This document summarizes male infertility, including its causes and evaluation/treatment. It discusses spermatogenesis directed by Y chromosome genes and roles of the testes, LH, FSH, and epididymis. Normal sperm counts and definitions of oligospermia and azoospermia are provided. Causes of azoospermia are classified as obstructive or non-obstructive and can be pretesticular, testicular, or post-testicular. Evaluation involves endocrine and genetic testing as well as imaging of the testes and ducts. Treatment depends on the location and cause, such as hormone therapy, surgical repair, or sperm retrieval techniques.

2.  Spermatogenesis is directed by genes on the
Y chromosome
 Testes: seminiferous tubules, sertoli cells,
leydig cells
 LH, FSH
 Epididymis, vas deferens
 Seminal fluid

4.  Normal sperm count- 20 million/mL or
more*
 Oligospermia (low counts)- concentration
of fewer than 20 million/mL*; less than 5
million/mL-severe
 Azoospermia- total absence of sperm in
semen

5. Classified:
 Obstructive causes- Obstructive
azoospermia
(spermatozoa production in testes is
defective)
 Non-obstructive causes-Non-Obstructive
azoopermia (inability of produced
spermatozoa to reach the emitted semen)

6.  Defects in any of the “ducts” involved in the sperm
delivery system such as:
 1) epididymis, 2) vas deferens, 3) ampulla of the vas
and 4) ejaculatory duct.
Defects in any of the ducts involved in the sperm
delivery system such as:
1) 1) epididymis, 2) vas deferens, 3) ampulla of
the vas and 4) ejaculatory duct
2) Can be congenital or acquired
1) CBAVD vasectomy
2) infections

7.  Karyotypic abnormality such as Klinefelter
syndrome (47,XXY)
tall, gynaecomastia, small firm testes
 Deletion of a small portion of theY
chromosome (microdeletion)-Azoospermia
factor(AZF)
 Testicular failure

8.  Pretesticular
 Testicular
 Post-testicular

9.  Due to a hypothalamus or pituitary
abnormality- secondary testicular failure
Hypothalamic disorders
Hypogonadotropic hypogondanism
Tumors
Infiltrative diseases-TB, sarcoidosis, histocytosis
Drugs
Pituitary disorders
congenita;l
Tumors
radiation
granuloma

10. Peripheral organs
Adrenal disorders
Liver failure

11.  Causes non-obstructive type
 Due to primary testicular failure
Chromosomal abnormalities
klinefelter
Mixed gonadal dysgenesis
Partial androgen insenstivity
Genetic disorders of spermatogenesis

12. Local conditions
varicocele
cryptochirdism
trauma
orchitis
radiation
chemotherapy
Tight underclothing
Substance abuse
Alchohol, smoking, caffeine
Occupational exposure to heat and toxins

13. Abnormalities of epididymis
Congenital block in the ducts
CBAVD
Acquired blocks in the ejaculatory ducts-infection, trauma
Antisperm antibodies
Erectile dysfuction
Idiopathic male infertility

14.  Endocrine evaluation
FSH, LH, prolactin, serum testosterone
 Karyotyping
Klinefelter,Y microdeletions
 Genetic testing
 Transrectal ultrasonography
Site of obstruction(ejaculatory duct obstruction)
 Scrotal ultrasonography
Evaluation of testes, epidymis
 Vasography
Patency of vas deferens
 Testicular biopsy
Spermatogenesis, atrophy

15.  Pretesticular azoospermia
GnRH therapy
hCG followed by hMG
Donor insemination
 Testicular azoospermia
TESE
TESA
Donor insemination
 Post testicular azoospermia
End to end anastomosis of epididymis
Vasoepididymostomy
MESA
PESA

16.  Williams, 2nd edition
 Lakshmi Seshadri, 2nd edition
 Dutta, 5th edition