Male infertility

Lecture name:-Male infertility.
Time :- 2 hours.
Aims of the lecture:-
At the end of the lecture, the students are able to:-
1-Identify the main causes of male infertility.
2-Diagnose and investigate cases of male infertility.
3-Treat cases of male infertility.
Male infertility:-
Infertility: - It is the inability of the couples to conceive after 1 year of unprotected
intercourse.
Causes:-
1-Male causes:- 30%.
2-Female causes:- 50%.
3-Mixed causes:- 20%.
Evaluation of male infertility:-
1) History:-
Thorough medical, surgical and sexual history is needed.
2) Physical examination:-
Precise physical examination is needed concentrating on:
1. General examination.
2. Examination of the external genitalia and breasts.
3. Neurological examination.
3) Lab. Investigation:-
1. Seminal fluid analysis (S.F.A):
Each infertile male should have at least 2 or 3 S.F.A over a period of several
weeks.
The specimens should be examined within 1-2 hr. of collection.
Normal values of S.F.A according to W.H.O. are:
.Ejaculate volume: 1.5 – 5 ml.
.Sperm count: > 20 million /ml.(?sperm count called Oligospermia while
absent of sperm called Azospermia)
.Motility : > 50% forward movement grade (a+b).( ? motility of sperm called
Asthenospermia).
.Morphology: >30% normal.
.Semen PH: alkaline (7.2 or more).
2. Hormonal evaluation:
.Indicated in sever oligospermia (<10 million sperm/ml) and those with
impaired sexual function (impotence, low libido).
.F.S.H.,L.H and testosterone should be measured first in infertile male
patients with suspected hormonal abnormalities.
3. Additional tests:
According to individual case and include one or more of the fallowing s:
.Antisperm antibodies. .Semen culture.
.Ultra structural evaluation. .Sperm penetration assay.
4) Radiological evaluation: may include:
1. Vasography:
Indicated in azospermic patient with active spermatogenesis on testicular
biopsy to determine the site of obstruction.
2. Trans rectal ultrasonography (TRUS):
To evaluate the prostate, seminal vesicles and ejaculatory ducts.
3. Scrotal ultrasonography:
The main application is for dx. Of varicocele.