This document discusses male infertility caused by poor sperm motility or asthenospermia. It defines asthenospermia as less than 40% sperm motility or less than 32% with progressive motility. Poor sperm motility can be caused by damage to the testicles from infections, injuries, varicocele, or drug/steroid use. Diagnosis involves semen analysis to assess sperm count, morphology, and motility. Lifestyle changes like reducing heat exposure, smoking, drugs, and weight can help improve motility. Treatments may include supplements, surgery to address issues like varicocele, or assisted reproduction techniques.

1. FAILURE TO CONCEIVE
By: Ajay kumar dwivedi
3rd year medicine
Unp

2. failure of conception after at least 12 months of unprotected
intercourse
 chance of a normal couple conceiving is estimated at 20-25% per
month, 75% by 6 months and 90% at 1 year
Epidemiology:
50% is due to male factor
25% of couples may be affected at some point in their reproductive
years

3. Pathophysiology:
failure of fertilization of the normal ovum due to
defective sperm development, function or inadequate
numbers.
 abnormality of morphology (teratospermia)
 low sperm number (oligospermai)
 abnormality of motility (asthenospermia)
 absent sperm (azoospermia)

4. Abnormality of motility
(Asthenospermia)

5. Sperm motility is the ability of sperm to move efficiently. This is
important in fertility because sperm need to move through the
woman's reproductive tract to reach and fertilize her egg. Poor
sperm motility can be a cause of male factor infertility.
Healthy sperm motility is defined as sperm with forward
progressions of at least 25 micrometers per second. If a man has
poor sperm mobility, it’s called asthenospermia or
asthenozoospermia.
defined as <40% sperm motility or less than 32% with

6. There are two kinds of sperm motility:
Progressive motility: refers to sperm that are swimming in
a mostly straight line or large circles.
Non-progressive motility: refers to sperm that do not
travel in straight lines or that swim in very tight circles
 For the sperm to get through the cervical mucus to fertilize a
woman's egg, they need to have progressive motility of at
least 25 micrometers a second.
 Poor sperm motility or asthenozoospermia is diagnosed
when less than 32 percent of the sperm are able to move
efficiently.

7. How does it affect fertility?
 Worldwide, around 60 to 80 million couples are affected by infertility, and the
rates vary from country to country.
In the United States, the rate is thought to be around 10 percent of couples. The
figure is based on the definition of infertility as the inability to conceive after 12
months of trying.
 Male factor infertility is when an issue with the man's biology makes him unable
to impregnate a woman. It accounts for between 40 to 50 percent of infertility
cases and affects around 7 percent of men.
Male infertility is usually the result of deficiencies in the semen, the most common
of which are:
 low sperm count or oligospermia
 poor sperm motility
 abnormal sperm shape or teratospermia
 Around 90 percent of male infertility issues are caused by low sperm count, but
poor sperm motility is an important factor also.

8. Causes of low motility
 The causes of low sperm motility vary, and many cases are unexplained.
 Damage to the testicles, which make and store sperm, can impact on the quality
of sperm.
 Common causes of testicle damage include:
 Infection
 testicular cancer
 testicular surgery
 an issue a man is born with undescended testicles
 Injury
 The long-term use of anabolic steroids can reduce sperm count and
motility.
 Drugs, such as cannabis and cocaine, as well as some herbal remedies,
can also affect semen quality.
 Varicocele, a condition of enlarged veins in the scrotum, has also been
associated with low sperm motility.

9. Diagnosis:
Semen analysis is the most basic and useful test, and it can
detect 9 out of 10 men with a fertility problem. The test assesses
the formation of the sperm, as well as how they interact in the
seminal fluid.
The sample is usually collected by masturbation. The man
will be asked to abstain from sex for between 2 and 7 days
before collecting the sample to increase the volume of semen.
It is necessary for the whole ejaculation is be collected in a
sterile container to ensure the test results are complete.
The sample is usually collected in a private room at the
doctor's office or collection facility, though in some
circumstances it can be produced at home. If this is the case,
the sample will need to be delivered for analysis within an
hour.

10. The sample should not be stored in the fridge, and doctors
recommend holding it close to the body during transportation
to keep it at body temperature. This will ensure it is the best
possible quality when it is analyzed.
Sometimes, the sample can be collected via sexual
intercourse, either in a specially designed condom or by
withdrawing before ejaculation. It is important not to use a
commercial condom for this, as many have lubricants or
spermicides that can taint the sample.
 Samples can vary for different reasons, including the length
of abstinence from sexual intercourse and illness. As a result,
two samples are usually collected. They may be anywhere
from 2 to 4 weeks apart.
 If the percentage of progressively motile sperm is less than
32 percent, the diagnosis may be poor sperm motility.

11. How to improve sperm motility?
 There are lifestyle choices people can make that will help improve
the quality of their sperm. Smoking can reduce fertility and has
been shown to affect sperm motility.
 Recreational drugs, including cannabis, amphetamines, and
opiates, and excessive alcohol consumption also reduce sperm
quality. Doctors advise people to avoid these if they are trying to
conceive.
 Being overweight with a body mass index of 25 or more can affect
both the quality and quantity of sperm.
 There is a link between an increased temperature of the scrotum
and a reduction in the quality of sperm. The ideal, sperm-
producing temperature is around 94 °F, or just below body
temperature, so loose-fitting underwear and taking simple
measures to keep the testicles cool may help.

12. Treatment
Poor sperm motility can lead to male infertility, but treatments are
available.
Some lifestyle changes may help increase sperm motility
for some men:
 exercise regularly,
 maintain a healthy weight
 limit cell phone exposure
 reduce alcohol
 quit smoking
 Some supplements may also help improve sperm
motility:
 Selenium (200mg) with vitamin E (400unit),

13. Surgical interventions to be considered include the following:
 Varicocelectomy,
 Vasovasostomy or vasoepididymostomy
 Transurethral resection of the ejaculatory ducts
 Sperm retrieval techniques
 Electroejaculation
 Artificial insemination
 Assisted reproduction techniques
 In vitro fertilization
 Gamete intrafallopian transfer (GIFT) and zygote intrafallopian
transfer (ZIFT)
 Intracytoplasmic sperm injectio

14. Absence of sperm
(Azoospermia)

15.  Azoospermia is defined as the absence of sperm in the ejaculation and is
identified in 1% of all men and up to 10% to 15% on infertile males.
 Aspermia is defined as a complete absence of seminal fluid
during orgasm.
 The initial diagnosis of azoospermia is made when no spermatozoa can be
detected on high-powered microscopic examination of centrifuged seminal fluid
on at least two occasions.
Etiology:
 Obstructive
 absent or obstructed vas deferens, epididymal or ejaculatory duct
obstruction related to infection or cystic fibrosis
 Non-obstructive
 hypogonadotrophism (Kallmann’s syndrome, pituitaru tumor)
 abnormalities of spermatogenesis (chromosomal abnormalities, toxins,
idiopathic, varicocoele, testicular torsion

16. Causes:

17. Defects in any of the ducts involved in the sperm delivery system
such as:
1. Epididymis,
2. Vas Deferens,
3. Ampulla of vas, and
4. Ejaculatory duct.
Ductal obstruction
Congenital (you were born with it)
Acquired (idiopathic)
Vasectomy
 most common cause
Infection
 Infection can make
a scar form in epididymis

18. Diagnosis
Medical History:
Childhood illness : orchitis or cryptorchidism
Genital trauma,
Prior pelvic/inguinal surgery,
Infection,
Gonadotoxin exposure: prior radiation, chemotherapy,
Current medical therapy,
Family history of birth defects,
Mental retardation,
Reproductive failure,
Cystic fibrosis
Physical Examination:
 Testis size and consistency (normal testis
volume > 19 ML),
 Consistency of epididymis,
 Secondary sex characteristics,
 Presence and consistency of the vasa
deferentia,
 Presence of varicocele,
 Masses upon digital rectal examination.

19. Hormone assay:
 raised FSH indicates non-obstructive cause ,
 normal FSH with normal testes indicates obstruction
Chromosomal analysis:
 Used to exclude Kleinfelter’s syndrome in patient presenting with
azoospermia, small soft testes, gynecomastia, elevated FSH/LH and low
testosterone.
Testicular biopsy:
performed to assess if normal sperm maturation is occurring,
for sperm retrieval for later therapeutic use
Trans-rectal ultrasound scan:
performed to assess absence or blockage of vas deferens and ejaculatory duct
obstruction,
exclude cystic fibrosis in patients with vas deferens defect

20. Management:
Bilateral absence or agenesis of vas deferens:
 Microsurgical epididymal sperm aspiration (MESA),
 consider artificial insemination using donor (AID),
Primary testicular failure with testicular atrophy:
 Testicular sperm extraction (TESE),
 in vitro fertilization (IVF),
 AID,
Primary testicular failure with normal testes:
 TESE, IVF, AID,
Obstructive cause with normal testis:
 epididymovasostomy,
 vasosostomy

21. THANK
YOU…!