Presentation on theme: "Male infertility Work up and Management overview"— Presentation transcript:
1 Male infertility Work up and Management overview Dr. Anmar Nassir, FRCS(C)Canadian board in General UrologyFellowship in Andrology (U of Ottawa)Fellowship in EndoUrology and Laparoscopy (McMaster Univ)Assisstent Prof Umm Al-QuraConsultant Urology KFSH & RC
4 LH & FSH LH Activate testicular T production from Leydig cells Feed back inhibition by testosteroneFSHStimulate Sertoli cells & spermatogonial membranesThe major stimulator of seminiferous tubule growth during developmentFeed back inhibition by inhibin from Sertoli cells
5 Testosterone will initiate and maintain spermatogenesis Sperm fertility maturation, achieved at the level of the distal corpus or proximal cauda epididymis.
6 Physiology Epididymis: Vas: Seminal vesicles Prostate: MaturationTransportStorageVas:Transfer of spermSeminal vesicles(The main bulk of the ejaculate):Secretory products: e.g.fructose, prostaglandin, clotting factorsEjaculationCoagulation of semenProstate:LiquifactionZn: antibacterial & sperm stabilization
7 The scrotal temperature is is 2°C to 4°C below rectal temperature due to counter-current mechanism
8 Anatomical Physiology Epididymis:MaturationTransportStorageVas:Transfer of spermSeminal vesicles(The main bulk of the ejaculate):Secretory products: e.g.fructose,prostaglandin,clotting factorsEjaculationCoagulation of semenProstate:LiquifactionZn: antibacterial & sperm stabilizationSeminal vesicles 1.5 to 2.0 mL.Prostate 0.5 mL,Cowper's glands 0.1 to 0.2 mL,
11 Abnormalities in the woman are involved in approximately 75% of infertile couples. 30% Ovulatory disorders25% fallopian tube abnormalities4% endometriosis4% cervical mucus abnormalities4% hyperprolactinemiaConception rates drop more rapidly in the 35- to 39-year-old age group.
12 Many of the genes that affect male reproduction, including the androgen receptor gene, are located on the X chromosome.Therefore, family history should focus on the phenotype of the maternal uncles
16 Laboratory Assessment Semen analysis X2Quantitation of leukocytes in semenLab: Baseline, gluc. , U/AHormonal assay FSH, LH, Prol, TSH,Antisperm antibodies: semen or bloodAdvanced sperm fertility tests
17 Semen The WHO (1999) defines the following reference values: Volume: 2.0 ml or morepH:7.2 or moreSperm concentration:20 × 106 or more sperm/mlTotal sperm number:40 × 106 or more spermatozoa per ejaculateMotility:50% or more with grade A + B motilityor 25% or more with grade A motilityMorphology:30 %15 % or more by strict criteriaViability:75% or more of sperm viableWhite blood cells:Less than 1 million/ml
24 Varicocele 15% of the population 35% of male with 1ry infertility Semen 3cc, 10m/cc, 34% motile, 29% normal morphology and 0.9(10x6) WBC.On scrotal exam : bag of wormsVaricocele15% of the population35% of male with 1ry infertility75% of male with 2ry infertility40% bilateralVaricocele repair:75% improvement of semen35% initiate pregnancy
25 VaricoceleSemen samples from infertile men with varicoceles have demonstrated decreased motility in 90% of patients and sperm concentrations less than 20 million sperm/mL in 65% of patients.
26 Improvement in seminal parameters is demonstrated in approximately 70% of patients after surgical varicocele repair.Improvements in motility are most common, occurring in 70% of patients, with improved sperm densities in 51% and improved morphology in 44% of patients.Conception rates have averaged 33% to 50% compared with 16% in the control group