In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t...
Transcript of In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t...
![Page 1: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/1.jpg)
In the name of GodIn the name of God
Dr Dr SoltanzadehSoltanzadeh MD,UrologistMD,Urologist
![Page 2: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/2.jpg)
M l F t I f tilit A d T t tM l F t I f tilit A d T t tMale Factor Infertility And TreatmentMale Factor Infertility And Treatment
Male factor:Male factor:11 Pure 20%Pure 20%1.1. Pure 20%Pure 20%2.2. Both 30Both 30--40% 50%40% 50%
![Page 3: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/3.jpg)
E al ationE al ationEvaluation:Evaluation:
HistoryHistoryPh/ExPh/ExPh/ExPh/ExLab dataLab data
![Page 4: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/4.jpg)
G l f l ti i id tifi dG l f l ti i id tifi dGoals of evaluation is identified :Goals of evaluation is identified :
1.1. Reversible conditionReversible condition22 Irreversible causeIrreversible cause ARTART2.2. Irreversible cause Irreversible cause ARTART3.3. Irreversible cause Irreversible cause Donor insemination adoptionDonor insemination adoption
Si ifi t d l i th lSi ifi t d l i th l4.4. Significant underlying pathologySignificant underlying pathology5.5. Genetic abnormalityGenetic abnormality effect offspringeffect offspring
![Page 5: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/5.jpg)
HistoHistoHistoryHistory
Infertility historyInfertility historySexual historySexual historySexual historySexual historyFamily historyFamily historyP t hi tP t hi tPast historyPast history
![Page 6: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/6.jpg)
PMHPMHPMHPMH
Childhood Childhood DM DM ND ND INF INF Renal D Renal D Cancer Cancer Surgical Surgical Medication Medication GonadotoxinGonadotoxin
![Page 7: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/7.jpg)
Ph sical E aminationPh sical E aminationPhysical Examination:Physical Examination:
HypospadiasHypospadias & & ChordeeChordeeTestis volumeTestis volumeTestis volumeTestis volumeVas & Vas & epididymisepididymisDREDREDREDRESitusSitus inversusinversusVirilizationVirilizationGeneral ExaminationGeneral ExaminationGeneral Examination General Examination
![Page 8: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/8.jpg)
Basic Lab TestsBasic Lab TestsBasic Lab TestsBasic Lab Tests
![Page 9: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/9.jpg)
semen Analysissemen Analysis
NumberNumberCollection: abstinenceCollection: abstinence
containercontainerMethodology : Physical characteristicsMethodology : Physical characteristicsgy ygy y
1.1. LiquefactionLiquefaction2.2. VolumeVolume3.3. CountCount4.4. MotilityMotilityyy5.5. WBCWBC6.6. MorphologyMorphology
CASACASA1.1. VelocityVelocityyy2.2. Flagellar beat frequencyFlagellar beat frequency3.3. Lateral head Lateral head
PHPHFructose Fructose
![Page 10: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/10.jpg)
Ho monal assaHo monal assaHormonal assayHormonal assay
TestosteroneTestosteroneFSHFSHFSHFSHLHLHP l tiP l tiProlactineProlactine
![Page 11: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/11.jpg)
![Page 12: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/12.jpg)
Additional TestingAdditional TestingAdditional TestingAdditional Testing
![Page 13: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/13.jpg)
Le koc te stainingLe koc te stainingLeukocyte stainingLeukocyte staining
11//3 3 RC RC WBCWBCIndication : RC :Indication : RC : 1010--1515% / HPF% / HPFIndication : RC : Indication : RC : 1010 1515% / HPF% / HPF
11**101066 /mL/mLi l t ii l t i papanicolaou stainpapanicolaou stain
peroxidaseperoxidase
![Page 14: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/14.jpg)
Antispe mAntispe m AntibodAntibodAntispermAntisperm AntibodyAntibody
![Page 15: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/15.jpg)
Semen c lt eSemen c lt eSemen culture:Semen culture:
Indication: pyospermia + clinical symptomIndication: pyospermia + clinical symptomMycoplasma genitaliumMycoplasma genitaliumMycoplasma genitaliumMycoplasma genitaliumChlamydia trachomatis (PCR)Chlamydia trachomatis (PCR)
![Page 16: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/16.jpg)
DNA Integrity Testing:DNA Integrity Testing:DNA Integrity Testing:DNA Integrity Testing:Indications:Indications:
11 Unexplained infertilityUnexplained infertility1.1. Unexplained infertilityUnexplained infertility2.2. Repeated IVF failureRepeated IVF failure
Recurrent miscarriageRecurrent miscarriage3.3. Recurrent miscarriageRecurrent miscarriageRisk factors:Risk factors:
1.1. SmokingSmoking2.2. ToxinsToxins3.3. CancerCancer4.4. feverfever
![Page 17: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/17.jpg)
Ult a st ct al e al ationUlt a st ct al e al ationUltra structural evaluation:Ultra structural evaluation:
Indication: < Indication: < 55--1010%%MitochondriaMitochondriaMitochondriaMitochondriaOuter dense fiberOuter dense fiberMi t b lMi t b lMicrotubulesMicrotubules
![Page 18: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/18.jpg)
Radiologic e al ationRadiologic e al ationRadiologic evaluation:Radiologic evaluation:
VasographyVasographyVesiculographyVesiculographyVesiculographyVesiculographyTRUSTRUSV hV hVenographyVenographyScrotal USScrotal USAbdominal USAbdominal US
![Page 19: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/19.jpg)
Ac osome eactionAc osome eactionAcrosome reaction:Acrosome reaction:
Differentiation of acrosome intact from Differentiation of acrosome intact from reactedreactedUnexplained infertilityUnexplained infertilityICSIICSIICSIICSI
![Page 20: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/20.jpg)
Sperm Penetration Assay:Sperm Penetration Assay:R f ZPR f ZPRemove of ZPRemove of ZPScoring :Scoring :% of ova% of ova 1010 3030%%1.1. % of ova % of ova 1010--3030%%
2.2. Num of sperm/ovaNum of sperm/ovaEvaluation of :Evaluation of :Evaluation of :Evaluation of :
1.1. CapacitationCapacitation22 Acrosome reactionAcrosome reaction2.2. Acrosome reactionAcrosome reaction3.3. Fusion oolemaFusion oolema44 Incorporation into ooplasmIncorporation into ooplasm4.4. Incorporation into ooplasmIncorporation into ooplasm
Unexplained infertilityUnexplained infertilityGood sperm but low numberGood sperm but low numberGood sperm but low numberGood sperm but low numberAbnormal Abnormal ICSIICSI
![Page 21: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/21.jpg)
Hemizona AssayHemizona AssayS i t tiS i t ti1.1. Sperm zona interactionSperm zona interaction
2.2. ICSIICSI3.3. Not indicatedNot indicated
Reactive Oxygen TestingReactive Oxygen TestingROS/TACROS/TACSperm Viability AssaySperm Viability AssaySperm Viability AssaySperm Viability Assay
1.1. Eosin YEosin Y22 Trypan blueTrypan blue2.2. Trypan blueTrypan blue3.3. HOSTHOST
![Page 22: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/22.jpg)
Genetic TestingGenetic TestingGenetic Testing:Genetic Testing:
Prevalence increase with SC Prevalence increase with SC Karyotypic abnormalityKaryotypic abnormalityKaryotypic abnormalityKaryotypic abnormalityY chromosome MDY chromosome MDG t ti (AZF)G t ti (AZF)Gene mutation (AZF)Gene mutation (AZF)
Indication: sever oligospermiaIndication: sever oligospermianon obs. azoospermianon obs. azoospermia
![Page 23: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/23.jpg)
Testicular biopsy:Testicular biopsy:p yp yIndicationIndicationNormal: obs.AzoospermiaNormal: obs.AzoospermiaHypospermatogenesis: all germinal elementHypospermatogenesis: all germinal elementoligo>azoooligo>azooM t ti t t t tidM t ti t t t tidMaturation arrest : spermatocyte or spermatidMaturation arrest : spermatocyte or spermatid
azoo>oligoazoo>oligoGerm cell aplastia : normal to small size testisGerm cell aplastia : normal to small size testisGerm cell aplastia : normal to small size testisGerm cell aplastia : normal to small size testis
regionalregionalEnd stage testis : Tubular & Pretubular SclerosisEnd stage testis : Tubular & Pretubular Sclerosisgg
germ cell germ cell ––sertoly sertoly ±±l dl dleydig leydig ±±
![Page 24: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/24.jpg)
![Page 25: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/25.jpg)
Diso de of spe matogenesisDiso de of spe matogenesisDisorder of spermatogenesisDisorder of spermatogenesis
![Page 26: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/26.jpg)
Pit ita diseasePit ita diseasePituitary disease :Pituitary disease :
Time of onsetTime of onsetTestis size & consistencyTestis size & consistencyTestis size & consistency Testis size & consistency EthiologyEthiology
![Page 27: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/27.jpg)
Isolated Hypogonadotrpic Hypogonadism :Isolated Hypogonadotrpic Hypogonadism :Isolated Hypogonadotrpic Hypogonadism :Isolated Hypogonadotrpic Hypogonadism :
Congenital or IdiopathicCongenital or IdiopathicXL > AD AR & Mutation (XL > AD AR & Mutation (3030%)%)XL > AD,AR & Mutation (XL > AD,AR & Mutation (3030%)%)SymptomsSymptomsHCG FSHHCG FSH G RHG RH T t tT t tHCG, FSH, HCG, FSH, GnRHGnRH, Testosterone , Testosterone ,,clomipheneclomiphene
![Page 28: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/28.jpg)
Isolated FSH DeficiencIsolated FSH DeficiencIsolated FSH DeficiencyIsolated FSH Deficiency
Normal size testisNormal size testisOligo or AzooOligo or AzooOligo or AzooOligo or AzoohMGhMG
![Page 29: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/29.jpg)
And ogen E cessAnd ogen E cessAndrogen Excess:Androgen Excess:
CAH CAH 21 21 Hydroxilase >Hydroxilase >Adrenal & Testicular TumorAdrenal & Testicular TumorAdrenal & Testicular TumorAdrenal & Testicular TumorExogenousExogenousMRI CT USMRI CT USMRI , CT , USMRI , CT , US
![Page 30: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/30.jpg)
Est ogen e cessEst ogen e cessEstrogen excess :Estrogen excess :
Testicular Testicular SertoliSertoli Cell TumorCell TumorLeydigLeydig Cell TumorCell TumorLeydigLeydig Cell TumorCell TumorObesity ,hepatic Obesity ,hepatic disdisG tiG ti ED T ti At hED T ti At hGynecomastiaGynecomastia , ED , Testis Atrophy, ED , Testis Atrophy
![Page 31: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/31.jpg)
P olactin E cessP olactin E cessProlactin Excess:Prolactin Excess:
TumorTumorStress Medication IdiopathicStress Medication IdiopathicStress , Medication , IdiopathicStress , Medication , IdiopathicED & InfertilityED & InfertilityL t di dL t di dLater diagnosedLater diagnosedRuled out Hypothyroidism Ruled out Hypothyroidism
![Page 32: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/32.jpg)
Th oid Abno malitTh oid Abno malitThyroid Abnormality:Thyroid Abnormality:
Hyper & HypoHyper & Hypo
![Page 33: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/33.jpg)
A d I iti it S dA d I iti it S dAndrogen Insensitivity SyndromeAndrogen Insensitivity Syndrome
XLXLPhenotype male to femalePhenotype male to femalePhenotype male to femalePhenotype male to femaleAzoo or OligoAzoo or Oligo
![Page 34: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/34.jpg)
Genetic S nd omesGenetic S nd omesGenetic SyndromesGenetic Syndromes
Chromosomal disordersChromosomal disordersklineFelterklineFelter’’s Syndromes SyndromeXXY PXXY P 11//6006001.1. XXY , P XXY , P 11//600600
2.2. Pure or mosaicismPure or mosaicism3.3. AzoospermiaAzoospermiapp4.4. Tubular sclerosisTubular sclerosis5.5. GenicomastiaGenicomastia
B b d kB b d k6.6. Barbody karyotypeBarbody karyotype7.7. 50 50 fold higher risk of breast cancerfold higher risk of breast cancer88 MosaicismMosaicism ICSIICSI8.8. Mosaicism Mosaicism ICSIICSI
![Page 35: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/35.jpg)
XX MaleXX MaleXX Male:XX Male:
Similar to klinfelter syndromeSimilar to klinfelter syndromePortion of Y ch or SRY genePortion of Y ch or SRY genePortion of Y ch or SRY genePortion of Y ch or SRY geneazooazoo
![Page 36: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/36.jpg)
XYY S nd omeXYY S nd omeXYY Syndrome:XYY Syndrome:
Tall , AggressiveTall , AggressiveOligo or AzooOligo or AzooOligo or AzooOligo or AzooARTART
![Page 37: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/37.jpg)
Y ch omosome mic o deletionY ch omosome mic o deletionY chromosome micro deletion:Y chromosome micro deletion:
Not inheritedNot inheritedAZFcAZFc >> AZFbAZFb AZFaAZFaAZFcAZFc > > AZFbAZFb , , AZFaAZFaART & genetic counseling ART & genetic counseling
![Page 38: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/38.jpg)
Bilate al Ano chiaBilate al Ano chiaBilateral Anorchia:Bilateral Anorchia:
Infection , Vascular or torsionInfection , Vascular or torsionTestosteroneTestosteroneTestosterone Testosterone
![Page 39: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/39.jpg)
UDTUDTUDT:UDT:
11//3 3 bilateralbilateralDependent to testis levelDependent to testis levelDependent to testis levelDependent to testis levelUnilateral corrected Unilateral corrected fertility fertility 8080--9090%%Bil t l t dBil t l t d f tilitf tilit 3030 5050%%Bilateral corrected Bilateral corrected fertility fertility 3030--5050% % Retractile Testis Retractile Testis M h iM h iMechanismMechanism
![Page 40: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/40.jpg)
Va icoceleVa icoceleVaricocele:Varicocele:
Prevalence: L Prevalence: L 9090% ; bilateral % ; bilateral 1010%%Secondary > PrimarySecondary > Primaryy yy yHigher T & reflux of metabolites &Impaired Higher T & reflux of metabolites &Impaired venous drainagevenous drainageMotility > SC > MorphologyMotility > SC > MorphologyDiagnosisDiagnosisggGradingGradingSurgical approachSurgical approachSurgical approachSurgical approachSuccessful predictorsSuccessful predictors
![Page 41: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/41.jpg)
O chitisO chitisOrchitis:Orchitis:
MumpsMumps3030% at puberty% at puberty3030% at puberty% at puberty1010--3030% bilateral% bilateralI fI f 22b &b & G RHG RHInfInf αα22b & b & GnRHGnRHTESATESASyphilis, Gonorrhea , Leprosy , Syphilis, Gonorrhea , Leprosy , MononucleosisMononucleosis
![Page 42: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/42.jpg)
Chemothe apChemothe apChemotherapy:Chemotherapy:
Spermatogonia & SpermatocytesSpermatogonia & SpermatocytesDose & AgeDose & AgeDose & AgeDose & AgeAlkylating >Alkylating >H d kiH d ki ’’ (MOPP & COPP)(MOPP & COPP) NOVPNOVPHodgkinHodgkin’’s (MOPP & COPP)s (MOPP & COPP) NOVPNOVPRecovery : Recovery : 44yySperm banking & contraceptiveSperm banking & contraceptive
![Page 43: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/43.jpg)
RadiationRadiationRadiation:Radiation:
Dose & AgeDose & AgeRecoveryRecovery 22yyRecovery Recovery 22yy¼¼ permanentpermanentC t tiC t ti 66 2424Contraceptive Contraceptive 66--24 24 mm
![Page 44: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/44.jpg)
Drug & MedicationDrug & MedicationMarijuana: Marijuana: pyospermiapyospermia. . Tes.genicomastiaTes.genicomastia , SC , SC CocainCocain : : morphology,motilitymorphology,motility & SC& SCSpironolactoneSpironolactone : ( : ( aldostronealdostrone antagonist)antagonist)
antiandrogenantiandrogen effect effect SC SC Ca channel blocker : functional defectCa channel blocker : functional defectCa channel blocker : functional defect Ca channel blocker : functional defect DES : UDT & Cyst of DES : UDT & Cyst of epididymepididymNitrofurantoinNitrofurantoinNitrofurantoinNitrofurantoin,,Gentamycin,Erythromycin,TetracyclineGentamycin,Erythromycin,Tetracycline: : gonadotoxicgonadotoxic & function& functionCimetidinCimetidin : germ cell: germ cellCimetidinCimetidin : germ cell: germ cellSulfazalazineSulfazalazine: SC & motility: SC & motilityAlcohol :Alcohol : peritubularperitubular fibrosis & germ cellfibrosis & germ cellAlcohol : Alcohol : peritubularperitubular fibrosis & germ cellfibrosis & germ cell
free free testesSmoking : female > maleSmoking : female > male
![Page 45: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/45.jpg)
Idiopathic infe tilitIdiopathic infe tilitIdiopathic infertility:Idiopathic infertility:
3030% of patients% of patients2626% pregnancy rate% pregnancy ratep g yp g yGnRHGnRHGonadotropinsGonadotropinsGo adot op sGo adot op sClomiphenClomiphen & & TamoxifenTamoxifen & & TestolactoneTestolactone & & AnastrozoleAnastrozoleAndrogensAndrogensThyroxineThyroxine ,, argininarginin ,, corticostroidscorticostroids,, VitVit A,E,CA,E,CThyroxineThyroxine , , argininarginin , , corticostroidscorticostroids, , VitVit A,E,CA,E,CL L CarnitineCarnitine & & KallekreinKallekrein
![Page 46: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/46.jpg)
Spe m deli e diso de sSpe m deli e diso de sSperm delivery disorders:Sperm delivery disorders:
DuctalDuctal obstructionobstructionCBAVD ICSI + Genetic counselingCBAVD ICSI + Genetic counselingCBAVD , ICSI + Genetic counselingCBAVD , ICSI + Genetic counselingEjEj. . DuctalDuctal Obstruction : TUREDObstruction : TUREDVV d fd f && idid lidid l bbVas Vas deferendeferen & & epididymalepididymal obs.obs.
![Page 47: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/47.jpg)
Vasectom e e salVasectom e e salVasectomy reversal :Vasectomy reversal :
66% of men who have undergone % of men who have undergone vasectomyvasectomyyySecondary ep.obs (Secondary ep.obs (6262%% 1515yo)yo)Sperm & fluid copious and clearSperm & fluid copious and clearSperm & fluid copious and clearSperm & fluid copious and clear
![Page 48: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/48.jpg)
![Page 49: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/49.jpg)
![Page 50: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/50.jpg)
Vasoepid mostomVasoepid mostomVasoepidymostomy:Vasoepidymostomy:
VasectomyVasectomyInfectionInfectionInfectionInfectionCFCF
![Page 51: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/51.jpg)
End to End End to End AnastomosisAnastomosis
![Page 52: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/52.jpg)
End to Side End to Side AnastomosisAnastomosis
![Page 53: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/53.jpg)
Ejaculatory problems:Ejaculatory problems:Distinguish from Distinguish from anorgasmiaanorgasmiaPharmacologic therapy:Pharmacologic therapy:Pharmacologic therapy: Pharmacologic therapy:
1.1. Normal B.NNormal B.N2.2. EmissionEmission
PsuedoephedrinePsuedoephedrine 60 60 mg QIDmg QIDpp g Qg QImipraminImipramin 25 25 mg BDmg BDCyclicCyclicRecovery of spermRecovery of sperm
11 Fluid intakeFluid intake1.1. Fluid intakeFluid intake2.2. Sodium bicarbonateSodium bicarbonate3.3. Media into bladderMedia into bladder
SCISCI1.1. Vibration Vibration 7070% UMN% UMN2.2. TT11--TT6 6 BCR or Hip RBCR or Hip R3.3. TT77--TT12 12 both reflexboth reflex
Electro ejaculation:Electro ejaculation:Electro ejaculation:Electro ejaculation:1.1. SCISCI2.2. RPLNDRPLND3.3. MSMS
A iA i d fl id fl i b Tb T444.4. Autonomic Autonomic dysreflexiadysreflexia above Tabove T44
![Page 54: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/54.jpg)
Spe m f nction diso deSpe m f nction diso deSperm function disorderSperm function disorder
Immunologic infertility Immunologic infertility SppressSppress AbAb :: corticostroidcorticostroid:: high dose cyclichigh dose cyclicSppressSppress AbAb : : corticostroidcorticostroid: : high dose cyclichigh dose cyclic
low dose low dose longtermlongterm3030 4040%%3030--4040%%
Processing technique : Processing technique : chymotripsinchymotripsinICSIICSI
![Page 55: In the name of Godiacld.ir/DL/co/10/infertilityinmendrsoltanzadeh.pdf · M l F t I f tilit A d T t tMale Factor Infertility And Treatment Male factor: 1. Pure 20%Pure 20% 2. Both](https://reader034.fdocuments.net/reader034/viewer/2022043018/5f3a720ef1ae33532a1ca064/html5/thumbnails/55.jpg)
Ult a st ct al Abno malitUlt a st ct al Abno malitUltra structural Abnormality:Ultra structural Abnormality:
Electron microscopyElectron microscopyOuter dense fiberOuter dense fiberMicrotubulMicrotubulMicrotubulMicrotubulMitochondriaMitochondriaConnecting pieceConnecting pieceAc osomeAc osomeAcrosomeAcrosome
Immotile cilia syndrome ARImmotile cilia syndrome ARDysplasia fibrous sheath (stump tail Dysplasia fibrous sheath (stump tail synsyn) I,II) I,IIRound head sperm: Round head sperm: acrosomeacrosome & & cytoskeletalcytoskeletal Pr (Pr (--) I,II) I,IIConnecting piece : pin headConnecting piece : pin headConnecting piece : pin headConnecting piece : pin headICSIICSI