Neurogenic– DM, SM • Anatomical • Jatrogenic – drugs, operations • disejaculation • Functional – anorgazmia • Neurogenic – spinal injury • Jatrogenic – drugs, chemiotherapy, radiotherapy, operations  TYPE II – azoospermia (0,9%-16%) • Pre-testicular causes • Hypothalamic or pituitary disorder – LH, FSH deficiency, Kallman syndrome, trauma, tumors, inflammation, meningitis • Testicular causes • Primary testicular failure • Congenital – 47XXY, del Y, AZF • Acquired- mumps, testicular torsion, castration • Jatrogenic – radiotherapy, chemotherapy • Post-testicular causes • Congenital • Acquired – inflammations (gonorrhea) • Jatrogenic – vasectomy, hernia operation Diagnostic tests for Assisted Reproductive Technology- ICSI • FSH • If < 12IU – sperm biopsy is effective in 80-90% • Blocked ejaculatory duct (Micro-Epididymal Sperm Aspiration –MESE) • Other (Testicular Sperm Extirpation- TESE, Testicular Sperm Aspiration- TESA)  TYPE III – immunological infertility (3,4%-25%) Antisperm antibodies – the immune system may produce antibodies that attack and weaken or disable sperm • Auto-immunological diseases • Consequences of testicular trauma Congenital • Undescended testicles Sexually transmitted disease (gonorrhoea) or testicular infection (mumps) • Vascular Testicular torsion • Varicocoeles Diseases: Thyroid failure; Addison disease. • auto-immunological diseases; • Environmental factors Drugs (sulfasalazine, T, chemotherapy) • Temperature Other factors (X-rays, lead, cigarette s

1. ANDROLOGY

2. Andrology
• Habard Siebke first used the term andrology in 1951, and the field first
emerged from dermatology in Germany.
• However, urology, gynecology, and endocrinology have a greater impact
on modern andrology.
• At least 15% of couples throughout the world experience andrological
issues, which have become both a prevalent and significant problem.
• Male infertility, male contraception, hypogonadism, erectile dysfunction,
and male senescence are among the main issues addressed by andrology.
• Andrology encompasses a variety of conditions, including testicular
cancer, prostate disorders like benign prostatic hyperplasia and
carcinoma, delayed puberty, family planning and contraception,
cryopreservation of semen and testicular tissue, hormone replacement
therapy, forensic paternity issues, and aging in men.

3. Symptomatology of male
infertility
• TYPE I – erection problems (0,3-7%)
• TYPE II – azoospermia (0,9%-16%)
• TYPE III – immunological infertility (3,4%-25%)
• TYPE IV – abnormal seminal quality (23%-48%)
• TYPE V – idiopathic sperm dysfunction (0-25%)

4. Diagnosis
• General examination
• Semen analysis
• Other diagnostic tests:
• USG
• Hormonal diagnostic
• Diagnostic tests for Assisted Reproductive Technology

5. TYPE I – erection problems
(0,3-7%)
• Normal ejaculation
• Hypospermia (semen volume < 2,0 ml) – chronic prostatitis
• Impotence
• Retrograde ejaculation
• Neurogenic– DM, SM
• Anatomical
• Jatrogenic – drugs, operations
• disejaculation
• Functional – anorgazmia
• Neurogenic – spinal injury
• Jatrogenic – drugs, chemiotherapy, radiotherapy, operations

6. TYPE II – azoospermia
(0,9%-16%)
• Pre-testicular causes
• Hypothalamic or pituitary disorder – LH, FSH deficiency, Kallman
syndrome, trauma, tumors, inflammation, meningitis
• Testicular causes
• Primary testicular failure
• Congenital – 47XXY, del Y, AZF
• Acquired- mumps, testicular torsion, castration
• Jatrogenic – radiotherapy, chemotherapy
• Post-testicular causes
• Congenital
• Acquired – inflammations (gonorrhea)
• Jatrogenic – vasectomy, hernia operation

7. Diagnostic tests for Assisted
Reproductive Technology- ICSI
• FSH
• If < 12IU – sperm biopsy is effective in 80-90%
• Blocked ejaculatory duct (Micro-Epididymal Sperm
Aspiration –MESE)
• Other (Testicular Sperm Extirpation- TESE, Testicular
Sperm Aspiration- TESA)

8. TYPE III – immunological infertility
(3,4%-25%)
Antisperm antibodies – the immune system may produce antibodies that attack
and weaken or disable sperm
• Auto-immunological diseases
• Consequences of testicular trauma
Congenital
• Undescended testicles Sexually transmitted disease (gonorrhoea) or testicular
infection (mumps)
• Vascular Testicular torsion
• Varicocoeles Diseases: Thyroid failure; Addison disease.
• auto-immunological diseases;
• Environmental factors Drugs (sulfasalazine, T, chemotherapy)
• Temperature Other factors (X-rays, lead, cigarette smoke, alcohol; marijuana, and
frequently wearing tight-fitting pants)

9. Treatment
• Risk factor elimination
• Give up smoking
• Testicular temperature decrease
• Regular sexual intercourses (2-3 per week)
• Antioxydants
• Vitamin E, C, Zinc
• Tetracicline
• Chlamydia Trachomatis infection

10. Treatment (pharmacotherapy)
Pharmacotherapy
• Risk factor elimination
• Hormonal treatment
• Testosterone
• hCG
• FSH
Varicose veins in the spermatic cord
• Physical examination
• Valsalva test examination ( or during cough)
• large veins during palpation
Other diagnostic test
• Semen analysis (SA) USG
• Treatment • Operation • ART- IUI, IVF, ICSI

11. Diagnostic and therapeutic algorithm
(female) and Sperm analysis
• Sperm analysis
• IUI Treatment: operation, CC, hMG (FSH) O, ICSI azoospermia
Testicular cells? TESE, MESA
• Sperm analysis- recommendation by WHO
• General female infertility diagnostic test- SA
• Sterility
• Sample should be delivered to laboratory in 60 min. after ejaculation
• Abstinence min. 48 hours max. 7 days
• The next semen analysis between 7 days and 3 months

12. What is semen analysis?
Semen analysis? is a test on the fluid that is released when a man has
an orgasm.
• Inflects the quality and quantity of spermatogenesis, spermiogensis,
sperm transportation, and maturation process.
• it is usually one of the first tests done to help determine whether a
man has a problem fathering a child (infertility).
Modern approach is to interpret with regard to:
• diagnosis of specific lesions; and
• indicators of dysfunctional and/or functional potential.
• Requires understanding of the relevance of sperm pathophysiology.
• In any case, the results must be accurate and reliable.

13. Why perform semen analysis?
1. Diagnosis of sterility
2. Diagnosis of infertility (as part of a couple's infertility investigation) •
Prognosis for fertility
3. Effectiveness of vasectomy
Identify treatment options
• surgical treatment
• medical treatment
• assisted conception treatment
• Cryopersvation Therefore = a screening test to help direct management.

14. How is semen analysis done?
• Analysis is done through two steps -Sample collection -
Sample analysis, according to World Health Organization:
Department of Reproductive Health and Research WHO
laboratory manual for the examination and processing of
human semen. 5th edition. 2010.
• International minimum standards are, by consensus, the
World Health Organization’s Lab Manual.
• Focus is on standardization with expanded section on quality
control.

15. Semen collection
• Sexual abstinence - 2- 7 days -No “ejaculation” not just “No
intercourse”
• Specimen collection (Ways to collect semen) - Masturbation
(Optimal specimen for analysis) - Coitus interrupts (often lost a part) -
Split ejaculate (2 containers) - Accepted lubricants (non sperm toxic)
• Specimen containers -non sperm toxic ( containers, condoms) only
provided by the laboratory.
• Specimen Transport - In the laboratory location (Ideal) - Off site (
within 1 hour), avoid excess heat or container damage, instruct in the
semen report, patient assignment Semen collection

16. Retrograde ejaculation
• In some men, the semen passes back into the bladder at
ejaculation - this is confirmed by examination of a sample of
post-ejaculatory urine.
• The man must take sodium bicarbonate the day before, and the
day of, his appointment – to alkalinize his urine or FNA is
recommended.
• Before collection, he should pass urine and then wait until he
feels there is some urine in his bladder before masturbating
• Assess volume and pH of the urine.
• Centrifuge, resuspend pellets Perform a standard semen
analysis with this suspension

17. Microscopic Analysis and
Macroscopic analysis
Microscopic Analysis
Sperm count
Liquefaction
Sperm motility
Viscosity
Sperm kinetics
Volume
Sperm morphology
Color and Turbidity
Aggregation
pH
Agglutination
Vitality Determination of Immature
germ cells and Leukocytes RBCs
Macroscopic examination
Liquefaction
• Non liquefied semen is a fairly rare
occurrence, may indicate prostatic
dysfunction, and should be noted.
• Aspirate the specimen into plastic pasture
pipette and observe it If homogeneous and
quite watery Liquefaction is complete If
heterogeneous mixture Liquefaction is not
complete
• Note: Normal liquefied semen samples may
contain jelly-like granules (gelatinous bodies)
which do not liquefy.
• If after 2 hours the specimen has not
liquified proteolytic enzymes such as alpha-
chymotrypsin may be added to allow the rest
of the analysis to be performed.

18. Computer Aided Semen
Analysis - CASA
Advantages:
1. Increased objectivity and consistency of measurements.
2. Increased accuracy and precision of analysis.
3. Provides a description of vigor ( velocity and tail beat frequency)
and pattern of motion (Linearity, and amplitude of lateral head
displacement)
Disadvantages:
1. Can overestimate or underestimate sperm count.
2. Sperm count should be between 20-50 million/mL for accurate
analysis. 3. Requires extensive QC to demonstrate accuracy and
precision.

19. Count and motility estimation by
CASA
The sperm tracks are analyzed and a number of kinematic parameters are
derived, including:
• Velocity (VCL, VSL and VAP) –
• Velocity ratios (expression of the path shape and regularity) –
• Amplitude of lateral head displacement – Beat/cross frequency
The proportion of sperm in a sample which meet particular kinematic criteria
is used to predict (failure) of:
• Mucus-penetrating ability
• Hyperactivation (a marker of sperm function)
• Able to assess the kinematics of hundreds of sperm in a couple of minutes
Computer Aided Semen Analysis - CASA

20. IMMUNOBEAD TEST
• IMMUNOBEAD TEST
• Microscopic polyacrylamide spheres, ranging in size from 2 to 10 um, coated
with anti-human immunoglobins against human IgG, IgA or IgM
• Normal sperm range
• Motility >50% 4 or 3 ; or >25% 4
• Sperm count >20·106/ml
• WBC count <106/ml
• Spermatozoa <5·106/ml
• Autoagglutinating <10%
• Immunebead test <10%
• Sperm morphology >30% normal forms (WHO); 5-14% strict criteria
(Kruger)

21. ERECTILE DYSFUNCTION: A COMMON
HEALTH PROBLEM

22. INCIDENCE OF ERECTILE
DYSFUNCTION

24. THANK YOU S