male infertility dr. qiu yiqing the second affiliated hospital of zhejiang university
TRANSCRIPT
![Page 1: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/1.jpg)
Male InfertilityMale Infertility
Dr. Qiu YiqingDr. Qiu Yiqing
The second affiliated hospital of ZhejianThe second affiliated hospital of Zhejiang Universityg University
![Page 2: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/2.jpg)
DefinitionDefinition• inability to conceive after 1 year of
unprotected sexual intercourse.
• 15% of couples. 40%: male; 40%: female; 20%: both
![Page 3: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/3.jpg)
Hypothalamic- Pituitary- Gonadal AxisHypothalamic- Pituitary- Gonadal Axis
![Page 4: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/4.jpg)
Testis functionTestis function• Endocrine: testosterone, 2% free, 98% bound to
sex hormone binding globulin (SHBG).
• Estrogen, thyroid hormone: decrease SHBG, increase free T;
• Androgen, growth hormone, obesity: on the contrary
• Exocrine: sperm
![Page 5: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/5.jpg)
SpermatogenesisSpermatogenesis• Sertoli cell: tight junction. The strongest intercellular
barriers in the body: blood-testis barrier; nurse cells
• Germ cells: spermatogonia; primary spermatocytes; secondary spermatocytes, spermatid. Mitosis and meiosis
![Page 6: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/6.jpg)
![Page 7: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/7.jpg)
![Page 8: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/8.jpg)
![Page 9: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/9.jpg)
cyclescycles• within the human testis, 60 days;
sperm maturation: 10-15 days
![Page 10: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/10.jpg)
FertilizationFertilization• Middle of the female menstrual cycle, th
e cervical mucus changes
• Acrosome reaction, zona reaction
![Page 11: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/11.jpg)
![Page 12: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/12.jpg)
![Page 13: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/13.jpg)
Diagnosis of male infertilityDiagnosis of male infertilityHistory• Duration of infertility; earlier pregnancies• Sexual history, timing and frequency, lubricants• Medical and surgical history• fever, acute infection, surgical procedure of bladder, retroperito
neum, pelvis, hernia• Childhood diseases: mumps, cryptorchidism• Medication, pesticides, radiation, tobacco, cocaine, m
arijuana, androgenic steroids, hot tubs or saunas• Family history
![Page 14: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/14.jpg)
Physical examinationPhysical examination• Virilize: body hair, gynecomastia• Scrotal contents• Testis: size and consistency• Epididymis; vas deferens; varicocele• Other abnormalities
![Page 15: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/15.jpg)
Laboratory testsLaboratory tests• Urinalysis• Semen analysis• Semen collection: 48-72 hours of sexual abstin
ence.• Seminal fructose and postejaculate urinalysis• Fructose: derived from the seminal vesicle• Hormone assessment• FSH and testosterone
![Page 16: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/16.jpg)
![Page 17: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/17.jpg)
![Page 18: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/18.jpg)
Adjunctive testsAdjunctive tests• semen leukocyte analysis; • antisperm antibody test; • hypoosmotic swelling test;• sperm penetration assay; • sperm chromatin structure; • chromosomal studies; • genetic analysis
![Page 19: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/19.jpg)
• Radiologic testing• scrotal ultrasound, transrectal ultrasound• CT scan or MRI of the pelvis
• Testis biopsy & vasography• Fine-needle aspiration ‘mapping’ of the tes
tes• Semen culture
![Page 20: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/20.jpg)
Mapping of testesMapping of testes
![Page 21: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/21.jpg)
![Page 22: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/22.jpg)
Causes of male infertilityCauses of male infertility
• Pretesticular• Testicular• posttesticular
![Page 23: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/23.jpg)
Pretesticular causes of infertilityPretesticular causes of infertility
![Page 24: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/24.jpg)
Testicular causes of infertilityTesticular causes of infertility
![Page 25: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/25.jpg)
Medications associated with infertilityMedications associated with infertility
• Ketoconazole, spironolactone, alcohol inhibit T synthesis
• Cimetidine: androgen antagonist• Marijuana, heroin, methadone: lower T levels• Pesticides, estrogen like activity• Chemotherapy• Calcium channel blockers; sulfasalazine; colchicine; al
lopurinol; alpha-blockers; nitrofurantoin; antipsychotics; antidepressants
![Page 26: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/26.jpg)
varicocelevaricoceleNormal: 15%; infertility: 40%
![Page 27: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/27.jpg)
Posttesticular causes of infertilityPosttesticular causes of infertility
![Page 28: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/28.jpg)
![Page 29: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/29.jpg)
![Page 30: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/30.jpg)
Posttesticular causes of infertilityPosttesticular causes of infertility
![Page 31: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/31.jpg)
Treatment of male infertility (Surgical Treatment of male infertility (Surgical treatments)treatments)
• Varicocele: • Vasovasostomy or epididymovasostomy• Ejaculatory duct obstruction: TURED• Electroejaculation spinal cord injury; pelvic or retroperitoneal su
rgery injured the pelvic sympathetic nerves. • Sperm aspiration: vas deferens, epididymis, or testicle.• Orchidopexy: within two years of age• Testicular torsion; the unaffected, contralateral testis can becom
e infertile after torsion of its mate. Sympathetic orchidopathia, immunologic in nature.
• Pituitary ablation• Elevated serum prolactin levels stemming from a pituitary adeno
ma can be treated medically and surgically.
![Page 32: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/32.jpg)
Surgical management of male Surgical management of male infertilityinfertility
• Testis biopsy
![Page 33: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/33.jpg)
Surgical management of male infertilitySurgical management of male infertility• Vasography:
![Page 34: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/34.jpg)
• Vasography
Surgical management of male infertilitySurgical management of male infertility
![Page 35: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/35.jpg)
Surgical management of male infertilitySurgical management of male infertility• Vasovasostomy
![Page 36: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/36.jpg)
Surgical management of male infertilitySurgical management of male infertility• Vasovasostomy
![Page 37: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/37.jpg)
Surgical management of male infertilitySurgical management of male infertility• Vasoepididymostomy
![Page 38: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/38.jpg)
Surgical management of male infertilitySurgical management of male infertility• Transurethral resection of the ejaculatory ducts
![Page 39: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/39.jpg)
Treatment of male infertility (Nonsurgical Treatment of male infertility (Nonsurgical treatments)treatments)
• Pyospermia: evaluate the patient for sexually transmitted diseases, penile discharge, prostatitis, or epididymitis
• Coital therapy• Immunologic infertility• Corticosteroid suppression, sperm washing, IUI, IVF, a
nd ICSI.
![Page 40: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/40.jpg)
Medical therapyMedical therapy
• Hyperprolactinemia; hypothyroidism; congenital adrenal hyperplasia; testosterone excess/ deficiency: Kallmann syndrome, HCG, FSH
• Empiric medical therapy• clomiphene citrate: antiestrogen, increase secretio
n of GNRH, FSH, and LH. Low sperm count• antioxidant therapy: vit E• growth hormone
![Page 41: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/41.jpg)
Assisted reproductive technologiesAssisted reproductive technologies• Intrauterine insemination (IUI): Cervical factors; low sperm qualit
y, immunologic infertility, poor sperm delivery. At least 5-40 million motile sperm in the ejaculate
• In Vitro Fertilization and Intracytoplasmic sperm injection• IVF: controlled ovarian stimulation and ultrasound-guided transv
aginal egg retrieval from the ovaries before normal ovulation. 500,000 to 5 million sperms are required
• ICSI: one viable sperm
• Eliminate many natural selection barriers that exist during natural fertilization, genetic defects that caused the infertility are expected to be passed on to offspring unabated.
• Preimplantation genetic diagnosis
![Page 42: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/42.jpg)
ICSI IUIIVF
![Page 43: Male Infertility Dr. Qiu Yiqing The second affiliated hospital of Zhejiang University](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d975503460f94a814c8/html5/thumbnails/43.jpg)