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Male Infertility

This document discusses the causes and treatment of male infertility. It identifies pretesticular, testicular, and post-testicular causes including hormonal disorders, genetic abnormalities, infections, trauma, and blockages. Evaluations include semen analysis, hormone levels, imaging, and biopsies. Treatment involves lifestyle changes, medical therapies like hormones, surgery to repair issues, artificial insemination, and assisted reproductive technologies like IVF and ICSI. The goal is to address the underlying cause and support conception and delivery of a healthy baby.

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39 views

Male Infertility

This document discusses the causes and treatment of male infertility. It identifies pretesticular, testicular, and post-testicular causes including hormonal disorders, genetic abnormalities, infections, trauma, and blockages. Evaluations include semen analysis, hormone levels, imaging, and biopsies. Treatment involves lifestyle changes, medical therapies like hormones, surgery to repair issues, artificial insemination, and assisted reproductive technologies like IVF and ICSI. The goal is to address the underlying cause and support conception and delivery of a healthy baby.

Uploaded by

giri00767098
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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MALE INFERTILITY

SINJULA P S
Roll No:197
MALE GENITALIA
CAUSES OF MALE INFERTILITY
1. Pretesticular causes
2. Testicular causes
3. Post-testicular causes
PRETESTICULAR CAUSES
a)Hypothalamic disorders
Hypogonadotrophic hypogonadism
Tumours
Drugs
b)Pituitary
Pituitary failure
c) Peripheral organs
Adrenal disorders
Liver failure
TESTICULAR CAUSES

Chromosomal abnormalities
Klinefelter syndrome
Mixed gonadal dysgenesis
Down syndrome

Local condition
Varicocele
Cryptorchidism
Trauma
Orchitis
LOCAL CAUSES
Radiation
Chemotherapy
Tight underclothing
Occupational exposure to heat & toxins
SUBSTANCE ABUSE
Alchohol, Smoking, Caffeine
POST-TESTICULAR CAUSES
Congenital block in the ducts
Congenital bilateral absence of vas deference
Acquired blocks in the ducts
Antisperm antibodies
Erectile dysfunction
HISTORY:MALE PARTNER
Age
Occupation
Smoking,Alcohol,Substance abuse
Sexual history
Anosmia,Hyposmia
Past history-Surgery
Injury
Infections
PHYSICAL EXAMINATION
GENERAL EXAMINATION
BMI,BP,Hair growth,Gynaecomastia
EXAMINATION OF GENITALIA
Testicular volume,consistency
Epididymal fullness,tenderness,thickening
Varicocele
Vas deferens
INVESTIGATIONS
NORMAL SEMEN ANALYSIS
Volume : 2ml or more
pH : 7.2-7.8
Sperm count : 20 million/mL or more
Motility : 50% or more
Morphology : >30% normal
Viability : 75% or more alive
WBC : < 1 million/mL
Round cells : < 5 million/ mL
ABNORMAL SEMEN ANALYSIS
Aspermia- Absence of semen

Oligospermia- Reduced semen volume

Azoospermia- Absence of sperm in semen

Oligozoospermia- < 20 million sperms/mL

Asthenospermia- ↓ed sperm motility

Teratozoospermia- Abnormal morphology

Leukocytospermia- ↑ed WBC in semen

Necrozoospermia- All sperms nonviable


OTHER INVESTIGATIONS
ENDOCRINE EVALUATION

FSH,LH,Prolactin,Testosterone
KARYOTYPING

Klinefelter syndrome
TRANSRECTAL USG

Ejaculatory duct obstruction


SCROTAL USG

Evaluation of testes,Epididymis
VASOGRAPHY

Patency of vas deferens


TESTICULAR BIOPSY

Spermatogenesis,Atrophy
TREATMENT OF MALE INFERTILITY
GENERAL MEASURES

MEDICAL TREATMENT

SURGICAL TREATMENT

ARTIFICIAL INSEMINATION

ASSISTED REPRODUCTIVE TECHNIQUES


GENERAL MEASURES
Healthy diet & exercise
Cessation of smoking & alcohol
Avoid exposure to heat & pollutants
Avoid tight underclothing
Avoid stress
Avoid drugs which could be responsible for infertility
MEDICAL TREATMENT
Hormonal treatment
Pulsatile GnRH therapy
Inj. hCG 1000-2500 IU twice a week initially
hMG 150 IU thrice weekly
Other empirical treatment
Antioxidants,lycopenes,coenzyme Q
SURGICAL TREATMENT
Surgical correction of varicocele

Microsurgical anastomosis
Epididymal obstruction
Following vasectomy
Previosly used to treat post-testicular azoospermia
ARTIFICIAL INSEMINATION
INDICATIONS
Oligospermia
Impotence
Premature ejaculation,Retrograde ejaculation
Hypospadiasis
Antispermal antibodies in cervical mucus
Unexplained infertility
Donor semen
INTRAUTERINE INSEMINATION
Placement of 0.3-0.5mL of washed ,processed & concentrated

sperm into intrauterine cavity by means of transcervical catheter


Superovulation-to ↑ success rate

 Clomiphene citrate/Gonadotrophines
Performed around time of ovulation

Follicular monitoring

hCG to trigger ovulation


ASSISTED REPRODUCTIVE TECHNIQUES
In vitro fertilisation(IVF)

Assisted fertilisation techniques

 Intracytoplasmic sperm injection(ICSI)


 Assisted hatching
Gamete intrafallopian transfer(GIFT)

Zygote intrafallopian transfer(ZIFT)

Invitro maturation of oocyte(IVM)


Cont…
Preimplantation genetic diagnosis(PGD)

Sperm retrieval techniques

Testicular sperm extraction(TESE)

Microsurgical epididymalsperm aspiration(MESA )


Percutaneus epididymal sperm aspiration(PESA)
Testicular sperm fine-needle aspiration(TESA)
 ALTERNATIVE METHODS

Donor oocyte
Donor sperm

Donor embryo
Gestational surrogacy

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