Male Infertility

Male Infertility

Infertility in men can be explained by deficiencies in sperm formation, concentration, or transportation.

Causes :

- Pituitary, Hypothalamus, Thyroid, adrenal - Hormonal Causes

- Genetic & Chromosomal Disorders

- Testicular - Trauma, Varicocele, Klinefelter, Atrophy, Torsion, Orchitis, Cancers, Chemotherapy, Radiation, Sickle Cell Anemia, etc.

- Post Testicular - Block in the vas deferens (tube transmitting the sperms), Cystic Fibrosis, Antisperm Antibodies, Ejaculatory Duct Obstruction

- Ejaculatory - Diabetic neuropathy, Bladder neck surgery, Retroperitoneal lymph node dissection, Transurethral prostatectomy, Colon or rectal surgery, Multiple sclerosis, Spinal cord injury.

The initial step in the evaluation of an infertile male is to obtain a thorough medical and urologic history. Important considerations include the duration of infertility, previous fertility in the patient and the partner, and prior evaluations.

Diagnosis

The semen analysis is the cornerstone of the male infertility workup and includes assessment of the following:

- Volume (normal, 1.5-5 mL)

- Quality

- Density (normal, >15 million sperm/mL)

- Motility (normal, >40% of sperm having normal movement)

- Morphology (sample lower limit for percentage of normal sperm is 4%)

- Signs of infection

- Levels of zinc, citric acid, acid phosphatase, or alpha-glucosidase

Other laboratory tests that may be helpful include the following:

- Antisperm antibody test

- Hormonal analysis (FSH, LH, TSH, testosterone, prolactin)

- Genetic testing (karyotype, CFTR, AZF deletions if severe oligospermia (<5 million sperm/mL)

Imaging studies employed in this setting may include the following:

- Transrectal ultrasonography

- Scrotal ultrasonography

- Vasography

If the test result is normal, consider sperm function tests, such as the following:

- Capacitation assay

- Acrosome reaction assay

- Sperm penetration assay

- Hypoosmotic swelling test

- Inhibin B level

- Vitality stains

Testicular biopsy is indicated in azoospermic men with a normal-sized testis and normal findings on hormonal studies to evaluate for ductal obstruction, to further evaluate idiopathic infertility, and to retrieve sperm.

The following causes of infertility, if identified, can often be treated by medical means:

- Endocrinopathies

- Antisperm antibodies

- Retrograde ejaculation

- Poor semen quality or number

- Lifestyle issues

- Infections

Surgical interventions to be considered include the following:

- Varicocelectomy

- Vasovasostomy or vasoepididymostomy

- Transurethral resection of the ejaculatory ducts

- Sperm retrieval techniques

- Electroejaculation

- Artificial insemination

- Assisted reproduction techniques

- In vitro fertilization

- Gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT)

- Intracytoplasmic sperm injection

Call Ray & Rio’s Speciality Clinic today to book and appointment with our Urology experts.

Urologist Appointment: + 91-9840762083.

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