Male Infertility

Infertile Male

Males with sperm parameters below theWHO standards

Male factor 40%Female factor 40%Both 20%

16-18 million new couples / yearSperm count on the decline A decade ago 60 million Now 20 million

EnvironmentalLifestyleDietaryCongenitalInfectionOccupation

Causes

Pesticides, Chemicals, heavy metalsAir and water pollutionRadiation ‘Cell phone’

Environmental

SmokingAlcoholPreservatives ‘fast food’Genetically Modified foodHormonesTestosterone and EstrogensTight Dress

Life style

Food additivesProtein SupplementsHormones and Steroids Varicocele

Body Building

Hypogonodotropic HypogonadismCryptorchidismKline feltersMaturation arrestSartoli only cell syndromeAbsence of Vas and Seminal vesicles

Congential

Epididymo OrchitisMumpsSeminal VasiculitisGu Koch's

Police,Guards, Post men, Sales menHMT, Athletes and Body BuildersCooks, Bakery, Foundry, SmithyFarmersDrivers-‘Bangalore Bike Riders’

Occupation

Infection

Defective sperms is the most commoncauseSperm is highly sensitive tooxygen radicals

Infection Aging Environmental

Oxidative stress

Poor Semen is significantlydue to three factors

Oligospermia

Low sperm count < 15 mlAsthinospermiaPoor motility < 32 %Teratospermia

Poor morphology <4%

Semen AnalysisDoppler scrotumTRUSVasography

Diagnosis

Varicocele

Dilated Pimpiniform plexus

Increases Testes TemperaturePoor testes function 1O C increase- 14% reduction

Commonest cause of male infertility

15% General population35% Primary infertile Men75% Secondary infertile Men

Common among...

People who work standing(PostMan, salesman, guards, police)People work hard HMT, Bodybuilders, Jym goers, sportsmanPeople work in hot areas (Smithy, Foundry, cooks, drivers)

DiagnosisClinical

Grade 1: Felt on ValsalvaGrade 2: Felt on restGrade 3: easily visible

Scrotal Doppler

Improves testicular function 80% Repair will halt any further damage

Why Surgery

VaricocelectomySurgery Varicocele ligation

Scrotal approach: damage to artery PALAMO’S:

High Recurrence

Microsurgical:  Gold standared Best results, least

recurrence,  hydrocele

 Embolisation and Scelrotherapy: High

complications

 Laparoscopic Varicocele ligation

Early surgery Better resultsGrade 2­3 better recoveryMicrosurgical best resultsLeast complications

Obstructive AzospermiaVasectomyHernia and Hydrocele SurgeryChronic EpidimytisScrotal injuryEjaculatory duct obstructionGenital Koch’s

VasographyRadiological  study: Obstructive AzospermiaDone at time of corrective surgery.Complication: Stricture at the puncture site.Commonest: Ejaculatory duct obstruction

TURED: Ejaculatory duct obstructionVaso­vasostomy: Vas obstructionVaso­Epididymostomy: Epididymal obstruction

Sperm Retrieval

Sperms retrieved Surgically from    Vas or testesObstructive AzospermiaPoor semen quality

 

    Cryptorchidism

    Klinefelters

    Maturation arrest

PESA Epididymal Open Microsurgical Better results Percutaneous: Less reliableEpididymal ducts opened microscopy Sperms aspirated with pipette

Testes TESA Failure of PESA Non Obstructive Azospermia Testes opened Microscopy Sperms aspirated from testes tubules

Male Infertility is on riseQuality of Sperm is down

Environment and Life styleVaricocele commonest cause

Surgery for Obstructive Azo on declineSuccess of sperm retrieval improvingRole of Antoxidents Micro nutrients ispromisingAssisted Reproduction success is onthe raise.