Definition
refers to a male's inability to
causepregnancyin a fertile female
In humans it accounts for 40-50%
ofinfertility. Male infertility is commonly
due to deficiencies in the semen, and
semen quality is used as a surrogate
measure ofmalefecundity.
Infertility is a widespread problem.
For about one in five infertile couples the
problem lies solely in the male partner (male
infertility).
Pre-testicular causes
Pre-testicular factors refer to
conditions that impede adequate
support of the testes and include
situations of poor hormonal support
and poor general health including:
Hypogonadotropic hypogonadismdue to various causes
Obesityincreases the risk of hypogonadotropic
hypogonadism.Animal models indicate that obesity
causes leptin insensitivity in thehypothalamus,
leading to decreased Kiss1expression, which, in turn,
alters the release ofgonadotropin-releasing
hormone(GnRH).
Drugs,alcohol
Strenuous riding (bicycle riding,horseback riding)
Medications, including those that affect
spermatogenesis such aschemotherapy,anabolic
steroids,cimetidine,spironolactone; those that
decrease FSH levels such asphenytoin; those that
decrease sperm motility such
assulfasalazineandnitrofurantoin
Genetic abnormalities such as aRobertsonian
translocation
Tobacco Smoking
Male smokers also have approximately 30%
higher odds of infertility. There is increasing
evidence that the harmful products of tobacco
smoking kill sperm cells.Therefore, some
governments require manufacturers to put warnings
on packets. Smoking tobacco increases intake of
cadmium, because the tobacco plant absorbs the
metal. Cadmium, being chemically similar to zinc,
may replace zinc in the DNA polymerase, which
plays a critical role in sperm production. Zinc
replaced by cadmium in DNA polymerase can be
particularly damaging to the testes.
DNA Damage
Common inherited variants in genes
that encode enzymes employed in DNA
mismatch repair are associated with
increased risk of sperm DNA damage and
male infertility.As men age there is a
consistent decline in semen quality, and
this decline appears to be due to DNA
damage.(Silva et al., 2012). These
findings suggest that DNA damage is an
important factor in male infertility.
Testicular Factors
Testicular factors refer to
conditions where the testes produce
semen of low quantity and/or poor
quality despite adequate hormonal
support and include:
Age
Genetic defects on theY chromosome
Abnormal set of chromosomes
Y chromosome microdeletions
Klinefelter syndrome
Neoplasm, e.g.seminoma
Idiopathicfailure
Cryptorchidism
Varicocele(14% in one study)
Trauma
Hydrocele
Mumps
Malaria
Testicular cancer
Defects inUSP26in some cases
Acrosomaldefects affecting egg
penetration
Idiopathic oligospermia- unexplained
sperm deficiencies account for 30% of
male infertility.
Post-testicular causes
Post-testicular factors
decrease male fertility due to
conditions that affect the male
genital system after testicular
sperm production and include
defects of the genital tract as
well as problems inejaculation:
Vas deferensobstruction
Lack ofVas deferens, often related to
genetic markers forCystic Fibrosis
Infection, e.g.prostatitis
Retrograde ejaculation
Ejaculatory duct obstruction
Hypospadias
Impotence
Spermatogenesis
Sertoli cell
this is the only place in the testes where the
spermatozoa are produced
nourishes the developing sperm cells
Also called as nurse cell
The strongest intercellular barriers in the body
blood-testis barrier
Germ cells:
primary spermatocytes
spermatogonia
secondary spermatocytes
Spermatid
Cycles
within the human testis: 60 days
sperm maturation: 10-15 days
Diagnosis of Male Infertility
History
Duration of infertility; earlier pregnancies
Sexual history, timing and frequency, lubricants
Medical and surgical history
- fever, acute infection, surgical procedure of bladder,
pelvis, hernia
Childhood diseases: mumps, cryptorchidism
Medication, radiation, tobacco, cocaine,
marijuana, androgenic steroids, hot tubs
Family history
Physical examination
Body hair
Gynecomastia
Testis: size and consistency
Epididymis; vas deferens
Varicocele
is a commonendocrine disorder in which there is a
benign enlargement of breast tissue in males
This occurs when the veins in the testicular cord
(around the vas deferens) become engorged with blood.
Other abnormalities
G
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Laboratory tests
Urinalysis
Semen analysis
Semen collection: 48-72 hours of sexual
abstinence
Seminal fructose and post ejaculate
urinalysis
Fructose: derived from the seminal vesicle
Hormone assessment
FSH and testosterone
Diagnostic Tests
Radiologic testing
Scrotal ultrasound
CT scan or MRI of the pelvis
Testis biopsy
Vasography
is a test to remove a small sample of tissue from one or
bothtesticlesand examine it under a microscope to
evaluate a man's ability to father a child.
is anX-ray studyof thevas deferensto see if there is
blockage
Fine-needle aspiration mapping of the testes
Semen culture
Mapping of testes
Sperm Mapping
Treatment of male infertility (Surgical
treatments)
Vasovasostomy or epididymovasostomy
Ejaculatory duct obstruction
TURED (Transurethral Resection of the Ejaculatory Ducts )
is performed to treat obstructive male infertility conditions
Sperm aspiration: vas deferens, epididymis, or testicle.
Orchidopexy: within two years of age
literally connection of thevasto the vas
is asurgeryto move an undescendedtesticleinto thescrotum and
permanently fix it there
Testicular torsion
occurs when thespermatic cord(from which thetesticle is
suspended) twists, cutting off the testicle's blood supply, a
condition calledischemia
Surgical management of male
infertility
Testis biopsy
Surgical management of male
infertility
Vasography:
Surgical management of male
infertility
Vasography
Surgical management of male
infertility
Vasovasostomy
Surgical management of male
infertility
Vasovasostomy
Surgical management of male
infertility
Vasoepididymostomy
Surgical management of male
infertility
Transurethral resection of the ejaculatory ducts (TURED)
Treatment of male infertility (Nonsurgical
treatments)
Pyospermia (is a condition in which there is an
unusually high number of white blood cells in the
semen)
evaluate the patient for sexually transmitted diseases,
penile discharge, prostatitis, or epididymitis
Coital therapy
Immunologic infertility
Corticosteroid suppression, sperm washing, IUI, IVF,
and ICSI.
Medical therapy
Hyperprolactinemia; hypothyroidism; congenital
adrenal hyperplasia; testosterone excess/
deficiency: Kallmann syndrome, HCG, FSH
Empiric medical therapy
clomiphene citrate: antiestrogen, increase
secretion of GNRH, FSH, and LH. Low sperm count
antioxidant therapy: vit E
growth hormone
