Male infertility Flashcards
Reasons for male infertility
Problems with male reproductive system (30%) Varicoceles Infection Obstruction Endocrine problems
Testicular varicocele
Abnormally dilated pampiniform plexus
Which is the venous network that drains blood from the testicles
Varicocele responsible for what percentage of infertility?
40%
How are varicoceles diagnosed?
Dubin system
Intraobserver variation in diagnosis of grade
Cause of varicocele
Multi-factorial mechanisms by which dilated scrotal veins impair spermatogenesis
Anatomical differences in venous drainage between the left and right internal spermatic vein
Account for predominance of left sided varicocele
Progressive toxic effects of varicoceles
Elevated temperature and oxidative stress
Increase temperature in the testicles
Decreases sperm count and sperm quality
Mechanism of damage in varicocele
Unknown, presumed to be due to damage to DNA and proteins in the nucleus of spermatic tubule cells and Leydig cells
Radiation causing infertility by Radiofrequency electromagnetic fields (RF-EMF)
Have negative effects on semen parameters
RF-EMF affects..
Kinase role in cellular metabolism and produces genotoxicity, genomic instability and oxidative stress
RF-EMF is omitted from..
Mobile phones, laptops and microwave ovens
Specific absorption rate (SAR) absorbed by human tissue depends on..
Frequency, intensity, polarisation, duration of exposure and position of the device
Radiation responsible for causing infertility due to..
Over production of ROS in exposed cells
Desai et al., 2009
Concluded that RF-EMF exposure might induce DNA damage due to increase oxidative stess
Desai et al., 2009
DNA damaged due to increase oxidative stress
May accelerate spermatoxoal cell death and promote testicular carcinogenesis
Pandey et al 2017
Reported sig increase in abnormal cells- spermatogonia and decrease spermatids
Sig increase in DNA damage at 4hrs and 8 hrs exposure in male Swiss albino mice
Post-testicular obstructive azoospermia
Sperm is produced normally inside the testicle but there is a blockage or obstruction in the reproductive tubing that is preventing sperm from flowing out
Example of post-testicular obstructive azoospermia
Retrograde ejaculation
Retrograde ejaculation
Is the abnormal backward flow of semen into the bladder with ejaculation
What percentage of infertility is caused by RE?
0.3-2%
Jefferys et al 2012
RE is associated with
Dysfunction of the internal urethral sphincter mechanism
RE dysfunction caused by
Autonomic neuropathy or iatrogenic damage to sympathetic nerves or the bladder neck
RE diagnosis
Examine post-orgasm or post-coital urine samples
RE urine analysis
Sperm in urine
Vroege et al found fructose may also be found in urine analysis
Treatment of varicocele
Varicocelectomy
Can restore normal scrotal temperature
Limitation of varicoceletomy studies
Do not address factors that can affect scrotal temperature other than varicoceles e.g. external exposure to heat and daily postural changes
Abdel-Meguid et al 2011 showed..
Using 145 participants that inguinal varicocele repair sig improved semen parameters
Spontaneous pregnancy achieved by inguinal varicocele repair
Abdel-Meguid et al 2011
9%
Varicocele repair is preferred method of treatment before..
TESE/ICSI in all azoospermic men who have clinically palpable varicoceles
Treatment of radiation
Meena et al 2014
Proposed melatonin treatment to reverse effects of RF-EMF for sperm count, testosterone levels and DNA fragmentation
Roychonduhury et al 2017 suggested for RF-EMF damage
Consume green tea
Decreases oxidative stress
Treatment of RE
Sperm retrieved from epididymis or testis by TESE or PESA
Followed by IVF or intracytoplasmic sperm injection (ICIS)
Abrahams 1975 suggested what treatment for RE
Bladder neck reconstruction
2 patients went on to father children
