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Male subfertility

Male subfertility. Defined as the inability to conceive after 1 year of regular unprotected sexual intercourse. It affects approximately 15% of couples. Roughly : 40% male factor 40% femal factor 20% both. Male reproductive physiology The HPG axis. Hypothalamic–pituitary–testicular axis

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Male subfertility

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  1. Male subfertility

  2. Defined as the inability to conceive after 1 year of regular unprotected sexual intercourse. • It affects approximately 15% of couples. • Roughly : 40% male factor 40% femal factor 20% both

  3. Male reproductive physiology • The HPG axis. • Hypothalamic–pituitary–testicular axis • The hypothalamus secretes gonadotrophin-releasing hormone (GnRH). This causes pulsatile release of anterior pituitary gonadotrophins, called follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which act on the testis. • FSH stimulates the seminiferous tubules to produce • sperm • LH acts on Leydig cells to produce testosterone

  4. The Testis • Endocrine : leydic cell produce testesteron • Testestron coverated to dihydrotesterone • By action of 5alpha-raductase • Exocrine : The seminiferous tubules---- Spermatogenes is produce sperm

  5. Spermatogenesis • Is a complex process by which primitive, totipotent stem cells divide to either renew themselves or produce daughter cell that become spermatozoa. • The duration of entire spermatogenesis is 74 days. • Germ cells are replicate by meioses

  6. Management • History • Duration of sub fertility • Earliar prgnencies with same or ather partner • Sexual histry • General medical and surgical history • Childhood disease like mumps • Cryptorchidism • Exposure to medications and chimical • Family history

  7. Physical examination • Degree of virilization • Gynecomastia • Testicular size and consistancy • Status of epididymis • Varicocele • Penis and prostate

  8. Laboratory • GUE : infection, glucosuria, hematuria. • Semen analysis • is the primary source of information on sperm production & reproductive tract patency. sample collection, sexual abstinence duration 2-7 day. • WHO considered the minimum criteria for normal semen quality. • volume : 1.5-5ml • concen,: 20 million/ml and more • motility: >50% progression score : 2 (scale 1-4) • morphology : >30% • Other semen parameters • Fructose absent in semen-- Seminal vesicle agenesis • Retrograde ejaculation

  9. Hormone assessment • Evaluation the HPG axis • LH,FSH,testesteron and prolactine • Estradiol • FSH and testesteron may be sufficient • Indication • low sperm less than 10 million • Impairment of sexual function • Other endocrinopathy (thyroid dis.)

  10. Adjunctive tests Semen leukocyte analysis. pyospermia >1 million leukocyte/ml. Antisperm antibody (ASA) test. Mainly used in unexplained sub fertility

  11. Hypoosmotic swelling (HOST) test • differentiate immotile from dead sperm • (necrospermia). • Sperm –cervical mucus interaction • Chromosomal studies like • Cystic fibrosis mutation testing • Radiologic testing • scrotal ultrasound • Venograghy • TRUS • Testicular biopsy and vasography • Now use for sperm retrieval for ICSI in azoospermia

  12. Causes of male infertility Pretesticular causes hypothalamic disease Like gonadotropin deficiency pituitary disease pituitary insufficiency Hyperprolactinemia exogenous hormones

  13. Testicular causes • chromosomal like klinefelter syndrome • gonad toxins like radiation • systemic disease • testis injury • cryptorchidism • varicocele • idiopathic

  14. Posttesticular causes • Reproductive tract obstruction • Congenital blockage like • idiopathic epididymal obstruction • Acquired blockage • Vasectomydisorder of sperm function or motility • immotile cilia syndrome • disorder of coitus • impotence

  15. Treatment • Surgical treatment • Varicocelectomy • vaso-vasostomy • ejaculatory duct obstruction (TURED). • electroejaculation (spinal cord injuries).

  16. Nonsurgical treatment • Pyospermia treated by Doxycycline & trimethoprim-sulfa + antioxidant like vit. A, E,& C • Coital therapy : coitus every other day around time of ovulation • Immunologic infertility treated like steroids • Medical therapy :to treat specific hormonal abnonmality • Hyperprolactinemia • Hypo-hyperthyrodism • Hormonal deficiency

  17. Empiric Medical Therapy • Antiestrogen : like Clomiphene citrate • Antioxidant therapy • Antioxidant therapy • Growth hormone • ASSISTED REPRODUCTIVE TECHNOLOGIES • Intrauterine Insemination • In Vitro Fertilization • Interacytoplasmic sperm injection ICSI

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