Male Infertility

1
Male Infertility

• What is it?
• Why Evaluate
• 20 sole male factor
• 30 a shared factor
• 50 with a male factor

2
Male Infertility

• Why evaluate?
• Improve chances naturally
• Improve chances with IUI or IVF
• Improve chances of future pregnancy
• Improve overall health

3
Male Infertility

• -Why Evaluate?
• 2-5 have significant pathology

4
Male Infertility

• -Why evaluate?
• Assess risk to offspring

5
Male Infertility

• -Why evaluate?
• 28 of men with zero or low counts had genetic
  abnormalities
• Y chromosome deletions always transmitted

6
Male Infertility

• -Why evaluate?
• It may be treatable- 70 of cases are!

7
Male Infertility

• -Why evaluate?
• There may be a cost saving
• Marginal cost
• Vasovasotomy 20,921
• TESA/ICSI 73,146
• Varicocelectomy 26,268
• IVF/ICSI (47) 62,260

8
Male Infertility

• When?
• Timing
• -After six months of timed intercourse
• -At time of presentation

9
Male Infertility

• How?
• What should be done?
• History- reproductive, sexual, medical, surgical,
  family, infectious, toxic, pharmacologic,
  childhood, traumatic
• Exam- weight, height, body hair, thyroid,
  cardiac, lungs, abdomen, genitalia, testes,
  prostate, neurologic
• Testing- Two semen analysis, gonadotropins, ASA,
  WBCs, SPA, SCSA, ultrasound, genetics

10
Male Infertility

• Evaluation
• Semen analysis

11
Male Infertility

• How?
• Make a diagnosis
• Choose a treatment plan

12
Male Infertility

• Common Diagnoses
• Varicocele

13
Male Infertility

• Common Diagnoses
• Obstruction

14
Male Infertility

• Common Diagnoses
• Genetic
• Y Deletions
• Klinefelters
• Translocations
• Cystic Fibrosis

15
Male Infertility

• Common Diagnoses
• Hormonal
• Toxins
• Obesity
• Neurologic
• Idiopathic

16
Male Infertility

• Treat
• Non surgical
• Surgical

17
Male Infertility

• Treatment Surgical
• Vasal reconstruction

18
Male Infertility

• Treatment Surgical
• Sperm retrieval

19
Male Infertility

• Treatment Surgical
• Ejaculatory duct resection

20
Male Infertility

• Treatment Surgical
• Electroejaculation

21
Male Infertility

• Treatment Surgical
• Varicocele Ligation

22
Male Infertility

• Treatment Non surgical
• Hypogonadotropic hypogonadism

23
Male Infertility

• Treatment Non surgical
• Hyperprolactinemia

24
Male Infertility

• Treatment Non surgical
• Immunologic infertility

25
Male Infertility

• Treatment Non surgical
• Ejaculatory/Erectile disorders

26
Male Infertility

• Treatment Non surgical
• Non specific
• Gondadotropins
• Antiestrogens
• Aromatase inhibitors

27
Male Infertility

• Treatment Non surgical
• Miscellaneous
• L Carnitine
• Nutrition
• Vitamins

28
Male Infertility
Conclusion