This document discusses the evaluation of male infertility, which is often neglected. It outlines the components of a complete evaluation, including history, physical exam, semen analysis, imaging, and hormonal and genetic testing. Lifestyle factors like smoking, alcohol, obesity, medications, and environmental exposures can negatively impact fertility. A physical exam evaluates secondary sex characteristics, genitals, and tests for issues like varicocele. Semen analysis assesses volume, concentration, motility, and morphology. Additional tests may include ultrasounds, hormone levels, sperm DNA fragmentation, and genetic testing. Finding the cause of infertility helps determine the best treatment approach.

1. EVALUATION OF THE INFERTILE MALE
: A NEGLECTED FACET
DR G A RAMA RAJU
VISAKHAPATNAM

2. LEARNING OBJECTIVES
History Physical examination Quality semen analysis Imaging
HormonalDna fragmentationCosting of good male
work up

3. Krishna IVF Clinic
CARRYING FEELINGS OF LOVE AND AFFECTION

4. WHY SHOULD THE COUPLE COME
FOR THE FIRST VISIT :
Fertile Sub fertile infertile

5. INTERDEPENDENCE OF
MALE AND FEMALE
REPRODUCTION
• PROGNOSTICS ENDOMETRIOSIS ,TUBAL
FACTOR AND MALE FACTOR .
Andrology: Male Reproductive
Health and Dysfunction
edited by Eberhard Nieschlag,
Hermann Behre

6. WHAT DO GUIDELINE SAY
ROLE IN INDIA
KRISHNA IVF

7. COMPONENTS OF COMPLETE
EVALUATION
Complete
history
Physical
examination
Seminal analysis endocrine
Post ejaculation
urine analysis
Ultrasonograph
y
Specialized test Genetic test

8. REPRODUCTIVE HISTORY
AGE Coital frequency
Duration of
infertility
Childhood illness
/development
Systemic Medical
Previous surgeries Medication’s Sexual history gonadaotoxins

9. EFFECT OF PATERNAL AGE

10. SEXUAL
INTERCOURSE
FREQUENCY
•FERTILE

11. INFERTILE
• CLOSE TO 8% OF MEN ARE HAVING
SEX TWO OR LESS TIMES PER
MONTH AND 24% ARE ENGAGING
IN SEX FOUR OR LESS TIMES PER
MONTH.

12. MEDICAL DISORDER AND MALE
INFERTILITY
Kidney
Bowel
CopdLiver
Diabetes

13. DRUGS AND FERTILITY
QUESTION TO ASK IN MEDICATION
Antihypertensive and
calcium channel
Antidepressant
Epileptic
Antiviral
Finasteride
ANTILIPIDS

14. ENVIRONMENT
AND SEMEN
QUALITY
Furnaces in the industry
Pesticides
Dye industry
Drug manaufacturer
•Xylene
•Solvents
•Question to ask

15. SMOKING
•
• ROLE THE NICOTINE GUM

16. ALCOHOL
increase in serum free T with
increasing alcohol consumption
in the week preceding the visit
to the IVF center
The most pronounced effects
were seen in men who
consumed more than 25 units
per week.
Alcohol consumption was also
linked to changes in T and
SHBG levels.
The alcohol threshold level
required to affect semen
adversely remains unclear.
young men and men
undergoing ART cycles should
be advised to avoid habitual
alcohol consumption.

17. COSIBLING
AND MALE
INFERTILITY
Cystic fibrosis
Y chromosome deletion
Aurkc deletion
klinefelter syndrome
Lhcgr receptor mutation
Cryptorchidism
Many more

18. PHYSICAL EXAMINATION
Bmi
Secondary
sexual
Penis
Palpation of
testis
Varicocele
Rectal
examination

19. ROLE OBESITY AND MALE FACTOR
Jensen et al. reported higher
prevalence of oligozoospermia in
overweight and obese men
. Koloszar et al. demonstrated
decreased sperm count in obese
normozoospermic men
with nonobese fertile subjects.
Kort et al. (14) reported a
negative correlation between BMI
and total number of normal
spermatozoa.
Sallmén et al. reduced sperm
motility and increased sperm
fragmentation.

20. PHYSICAL EXAM
AND ORCHIOMETER

21. CRYPORCHIDISM
Single undecended testis
When to suggest orchidectomy
Role of treatment in undecended in a new born

22. Technology

23. THIS HAS HELPED ME

24. SPERM MORPHOLOGY

25. CASA

26. WHO MANUAL
IMAGE

27. LOW COST IVF
External Quality Assurance Schemes for Reproductive Medicine

28. ENDOCRINE EVALUATION
Abnormal low
counts
Impaired
function
Endocrinopath
FSH T TSH
Lh Free T
• IF above abnormal
@ inhibin

29. ULTRASOUND
AZOOSPERMIA LOW EJACULATE OAT NORMAL TESTIS
GUIDELINE
• NOT A ROUTINE
####
• Prostrate and analysis
• Seminal vesicle abnormaly and surgery
• Flow chart for low volume

30. ROLE OF TRANSRECTAL
ULTRASOUND
Affected men typically produce a low-volume acidic
ejaculate containing no sperm or fructose.
Men with CBAVD may exhibit similar findings because they
often have absent or atrophic seminal vesicles.
Men with partial ejaculatory duct obstruction often, but not
always, exhibit low semen volume, oligoasthenospermia,
and poor progressive motility.
Some experts recommend routine TRUS for oligospermic
men having low-volume ejaculates, palpable vasa, and
normal testicular size with normal serum T,

31. EPIDIDYMIS

32. TESTIS

33. ROLE OF VARICOCELE
• ???/

34. SPECIALISED TEST
VIABILITY
DNA
FRAGMENTAIO
ANTISPERM
ANTIBODY
LEUCOCYTES

35. SPERM DNA
FRAGMENTATIONN

36. GENTIC TEST.
KARYOTYPE
Y
DELETION
CFTR
AURKC ??????

37. ROLE OF TESTICULAR
BIOPSY
• ROLE OF DIAGNOSTIC BIOPSY MINIMAL
• CLUB WITH CRYOPRESERVATION
• FIRST TIMES GIVES BEST RESULT.
• FOLLOW-UP FOR AT 6 MONTHS

38. OBSTRUCTIVE AND NON OBSTRUCTIVE
AZOOSPERMIA
FSH Testis length T

39. IF YOU DON’T
FIND THE
CAUSE IN 50 %
THINK AGAIN

40. IF YOU DON’T
FIND THE
CAUSE IN 50 %
THINK AGAIN
Thank you