4- Male infertility_ Ethiology, diagnosis and treatment

Male Infertility

• Male infertility is a significant issue, affecting a range of men.
• Infertility is defined as one year of unprotected intercourse without conception.
• Subfertility means decreased reproductive efficiency in couples.
• Fecundability is the probability of pregnancy in a single menstrual cycle.
• Fecundity is the probability of achieving a live birth within a cycle.

Contents

• Introduction
• Spermatogenesis
• Causes
• Evaluation
• Management
• Recent advancements in male infertility

Introduction

• Infertility encompasses a spectrum of conditions, from complete inability to conceive to reduced reproductive efficiency.
• Identifying causes is crucial for appropriate management.

Spermatogenesis

• Spermatogenesis is the process of sperm development, taking approximately 70 days.
• During embryogenesis, there are roughly 300,000 spermatogonia in each gonad.
• By puberty, the number increases to 600 million in each testis.
• Sperm production happens in the seminiferous tubules of the testes, a process stimulated by testosterone alongside FSH.
• Sperm maturation occurs in the epididymis.
• Sperm is transported through the vas deferens.

Sperm Structure

• The sperm's structure plays a critical role in its function.
• Core components include the head, neck, midpiece, and tail, each with specific functions.

Physiology of Semen after Ejaculation

• Semen undergoes liquefaction after ejaculation.
• Sperm undergoes capacitation.
• Sperm undergoes the acrosome reaction.
• Sperm undergoes the cortical reaction.

Relative Prevalence of Infertility Etiologies

• Data (percentages) showing frequency distribution of different infertility causes:
  • Male factor: 20-30%
  • Both male & female: 10-40%
  • Female factor: 40-55%
  • Unexplained infertility: 10-20%

Semen Analysis Parameters

• Normal semen volume range: 1.5-5.0 mL

• Normal semen pH range: >7.2

• Normal viscosity range: <3

• Normal sperm concentration range: >20 million/mL

• Other crucial parameters include sperm motility, morphology, WBC count, and appropriate antibody testing.

• Refer to specific values/guidelines provided from 1992 and 2010.

History of Infertility

• Duration of infertility.
• Sexual dysfunction.
• History of infertility treatment.
• Childhood illnesses.
• Previous surgeries and medical conditions.
• Exposure to STDs, toxins, and occupational hazards.
• Current medications, allergies.
• Alcohol, drug use.

Physical Examination

• Penis examination.
• Testicular palpation and sizing.
• Vasa and epididymis assessment.
• Varicocele identification.
• Secondary sexual characteristics.
• Digital rectal examination.

Other Investigations

• Absence of fructose in semen.
• Semen culture/microscopy (if applicable).
• Urologic evaluation.
• Endocrine evaluation (FSH, LH, testosterone levels).
• Ultrasound (transrectal/transcrotal/renal).
• Testis biopsy.
• Vasography.

Indications for Specific Tests

• Abnormal semen analysis.
• Low FSH, LH, testosterone.
• Abnormal spermatogenesis.
• Testicular failure (elevated FSH and LH, low/normal testosterone).

Genetic Evaluation

• Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations.
• Chromosomal abnormalities, like Klinefelter syndrome.
• Y chromosome deletions.

Surgical Management

• Cryptorchidism (orchidopexy).
• Varicocele repair (high ligation).
• Gonadal failure (surgical retrieval, ICSI).

Drugs that Impair Male Fertility

• List of drugs impairing spermatogenesis, pituitary suppression, anti-androgenic effects, ejaculation failure, erectile dysfunction.

Types of Infertility Treatment

• Hypogonadotropic hypogonadism treatment
• Hypergonadotropic hypogonadism treatment
• Pretesticular treatment
• Post-testicular treatment

Surgical Treatment for Male Infertility

• Vasovasostomy
• Vasoepididymostomy
• Transurethral resection of ejaculatory ducts
• Varicocele repair
• Orchiopexy
• Vibrating and electric ejaculation techniques

Surgical Management of Infertility

• Cryptorchidism management (orchidopexy)
• Varicocele management (high ligation)
• Gonadal failure management (surgical retrieval, ICSI)

Explore the complex topic of male infertility, including definitions, causes, and management strategies. This quiz covers key aspects such as spermatogenesis, evaluation methods, and recent advancements in understanding male fertility issues.