MALE INFERTILITY

Male infertilityBasuki B. PurnomoDepartment of UrologyMedical School of Brawijaya UniversitySaiful Anwar General Hospital Malang1eve^^InfertilityIs defined as the inability to conceive a child after 1 year of unprotected sexual intecourse.Incidence: 15% of coupleContribution to subfertility Female factors 50% Male factors 20% Both male and female factors30% 2eve^^Anatomy of male reproductive organs

3eve^^Physiology of ejaculationErectionEmisionEjaculation

4eve^^Physiology of ejaculation

5eve^^

6eve^^Etiology : pre testicularHypothalamic diseaseGonadotropic deficiencyFertile eunuch syndrome Pituitary diseaseHyperprolactinemiaPituitary insufficiencyExogenous or endogenous hormone deficiencyEstrogensAndrogensGrowth hormone deficiencyHypo-hyper thyroidism7eve^^Etiology : testicularChromosomal causesKlinefelter syndromeXX male syndromeXYY syndrome

GonadotoxinsRadiationDrugRenal failureLiver failureTestis injuryTraumaTorsion CryptorchidismVaricocele

8eve^^Etiology : post testicularObstruction:Congenital blockageAcquired blockageVasectomyHernia surgeryInfectionFunctional blockageRetrograde ejaculationDisorders of sperm function or motilityDisorders of coitusErectile dysfunctionsHypospadiasTime of frequency9eve^^Vasectomy

10eve^^Evaluation Medical historyPhysical examinationLaboratoriesSemen analysisHormonal assaysTesticular biopsyImagingHead CT ScanSeminal vesiculography11eve^^Semen analysis

morphologymotilityConcentration12eve^^Semen analysisVolume semenTotal sperma (sperm concentration)

Motility Morfologi: bentuk normalAglutinasi spermaPiospermi::

::::1,5-5 mL> 50 juta> 20 juta/mL> 50%> 60%--13eve^^Treatment Pre testicular?Testicular?Post testicular?MedicalSurgicalAssisted reproductive techniqueDepend on Etiology :Treatment options14eve^^Surgical Varicocele: vasoligationObstruction of the vas: vaso-vasostomy, vaso-epididimostomySperm alloplasticVerumontanum resection15eve^^Vasectomy reversal (vaso-vasostomy)

16eve^^