MALE INFERTILITY
By:
Hj. Fatimah Usman, OBGYN (C)
Background
Definition
Infertility is the inability of a
sexually active, non-
contracepting couple to achieve
spontaneous pregnancy in one
year (WHO)
Epidemiology
In 30-40% of cases, no male-
infertility-associated factor is
found (idiopathic male infertility)
no previous history of
diseases affecting fertility, normal
physical examination and
endocrine, genetic and
biochemical laboratory testing
Male Reproductive System
In adult men each testis is normally: 15 and 35mL in
volume
The testes have two related but separate roles:
• to make sperm
• to make testosterone
Testosterone important for male puberty development of the penis and testes, facial
and body hair and a masculine physique
Testosterone and FSH pituitary gland act together on the seminiferous tubules
(sperm producing tubes) in the testes to make sperm
The Leydig cells make the male sex hormone testosterone
Spermatogenesis (sperm production) is a continuous process with millions of sperm being
made each day after puberty. It takes about 70 days to complete the development of sperm
that are able to swim and fertilize an egg
Semen is the mixture of fluids
from the testis and other glands
in the male reproductive tract
Fertilisation of the egg happens
when moving sperm bind
(stick) to and then penetrate
(enter) the egg
Th e process of making sperm
can be interrupted at various
stages for a number of reasons:
1. Absence of germ cells (called
Sertoli cell-only syndrome):
2. Maturation or germ cell
arrest
3. Hypospermatogenesis (lower
of number of sperm, smaller,
or sometimes no sperm
What Causes male infertility?
• Chromosomal / genetic • Infetion
• Undescended testes • Prostate-retaled problems
• Infection • Absence of vas deferens
• Torison • vasectomy
• Varicocele
Blockage of
• Medicine, chemicals, Sperm
radiation sperm
production
• unknown transport
problems
(obstruction)
Sexual
• Retrograde or
Problems Hormonal
premature ejaculation (erection & problems • Pituitary tumours
• Ejaculation failure ejaculatory) • Congenital
• Anabolic steroid abuse
• Erectile dysfunction
• Spinal cord injury
• Prostate surgery
• Some medecine
Chromosomal or Genetic Infertility
Chromosomal
Genetic defect
abnormalities
Sex chromosome X-linked genetic disorder
abnormalities Kallman syndrome
1. Klinefelter’s syndrome Mild androgen insensitivity
2. Dijsksdooj syndrome
Autosomal abnormalities Other X-linked disorder
Sperm chromosomal
abnormalities
How to • Avoid cigarette smoking, excess alcohol, sexually
transmitted infection, heat stress, anabolic steroids,
prevent? exposure harmful chemicals, controlled body weight
• Avoid vaginal luricants can kill sperm
• Anamnesis, medical history
Diagnose • Physical examination
• Additional examination (sperm analysis, US, genetic
test – for congenital, ect)
Treatment • Based on the etilogy
Semen Analysis
How to get a family?
Chances of natural If Failed the options of
conception conception
1/3 (38%) conceived in ART ( IVF or ICSI)
the first month of trying Donor insemination
2/3 (68%) by the third Adoption, foster parenting
month or permanent care
> ¾ (82%) by the six Deciding not to have
month children
> 9 of 10 couples (92%)
had conceived within a
year
Duration of
infertility
Age & Primary or
fertility status Prognostic
of female Factors secondary
partner infertility
Results of
semen analysis
