A/22. Male sexual disorders of fertility Flashcards
Infertility definition
failure to conceive after 1 year of regular unprotected sexual intercourse
% of couple that suffer from infertility
and female VS male
Affects 15% of couples;
50% of cases are associated with female factors,
20% associated with male factors, and
30%associated with both female and male factors.
Primary infertility
unable to conceive a first child (1 in 8 couples)
Secondary infertility
unable to conceive a subsequent child (1 in 6 couples)
Etiology of male sexual disorder of fertility
- Endocrine disorders:
*Pituitary disease
*Hypogonadotropic hypogonadism
*exogenic androgens - Disorders of spermatogenesis:
*chromosomal
*cryptorchidism
*testicular torsion
*infections - Sperm delivery disorders:
*Absence of vas deferens
*ductal obstruction
*erectile dysfunction
*ejaculatory dysfunction
*penile anatomical disorder, *retrograde ejaculation - Sperm function disorder
- Endocrine disorders causing infertility
- Pituitary disease
- Hypogonadotropic hypogonadism
- exogenic androgens
- Disorders of spermatogenesis that cause infertility
- chromosomal
- cryptorchidism
- testicular torsion
- infections
- Sperm delivery disorders that cause infertility
- Absence of vas deferens
- ductal obstruction
- erectile dysfunction
- ejaculatory dysfunction
- penile anatomical disorder,
- retrograde ejaculation
Evaluation and work-up of Male sexual disorders of fertility
1) History (including female partner)
2) Physical examination
3) Semen analysis
4) Hormonal levels (FSH, inhibin-B, prolactin, testosterone)
5) Immunological assays (MAR test, ASA test)
6) Genetic testing (karyotype, molecular methods, CFTR gene, FISH)
Further tests
* Markers of infection (WBC, biochemical assays)
* Markers of oxidative stress
* Sperm DNA fragmentation and chromatin condensation
* Hyaluronan binding assay (HBA)- evaluates sperm maturity
* Acrosome reaction assay
* Evaluation of prostatic and seminal secretions
Infertility History taking
History (including female partner)
- Sexual history provides details of erectile or ejaculatory dysfunction and abstinence
- Past medical and surgical history should elucidate
*previous GU infections,
*trauma,
*cryptorchidism or torsion;
the use of drugs should also be evaluated
Physical examination in infertility
- General physical examination (check for signs of chromosomal abnormalities)
- careful examination of the genitals; consider neurological evaluation
- Genital examination should include scrotal US to evaluate testicular size and abnormalities
to evaluate testicular size and abnormalities what to do?
scrotal US
Semen for analysis - how is the procedure?
Semen should be produced by
* masturbation after 3 days of abstinence
* and must be examined within 2 hrs of collection; two separate samples are usually analyzed
what is analysed in semen analysis
- Sperm count:
*oligospermia when < 15 million cells/mL) - Sperm motility:
*asthenozoospermia when < 32% motile spermatozoa - Sperm morphology: *teratozoospermia when < 4% morphologically normal cells
oligospermia
when < 15 million cells/mL)
