MALE INFERTILITY

By:
Hj. Fatimah Usman, OBGYN (C)
Background
 Definition
 Infertility is the inability of a
sexually active, non-
contracepting couple to achieve
spontaneous pregnancy in one
year (WHO)

 Epidemiology
 In 30-40% of cases, no male-
infertility-associated factor is
found (idiopathic male infertility)
 no previous history of
diseases affecting fertility, normal
physical examination and
endocrine, genetic and
biochemical laboratory testing
Male Reproductive System

In adult men each testis is normally: 15 and 35mL in

volume
The testes have two related but separate roles:
• to make sperm
• to make testosterone
 Testosterone  important for male puberty  development of the penis and testes, facial
and body hair and a masculine physique
 Testosterone and FSH  pituitary gland  act together on the seminiferous tubules
(sperm producing tubes) in the testes  to make sperm
 The Leydig cells  make the male sex hormone testosterone
 Spermatogenesis (sperm production) is a continuous process with millions of sperm being
made each day after puberty. It takes about 70 days to complete the development of sperm
that are able to swim and fertilize an egg
 Semen is the mixture of fluids
from the testis and other glands
in the male reproductive tract
 Fertilisation of the egg happens
when moving sperm bind
(stick) to and then penetrate
(enter) the egg

 Th e process of making sperm

can be interrupted at various
stages for a number of reasons:
1. Absence of germ cells (called
Sertoli cell-only syndrome):
2. Maturation or germ cell
arrest
3. Hypospermatogenesis (lower
of number of sperm, smaller,
or sometimes no sperm
What Causes male infertility?
• Chromosomal / genetic • Infetion
• Undescended testes • Prostate-retaled problems
• Infection • Absence of vas deferens
• Torison • vasectomy
• Varicocele
Blockage of
• Medicine, chemicals, Sperm
radiation sperm
production
• unknown transport
problems
(obstruction)

Sexual
• Retrograde or
Problems Hormonal
premature ejaculation (erection & problems • Pituitary tumours
• Ejaculation failure ejaculatory) • Congenital
• Anabolic steroid abuse
• Erectile dysfunction
• Spinal cord injury
• Prostate surgery
• Some medecine
 Chromosomal or Genetic Infertility
Chromosomal
Genetic defect
abnormalities
 Sex chromosome  X-linked genetic disorder
abnormalities  Kallman syndrome
1. Klinefelter’s syndrome  Mild androgen insensitivity
2. Dijsksdooj syndrome
 Autosomal abnormalities  Other X-linked disorder
 Sperm chromosomal
abnormalities
How to • Avoid cigarette smoking, excess alcohol, sexually
transmitted infection, heat stress, anabolic steroids,

prevent? exposure harmful chemicals, controlled body weight

• Avoid vaginal luricants  can kill sperm

• Anamnesis, medical history

Diagnose • Physical examination

• Additional examination (sperm analysis, US, genetic
test – for congenital, ect)

Treatment • Based on the etilogy

Semen Analysis
 How to get a family?
Chances of natural If Failed  the options of
conception conception
 1/3 (38%) conceived in  ART ( IVF or ICSI)
the first month of trying  Donor insemination
 2/3 (68%) by the third  Adoption, foster parenting
month or permanent care
 > ¾ (82%) by the six  Deciding not to have
month children
 > 9 of 10 couples (92%)
had conceived within a
year
 Duration of
infertility

Age & Primary or

fertility status Prognostic
of female Factors secondary
partner infertility

Results of
semen analysis