Male infertility
Infertility:
Is the inability of the couple to conceive after one year of
unprotected intercourse.
Causes:
1. Male causes 30%.
2. Female causes 50%.
3. Both 20%.
1. In case of male infertility proper history, sexual, medical and
surgical.
2. Proper physical examination includes:
.General examination
Examination of external genitalia regarding the shape if any
congenital malformation and secondary sexual character as
breast, hair distribution.
Neurological examination (to exclude neurological impotence).
3. Lab. Investigation:
A. seminal fluid examination conceder as a corner stone for
evaluation should do it at least 2-3 SFA over a period of several
weeks at same lab. Should be done at lab. And examine within
1-2 hours.
(WHO parameter for SFA:
Volume 1.5-5 ml, sperm count more than 15 million /ml,
motility more than 50% active sperm /ml, morphology more
than 30%, PH alkaline.).
B. hormonal assay:
FSH, LH, S.TESTOSTERON, PROLACTIN, AND THYROID
HORMONS) indicated in sever oligospermia (less than 10
million /ml. and those with sexual function impairment.
C. other test as: antisperm anti body, sperm penetration
assay, ultrastructural evaluation, semen culture.
D. imaging:
Scrotal U/S, rectal U/S, vasography.
Classification:
1. Pretesticular
:
A
. hypothalamic: as
*hypogonadotropic hypogonadism could be congenital or
acquired.
Treatment: androgen replacement therapy with testosterone
preparation for verilization, then gonadotropin treatment for
initiation of spermatogenesis with HCG, then addition FSH to
complete it.
*.isolated LH deficiency that treated by HCG.
*.isolated FSH deficiency: rare.
B
. pitutary disease:
As tumor, infection, surgery, radiation and others. This lead to
infertility and erectile dysfunction, head ach and visual
disturbance. Treated medically as bromocriptine, cabergoline
.and surgery.
D
. adrenal gland disease (androgen excess)
Due to exogenous or endogenous because cause negative
feedback.
Treated by glucocorticoids that decrease ACTH and decrease
adrenal androgen.
2. Testicular causes (disorder of spermatogenesis)
:
A. chromosomal disorder as
1. Klinefelter syndrome (xxy):
Small testis, gynecomastia and increase gonadotropin level
Treated by androgen for verilization. Usually infertile may
azoospermia now can use sperm extraction for ART (assisted
reproductive technique.
2. Noonan’s syndrome.
3. Y- chromosome microdeletion
B.
bilateral anorchia.
Absent testis congenitally.
Usually infertile and androgen treatment for verilization.
C.
cryptorchidism :( undescended testis);
Oligosprrmia in 50% of bilateral, an in25% of unilateral
Treated surgically.
D. varicocele:
Dilated pampiniform plexus. Surgical excision improvement
in70%.
E.
sertoli cell only syndrome:
Small tests, azoospermia, no treatment.
F. other as infection, drug, smoking.
G. idiopathic: about 25% no apparent cause.
Empirical treatment at least 3-6 months as anti-estrogen
Clomiphene, androgen, anti-oxidant) and ART.
3. Post testicular disorder of sperm transport):
A. duct obstruction: may congenital or acquired due to
infection.
May need surgery or ART.
B. ejaculatory problems:
Suspected in low valium ejaculate, may due to previous surgery
as TURP. Or due to neurological cause
Can treated by drugs as imipramine, ephedrine.
4. Sperm function disorder;
A: immunological: due to previous infection, surgery or
trauma, due to formation of antibody, can treat by
corticosteroids, or by ART.
B. structural abnormality of the sperm: can treat by ART.
By Assist. Professor
Dr. Muhammad R.Judi