Male Infertility

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MALE INFERTILITY
Besut Daryanto Department of Urology Medical School Brawijaya University Saiful Anwar General Hospital Malang

Urology
• the speciality that focuses on the urinary tract of males and females and on the reproductive system of males • Urologist is medical professional specializing in the field of urology who are trained to diagnose, treat and manage of urologic disorders.

Branch (division) of urology
• • • • • • Onco-urology Neuro-urology Pediatric-urology Plastic & reconstructive -urology Andrology Gynaeco-urology

Infertility
• Is defined as the inability to conceive a child after 1 year of unprotected sexual intecourse. • Incidence: 15% of couple • Contribution to subfertility
• Female factors 50% • Male factors 20% • Both male and female factors 30%

Anatomy of male reproductive organs

Physiology of ejaculation
• Erection • Emision • Ejaculation

Physiology of ejaculation

Etiology: pre testicular
• Hypothalamic disease
• Gonadotropic deficiency • Fertile eunuch syndrome

• Pituitary disease
• Hyperprolactinemia • Pituitary insufficiency

• Exogenous or endogenous hormone deficiency • Estrogens
• Androgens • Growth hormone deficiency • Hypo-hyper thyroidism

Etiology: testicular
• Chromosomal causes
• Klinefelter syndrome • XX male syndrome • XYY syndrome

• Gonadotoxins
• • • •

Radiation Drug Renal failure Liver failure

• Testis injury • Trauma • Torsion • Cryptorchidism • Varicocele

Etiology: post testicular
• Obstruction:
– Congenital blockage – Acquired blockage
• Vasectomy • Hernia surgery • Infection

– Functional blockage
• Retrograde ejaculation

• Disorders of sperm function or motility • Disorders of coitus
• Erectile dysfunctions • Hypospadias • Time of frequency

Vasectomy

Evaluation
• Medical history • Physical examination • Laboratories
• Semen analysis • Hormonal assays • Testicular biopsy

• Imaging
• Head CT Scan • Seminal vesiculography

Semen analysis
morphology motility Concentration

Semen analysis
Volume semen Total sperma (sperm concentration) 1,5-5 mL >50 juta >20 juta/mL >50% >60% -

Motility Morfologi: bentuk normal Aglutinasi sperma Piospermi

Treatment
Depend on Etiology: • Pre testicular? • Testicular? • Post testicular?

Treatment options
• Medical • Surgical • Assisted reproductive technique

Surgical
• Varicocele: vasoligation • Obstruction of the vas deferen: vaso-

vasostomy, vaso-epididimostomy • Sperm alloplastic • Verumontanum(depresi uretra laki2) resection

Vasectomy reversal (vaso-vasostomy)

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