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Male infertility
- 1. Male infertility : An update Dr. Narendra Gupta Vivekanand Hospital and Fertility center, Jaipur India Visit us at www.vivekanandfertility.in Dr.Narendra Gupta,vivekanandfertility.in
- 2. Male infertility • Male infertility is one of the most rapidly growing field in medicine, with dramatic advances in diagnosis and treatment. Dr.Narendra Gupta,vivekanandfertility.in
- 3. Semen analysis • Single most important and commonly employed test to evaluate an infertile man is semen analysis Dr.Narendra Gupta,vivekanandfertility.in
- 4. Classification • Normozoospermia • Oligozoospermia < 15 million/ml • Asthenozoospermia- less than 50% with forward progression or less than 25% with rapid progression • Teratozoosermia- less than 30% normal • OAT syndrome- all 3 variables abnormal • Azoospermia Dr.Narendra Gupta,vivekanandfertility.in
- 5. Male infertility • Sexual dysfunctions- non consummation of marriage, erectile dysfunction, Anatomical abnormalities like hypospadius, spinal cord injury etc. • Oligozoospermia- OAT- mild, moderate or severe • Azoospermia which can be further subdivided between pretesticular, testicular and post testicular or obstructive Dr.Narendra Gupta,vivekanandfertility.in
- 6. Quality Assessment Criteria WHO Laboratory manual for the examination and processing of human semen 2010 Volume : ≥ 2.0 ml pH : 7.2-8.0 Sperm concentration : 20 X 106 /ml Total count : 40 X 106 /ml Motility : ≥ 25% grade 1, ≥ 50% grade 2 Morphology : ≥ 13% normal forms Vitality : ≥75% White blood cells : ≤ 1 x 106 . • 1.5ml • 7.2 • 15 X 106 /ml • 39 X 106 /ml • 32% PR motility • 40% Total motility • 4% • 58% Dr.Narendra Gupta,vivekanandfertility.in
- 8. Etiology of OAT • Partial obstruction of the genital tract • Varicocele • Alcoholism • Prostatitis and male genital tract infections • Fever or systemic illness • Past H/O orchidopexy or herniorrhaphy in infancy • Mumps orchitis • Idiopathic- in more than 30-40 % cases cause remain unexplained Dr.Narendra Gupta,vivekanandfertility.in
- 9. Medical treatment • Hormonal therapy- doubtful CC, Tamoxifen, mesterolone, gonadotropin injections • Rarely severe OAT may be due to isolated deficiency of FSH which responds to gonadotropin replacement Dr.Narendra Gupta,vivekanandfertility.in
- 10. Clomiphene citrate • CC competitively binds to estrogen receptors in the hypothalamus and pituitary, thereby blocking feedback inhibition on these organs and effectively increasing the secretion of GnRH, FSH and LH • Dose: 12.5 to 50 mg/day continuously or on a 25 days cycle with a 5 day rest period each month. Dr.Narendra Gupta,vivekanandfertility.in
- 11. Sperm nutrients and anti-oxidants • Coenzyme Q-10 • Lycopene and Astaxanthin • Vitamin C • Zinc • Vitamin B-12 • L-Arginine • Vitamin-E • Selenium • L-Carnitine Dr.Narendra Gupta,vivekanandfertility.in
- 12. Intrauterine insemination • If the sperm count is between 5 million to 20 million/ ml, IUI offers a good pregnancy rate provided there is no female factor Dr.Narendra Gupta,vivekanandfertility.in
- 13. INTRACYTOPLASMIC SPERM INJECTION (ICSI) In severe OAT and cryptozoospermic patients ICSI is the treatment of choice. Dr.Narendra Gupta,vivekanandfertility.in
- 14. Azoospermia • Obstructive- it can be due to obstruction anywhere in the sperm tract, in the presence of normal spermatogenesis • Non obstructive- due to Hypothalamo pituitary failure or testicular failure Dr.Narendra Gupta,vivekanandfertility.in
- 15. Non obstructive Azoospermia • WHO group I- Hypogonadotropic hypogonadism • WHO group II- Hypergonadotropic hypogonadism or testicular or end organ failure Dr.Narendra Gupta,vivekanandfertility.in
- 16. Non obstructive Azoospermia Condition FSH Testes size Semen volume feature Hypo-Hypo Low or undetectabl e Small, soft Normal Hyposmia, anosmia may present Seminiferous tubular failure Elevated Small, soft or firm Normal Borderline Azoospermia Normal to mild elevation Normal to slightly small Normal Biopsy hypo spermatogenesis or maturation arreset Dr.Narendra Gupta,vivekanandfertility.in
- 17. Obstructive azoospermia • Testes are normal size, volume 15-20 ml and normal FSH Condition FSH Testes size Semen volume fructose Ejaculatory duct obstruction Normal Normal Very low absent Vasal aplasia Normal Normal Very low absent Vasal obstruction Normal Normal Normal present Epididymal obstruction Normal Normal Normal present Intratesticular obstruction Normal Normal Normal present Dr.Narendra Gupta,vivekanandfertility.in
- 18. Testicular biopsy • Shall we do testicular biopsy? • Where and who should do testicular biopsy ? • How should the information be interpreted? • Which technique should be used Dr.Narendra Gupta,vivekanandfertility.in
- 19. How should the information be interpreted? • Sertoli cells only, no germ cells • Spermatogonia only • Arrest at primary or secondary spermatocyte level • Spermatids round or elongated present • Spermatozoa present but only in few tubules • Normal spermatogenesis Dr.Narendra Gupta,vivekanandfertility.in
- 20. Semen bank and Donor insemination • Therapeutic donor insemination in azoospermic patients • Homologous (husband’s) sperms can also be preserved under the following circumstances- 1. In men who have difficulty in collecting semen on demand (for treatment or procedures) 2. Men away from treatment place 3. Prior to the starting of treatment in men undergoing cytotoxic chemotherapy or radiotherapy 4. Prior to vasectomy or after successful vasectomy reversal Dr.Narendra Gupta,vivekanandfertility.in
- 22. IMSI : Intracytoplasmic morphologically selected sperm injection • Morphologically selected normal sperm is injected in the egg. Theoretically this technique sound promising still it is in its infancy Dr.Narendra Gupta,vivekanandfertility.in
- 23. ICSI and Pregnancy Outcome • ICSI does not necessarily cause a new genetic problem rather makes possible the couple to have their genetic baby. • Current reviews have not documented an increase in chromosomal abnormalities and major malformations in ICSI babies. Dr.Narendra Gupta,vivekanandfertility.in
- 24. Conclusion • Extreme forms of male infertility can be treated with the help of assisted reproductive techniques like ICSI and IMSI • Testicular biopsy is an important diagnostic and therapeutic modality in expert hands. Dr.Narendra Gupta,vivekanandfertility.in
- 25. Contact us Vivekanand Hospital and Fertility Center, Jaipur India (Dedicated to the treatment of Infertile couples) Visit us at : vivekanandfertility.in Email us: drnarendra12@gmail.com Dr.Narendra Gupta,vivekanandfertility.in