The document discusses various biochemical tests used to evaluate male infertility, including semen analysis to examine sperm count, motility, and morphology, hormone analysis of testosterone, FSH, and LH levels, and immunological tests for sperm antibodies. Abnormalities in these tests can indicate issues like hypogonadism, where low testosterone with high or low FSH indicates testicular or pituitary/hypothalamic dysfunction impairing the hypothalamus-pituitary-testicular axis. A full evaluation including these tests is needed to properly diagnose the underlying cause of infertility in men.

1. BIOCHEMICAL TESTS
FOR INFERTILITY IN
MALE
Prepared By:
Bikram Adhikari
Roll no.: 3
Human Biology 7th
Batch

2. Infertility
• It is defined as not being able
to get pregnant despite having
frequent unprotected sex for at
least a year
• World wide 8-10% couples are
infertile

3. Primary/Secondary Infertility
• Primary infertility : Couple without a prior pregnancy.
• Secondary infertility : Couple with previous pregnancy
including miscarriage/ectopic.
Subfertility
• Women or couples with decreased reproductive efficiency

4. Male Infertility Factors

5. Male Infertility Factors

6. Infertility in male Evaluation
• 3 components:
• Semen analysis
• Hormone analysis
• Immunological analysis

7. Semen Analysis
• It consist of:
• Microscopic component
• Sperm concentration, motility and sperm morphology
• Macroscopic component
• Measurement of physical(volume) and chemical properties (pH)

8. Semen Analysis

9. Hormone Analysis
• It is performed if any abnormalities observed in sperm
analysis
• Serum Testosterone level, FSH and LH is analyzed
• Patients with supressed or boderline Testosterone are
evaluated with hCG stimulation test

10. Hypogonadism in male
• Hypergonatotropic Hypogonadism
• Decresed testosterone (<200ng/dL) with increased FSH
(>120mIU/mL) in serum suggest hypogonadotropic
hypogonadism
• Rise in FSH  Sertoli cell dysfunction
In azoospermic men, primary germinal cell
failure, Sertoli-cell-only syndrome,
Klinefelter's syndrome.
• Elevated FSH with decreased testosterone + oligospermia
primary testicular failure

11. Hypogonadism in male
• Hypogonatotropic Hypogonadism
• Decresed testosterone (<200ng/dL) and decreased FSH
<10mIU/mL) in serum  hypogonadotropic hypogonadism
• GnRH stimulation test distinguish pituitary versus
hypothalamic failure
i.v. injection of 100ug of GnRH
measurement of FSH and LH at 0,30, 60,
120, and 180 minutes after injection.
Results of the GnRH test
•Little to no increase in gonadotropins pituitary disease
•Delayed but significant increase >=7 mIU/mL within 180 minhypothalamic
disease

12. Evaluation of Immunological
Parameters• Sperm antibody(IgA or IgG) binding to head or tail antigens is
considered specific for immunologic infertility.
• Agglutination, ELISA, RIA, and immunofluorescent assays are
available
• Immunobead technique is the most widely used.
• In this technique, a polyacrylamide bead is coated with a rabbit
antihuman antibody. This binds to antibodies that are either
already present on human sperm, or present after incubation of
sperm with the appropriate fluid (cervical mucus or serum).
Beads that bind sperm are microscopically detected.

13. Algorithm for Evaluation of Male infertility

14. References
• McPherson RA. Pincus MR. Henry’s clinical Diagnosis
and Management by Laboratory Methods,22nd
Edition,Elsevier saunders.page:418-427
• Deep JP. Assisted Reproductive Technology:review
article.Journal of chitwan Medical College 2014;4(7):1-10.
• Carl A. Brutis. Tietz Textbook of Clinical chemistry and
Molecular Diagnostics.4th
edition. Infertility,pages:211-
2120, 1999

15. Thank You!
Any Questions????????????

16. • Type of Hypogonadism??? Which part is not functioning well in
Hypothalamus pituitary testicular axis???
Type of Hypogonadism???
Is the man fertile??