1. The focus of attention
Today’s focus

2. What we know

3. Fig. 46.8
Reproductive Anatomy of the Human Male

4. The male reproductive system comprises of
a pair of testes that are present in a thin-
walled sac called the scrotum. . A
temperature 2-3 degrees lower is ideal for
the production of sperms. Internally, the
testis is lobed. There are 15-20 lobes, each
having a network of seminiferous tubules
and the interstitial cells between the
tubules.
The seminiferous tubules produce sperms that are passed along the tubules
The sperms are produced by a process called the spermatogenesis. The
interstitial cells are also called the Leydig cells and they secrete the
hormone testosterone.
Testes

5. From the seminiferous tubules, the sperms are passed into a
network of 10-12 ducts called vasa efferentia. They are then
passed into a highly coiled tubular part called the epididymis.
The sperms from the epididymis pass into a distinct tube called
the vas deferens, also called the sperm duct. . Vas deferens is
joined by the duct from the seminal vesicle to form the
ejaculatory duct. The duct then passes through the prostrate
glands and opens into the urethra.
Duct System

6. Glands
The various glands associated with the male reproductive system
are as follows:
• Seminal vesicles
• Prostrate gland
• Cowper's glands
• Penis

7. 
Seminal Vesicles A pair of seminal vesicles are glands that are present behind
the urinary bladder. Each sperm duct has the seminal vesicle of its side secreting
a fluid into the common ejaculatory duct. This fluid along with the sperms is
called the semen, a milky fluid.

Prostate Gland It is a bi-lobed gland near the opening of the urethra. The
prostate gland also pours its secretion into the urethra.

Cowper's Glands They are a pair of small ovoid glands that secrete lubricating
fluid into the urethra just before it enters the penis.

Penis: Penis is a muscular organ containing erectile tissue. The tissue is richly
supplied with blood vessels.
Glands

8. Production
Of Sperm - Spermatogenesis

9. Fig. 46.11
Copyright © 2002 Pearson Education, Inc., publishing as Benjamin Cummings

10. Sperm

11. Sperm

55-65 µm in length

Three parts head, neck and tail. On the outside of the anterior two
thirds of the head is a thick cap called the acrosome that is formed
mainly from the Golgi apparatus.

It contains enzymes similar to those found in lysosomes
hyaluronidase and powerful proteolytic enzymes. These play
important roles in allowing the sperm to enter the ovum and fertilize
it.

12. Sperm
The tail of the sperm, called the flagellum, has three
major components:
(1) A central skeleton constructed of 11 microtubules, collectively
called the Axoneme
(2) A thin cell membrane covering the Axoneme
(3) A collection of mitochondria surrounding the axoneme in the
proximal portion of the tail (called the body of the tail)
Normal sperm move in a fluid medium at a velocity
of 1 to 4 mm/min.

13. Regulation of Sex Hormone Secretion
and Sperm Production
This process begins during
puberty
Gonadotropin releasing
hormone (GnRH) from the
hypothalamus stimulates the
production of the follicle-
stimulating hormone (FHS)
and luteinizing hormone (LH)
from the anterior pituitary.
Testes respond to FSH by
initializing spermatogenesis.
LH assists spermatogenesis
and production of testosterone.
Inhibin hormone controls
production of sperm count

15. Male infertility

Male infertility of unknown origin is a condition in
which fertility impairment occurs spontaneously
or due to an obscure or unknown cause
• It includes 2 categories,
1. Unexplained male infertility &
2. Idiopathic male infertility.
• The dividing line between them is semen analysis,
which is normal in the unexplained category and
abnormal in idiopathic infertility.

16. Terminologies
1.Azoospermia : Absence of Sperm
2.Oligozoospermia : Low Sperm Count
3.Asthenozoospermia : Sperm with Poor Motility
4.Teratozoospermia : Abnormal shape of Sperm

17. Causes - male infertility
When there is structural abnormality in the spermsWhen there is structural abnormality in the sperms
When there is functional abnormality in the spermsWhen there is functional abnormality in the sperms

18. Causes - male infertility
When Number is < 1m/ejaculateWhen Number is < 1m/ejaculate
When Progression is < 2/4When Progression is < 2/4
When Motility is < 20%When Motility is < 20%
When Abnormal forms are
> 85%
When Abnormal forms are
> 85%

19. Causes - oxidative stress

Oxidative stress (OS) is the imbalance between
the production of reactive oxygen species (ROS)
by the spermatozoa and leukocytes & the
antioxidant capacity of the seminal plasma.
1. The primary source of ROS production in infertile
patients is the immature spermatozoa.
2. Oxidative stress can damage the DNA of the
spermatozoa & prevent them fertilizing an egg.
3. Reactive oxygen species (ROS) includes oxygen
ions, free radicals and peroxides.

20. Causes-inadequate progression
Grade 0 is no movementGrade 0 is no movement
Grade 2 is slow movement but not straightGrade 2 is slow movement but not straight
Grade 1 is sluggish movementGrade 1 is sluggish movement
Grade 3 is movement in a straight lineGrade 3 is movement in a straight line
Grade 4 is terrific speed.Grade 4 is terrific speed.

21. ROS – In Male
Infertility

22. ROS – In male infertility

24. Role of ROS in male infertility
1. Idiopathic oxidative stress has been linked with male factor infertility as it
is known to contribute to defective spermatogenesis leading to male factor
infertility
2. Uncontrolled & excessive production of ROS overwhelms the limited
antioxidant defenses in semen resulting in seminal oxidative stress
3. Seminal oxidative stress correlates negatively with sperm concentration,
motility and function - adversely affecting fusion events required for
fertilization.
Superoxide anion, hydroxyl radical and hydrogen peroxide are major reactive
oxygen species (ROS) present in seminal plasma.

25. ROS - Role in male infertility
ROS are produced by the spermatozoa (especially damaged
spermatozoa) & seminal leucocytes - most notably granulocytes.
ROS directly damage sperm
DNA, compromising the
paternal genomic
contribution to the embryo
This, in turn, reduces the sperm’s motility and ability to fuse with the
oocyte.
Reports have indicated that high levels of ROS are
detected in semen samples of 25-40% of infertile men
& seems to be the leading cause infertility by 2
principal mechanisms:
ROS damage the sperm
membrane by causing
lipid peroxidation of
sperm membrane

26. Body's defense against ROS
To maintain
normal cell
function
Excess ROS is continuously
inactivated by seminal plasma
antioxidants
Glutathione
peroxidase
The seminal plasma antioxidants block the formation of new ROS
or act as scavengers and remove ROS already generated
Natural antioxidant enzyme systems include
Catalase
Superoxide
dismutase

27. Underlying facts on anti-oxidants
However in conditions of oxidative stress, production of ROS overwhelms
antioxidant defence.
However in conditions of oxidative stress, production of ROS overwhelms
antioxidant defence.
Hence, there is a pressing need for external
antioxidant support!
Hence, there is a pressing need for external
antioxidant support!
Antioxidants are the most important defence against free radical induced
infertility
Antioxidants are the most important defence against free radical induced
infertility
The several antioxidant strategies produced by the human body protect itself
from ROS damage
The several antioxidant strategies produced by the human body protect itself
from ROS damage
This permits normal oxidative metabolism to occur without damaging the cells,
while still allowing for normal ROS-mediated cellular responses such as
destruction of infectious pathogens and intracellular signalling
This permits normal oxidative metabolism to occur without damaging the cells,
while still allowing for normal ROS-mediated cellular responses such as
destruction of infectious pathogens and intracellular signalling

28. The need of the day

Levels of ROS within semen can be ↓ by
augmenting the scavenging capacity of seminal
plasma, by antioxidant supplement.
Antioxidant supplements boost sperm count,
morphology and sperm motility and prevent
DNA damage to sperm
Antioxidant supplements boost sperm count,
morphology and sperm motility and prevent
DNA damage to sperm
But, what can antioxidant do to the problem
of male infertility?
But, what can antioxidant do to the problem
of male infertility?

29. The therapeutic
supplementation in male
infertility

30. Clomiphene – Role in male fertility

Clomiphene citrate influences spermatogenesis and also
improves semen quality

31. Antioxidants in the therapy of male
infertility

Because ROS have been associated with sperm
DNA damage, investigators have studied possible
protective roles of antioxidants in preventing or
treating sperm DNA damage.

32. Antioxidants in the therapy of male
infertility

82% trials showed an improvement in either sperm quality or
pregnancy rate after antioxidant therapy.

10 trials examined pregnancy rate and 6 showed a significant
improvement after antioxidant therapy.

The use of oral antioxidants in infertile men could
improve sperm quality and pregnancy rates.

33. Antioxidants in the therapy of male
infertility
Ubidecarenone
Carotenoids (Lycopene)
Omega 3 fatty acids
Carnitine / Levo Carnitine
Vitamin E & Vitamin C
Selenium
Glutathione
N-acetyl cysteine
L Arginine
Trace Metals like Zinc
Vitamin B12

34. Ubidecarenone

Also known as Coenzyme Q10, ubiquinone,
coenzyme Q, and abbreviated at times to
CoQ10 , CoQ, Q10, or Q

Component of the electron transport chain and
participates in aerobic cellular respiration,
generating energy as ATP.

Unique capacity of this molecule:

35. Ubidecarenone - Role in male fertility

In sperm cells, Co Q10 is concentrated in the
mitochondrial mid-piece, where it is involved in
energy production.

It also functions as an antioxidant, preventing
lipid peroxidation of sperm membranes.

According to studies, Ubidecarenone shows
significant increase in:

36. Lycopene - Role in male fertility

Bright red carotenoid pigment, phytochemical and
powerful antioxidant with a major role in the
management of idiopathic male infertility.

Most efficient oxygen & free radical quencher and
prime carotenoid in plasma / other tissues

It is a component of human redox defence
mechanism against free radicals

Found in high concentrations in the testes and
seminal plasma

Decreased levels have been demonstrated in men
suffering from infertility.

37. Lycopene - Role in male fertility

Studies suggest efficacy of lycopene in male
infertility as it improves.

Sperm Concentration

Sperm Motility

Sperm Morphology

38. Mixed caretenoids - Role in male
fertility

Carotenoids work synergistically with Se and
vitaminE

Mixed carotenoids, taken with vitamins C and E,
may help protect sperm from damage by free
radicals as it improves -

Sperm Motility

Sperm Morphology

Sperm Concentration and

Improved Fertility rates

39. Omega-3 fatty acids - Role in male
fertility

Omega−3 fatty acids includes eicosapentaenoic
acid (EPA) and docosahexaenoic acid (DHA).

DHA (Docosahexaenoic acid) is essential for
male fertility.

Omega-3 fatty acids are abundant in the sperm with
DHA being abundant in the sperm tail to have
significant effect in sperm motility.

Its deficiency is linked to low sperm count and
infertility.

40. Omega-3 fatty acids - Role in male
fertility

Normal sperm cells contain an arc-like structure
called the acrosome. Acrosome is critical in
fertilization because it houses, organizes, and
concentrates a variety of enzymes that sperms
use to penetrate egg.

DHA is essential in fusing the building blocks of the
acrosome together.

Without DHA, this vital structure does not form and
sperm cells don't work

DHA plays a major role in regulating membrane
fluidity in sperm + regulation of spermatogenesis

41. Omega-3 fatty acids - Role in male
fertility

42. Wheat germ oil - Role in male fertility

Source of Vitamin E and primary function is as
an Antioxidant

It is a major chain-breaking antioxidant in the
sperm membranes

Protects the sperm membrane from oxidative
damage and increased levels are associated with
low levels of reactive oxygen species.

It scavenges all 3 types of free radicals, viz.

Superoxide,

Hydrogen peroxide and

hydroxyl radicals.

43. Wheat germ oil - Role in male fertility

Vitamin E enhances sperm performance

Vitamin E protects spermatozoa from:
1. Oxidative damage
2. Loss of motility

44. Calcium ascorbate – Role in male fertility

Natural form of Vitamin C that is a water-soluble
ROS scavenger with high potency.

Readily absorbed in the blood stream than the
other forms of calcium.

It is a strong antioxidant destroying free radicals
in the body and protects human spermatozoa
against endogenous oxidative damage by
neutralising :
1. Hydroxyl
2. Superoxide, &
3. Hydrogen peroxide radicals

45. Calcium ascorbate – Role in male fertility

Vitamin C Prevents sperm agglutination.

Vitamins C and E act synergistically to protect
against peroxidative attack on spermatozoa.

46. Vitamin B 12 - Role in Male Fertility

Vitamin B12 is important in cellular replication,
especially for the synthesis of RNA and DNA

Deficiency states have been associated with
decreased sperm count and motility

B12 supplementation improves sperm
parameters such as:
1. Sperm concentration,
2. Sperm count and
3. Sperm motility.

47. Selenium - Role in Male Fertility

Selenium is a nonmetal & a trace mineral that is
essential to good health but required only in small
amounts.

Its antioxidant properties helps prevent cellular
damage from free radicals

Protects against oxidative sperm DNA damage
and is required for:
1. Normal testicular development
2. Spermatogenesis
3. Motility and function

48. Selenium - Role in Male Fertility

Essential for formation of phospholipid
hydroperoxide glutathione peroxidase - an
enzyme present in spermatids which becomes a
structural protein comprising over 50 % of the
mitochondrial capsule in the mid-piece of mature
spermatozoa.

Deficiency leads to instability of the mid-piece,
resulting in
− Defective motility
− Breakage of the spermatozoal mid-piece and
− Increased morphological abnormalities, mostly affecting the
sperm head

49. Zinc - Role in male fertility

Zinc is a trace mineral essential for normal
functioning of the male reproductive system.

Zinc levels are generally lower in infertile men
with diminished sperm count

Zinc supplementation shows improvement in
sperm quality, sperm motility, fertilisation capacity
and a reduction in the incidence of anti-sperm
antibodies.

50. Zinc - Role in male fertility

Zinc is found in high concentration in sperm, and
is vital in making the outer layer of the sperm, as
well as the tail.

Zinc deficiency is associated with decreased
testosterone levels and sperm count

Administration of exogenous systemic zinc to
males with zinc deficiency can improve sperm
production and sperm motility.

Supplementing zinc in the diet can re-establish
testosterone and sperm count levels to acceptable
levels

51. Zinc - Role in male fertility

Zinc therapy results in significant improvement in
sperm quality with increase in sperm density,
progressive motility and improve conception and
pregnancy outcome

52. Piperine

Piperine is an alkaloid - a standardized extract
from the fruits of Piper nigrum L. (black pepper)
or Piper longum L. (long pepper)

Piperine may be co-administered with various
nutrients for human health.

It has antioxidant activity

It lowers lipid peroxidation

It increases the plasma levels of Coenzyme Q10
following oral supplementation.

53. Levocarnitine:
Provide energetic substrate for spermatozoa.
Sucessful maturation of sperm.
Increases spermatozoa per ejaculate
Increase in progressive linear sperm motility in
idiopathic asthenospermia.
L Arginine:
Precursor of nitric oxide, which effectively improves sexual
performance.
Effective even in erectile dysfunction cases
Increase sperm count, quality, and fertility