OBJECTIVE Understanding infertility in male. Differentiate infertility & impotency. To understand the causes of male infertility.
OUTLINE Anatomy of the Male Reproductive System Recap of Male Physiology Causes of Male Infertility A. Pre Testicular B. Testicular C. Post Testicular
Summary
INFERTILITY VS IMPOTENCY Infertility: Inability to achieve conception despite one year of frequent unprotected intercourse. Impotence: Inability to develop or maintain an erection of the penis during sexual activity in humans.
MALE HYPOGONADISM DEFINITION: condition when the testis does not produce enough male sex hormone( testosterone). Two types:
I. Primary: also known as primary testicular failure
problem originates from the testes.
II. Secondary : problem arising from the hypothalamuspituitary axis.
CATEGORIES OF MALE INFERTILITY
Pre Testicular Testicular Post Testicular
1.) Pre Testicular
1. Hypothalamus-pituitary axis disorders which causes infertility in men. 2. Three main disorders: Congenital Acquired Systemic
i.) Congenital Kallmanns Syndrome ( Hypogonadotropic Hypogonadism) - primary GnRH deficiency less production of LH and FSH no testosterone production. Associated with inability to smell( anosmia). Red-green color blindness.
2.) Testicular Can be in Genetic or Non- genetic in nature. I. Genetics: Klinefelter Syndrome, Cryptorchidism. II. Non Genetics: Drugs, Radiation, Trauma, Infections, Varicocele.
i.)
Klinefelter Syndrome
Sex chromosome aneuploidy: with an extra X ( XXY)
chromosome. These patients often have : 1.) Very small testes 2.) Azoospermia
ii) Cryptorchidism Most common genital problem encountered in paediatrics. Generally referred to Undescended testis. Some cases partially reversible through surgery( Orchiopexy) Individuals have low sperm count, poor sperm quality, lower fertility rates due to Impaired
iii) Varicocele Dilatation of the pampiniform venous plexus within the scrotum. Seen in 40% of male infertility interferes with thermoregulation. Left testicle > right testicle. Blocks the epididymis and vas deferens. Seen in 10-15% of normal men and even higher percentage in infertile man
iv) Drugs Many drugs are associated with impaired spermatogenesis or Leydig cell dysfunction. Most importantly Alkylating agents. Ex: Cyclophosphamide, Chlorambucil) Anti Androgens Ex: Flutamide, Spironolactone, Ketoconazole, Cimetidine. Leads to: Testicular dysfunction by inhibiting androgen production.
v) Infection Viral Orchitis, especially MUMPS well recognized cause of infertility. Causative agent: Echovirus & Arbovirus. Previous Sexually Transmitted Disease(STD): Chlamydia, Gonorrhoea Other infectious causes : Tuberculosis, Leprosy These infections germinal cell damage male infertility.
Other Causes Testicular Cancer.
Testicular Torsion twisting of the testis and
spermatic cord ischemia.
3.) Post Testicular
Factors that do not allow the normal transport of sperm through the ductal system. Examples of sperm transport disorders are 1. Epididymal dysfunction ( drugs, infection) 2. Abnormalities of the vas deferens ( congenital absence, Youngs syndrome, infection, vasectomy). 3. Seminal vesicle and prostate. 4. Ejaculatory duct disorders.
Sexual dysfunction : 1. Ejaculatory dysfunction, premature ejaculation, erectile
i) Abnormalities of vas deferens
Infection: Gonorrhoea, Chlamydia, Tuberculosis. These infections causes obstruction of the vas deferens Ligation of vas deferens Vasectomy 1-2% have Bilateral Congenital Absence of vas deferens I.
Due to mutations of CFTR gene
II. Mutations manifests other findings: Sinusitis, Bronchiectasis,
infertility (oligozoospermia).
Other Causes of Infertility
Smoking - Environmental Toxin: cadmium, mercury, lead Obesity Hyperthermia
