Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male &...
Transcript of Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male &...
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Male Factor InfertilityMr Ted McDermott, Consultant Urologist
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Male Factor Infertility
Definiton: Inability to achieve pregnancy after one year
of unprotected intercourse
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Incidence
15% of couples
30% male factor only
20% male & female factor
Male factors: 70% diagnosed by non-invasive cost
efficient investigations
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Treatment
Depends on underlying aetiology
Optimizing sperm production
Surgery may be individually optimized
More complex problems may need IVF/ICSI
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Pathophysiology
Hypothalamus GnRH
GnRH Pituitary
Pituitary FSH + LH
FSH Sertoli cells for
sperm
LH Leydig cells for
testosterone + inhibin
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Incidence
15% of couples BUT
23% conceive within 2 years
10% more conceive within 4 ½ years
7.6% conceive with counts <2million
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Global sperm count trend
113 million/cc in 1940
66 million/cc in 1990
? Patients presenting
Counting techniques
Toxins in environment
Geographic presentation
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Morbidity and Mortality
Associated with;
Pituitary Adenoma
Testicular Cancer
Liver Failure
Renal Failure
Increased overall lifetime risk of cancer of 2.2% vs 1.1%
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Age
Reduced fertility with age
50% of sperm lost by 50 years
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Patient Evaluation
History:
Duration of infertility
Previous Fertility
Sexual History
Childhood Urological Procedures
PMHx:
Testis Cancer
Diabetes
Other Cancer
Obesity
Respiratory Diseases STD
Medication: Testosterone
Social History:
Excessive sporting activity, Hash,
Alcohol, Emotional Stressors,
Environmental exposures
Drugs:
Chemotherapy, Tetracycline,
Nitrofurantoin
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Physical Examination
Body Habitus
Secondary sexual characteristics
Penis Abnormalities
Testes for position
Size: 3-4cm
Vas
Varicocele
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Diagnosis
Semen analysis
pH 7.05 – 7.8
Density 15 million/cc
Motility – 40% normal movement
Morphology – 4% upwards
Infection – round or white cell elevation
Antisperm antibody
Blood
Hormone and genetic typing
FSH, LH, Prolactin, Testosterone
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Testosterone
Diurnal pattern
Higher in the morning
Excessive levels inhibit GnRH
Intratesticular is a separate issue
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Sperm Production
74 days
16 steps
Spermatids (Stage 6 used for ICSI)
Epididymis (Sperm maturation to
allow egg penetration)
Ejaculatory Content – Seminal
vesicles 40-80% including fructose
Prostate Gland 10 – 30%
Sperm 5%
Cowper Glands 2-5%
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Correctable Causes
Varicocele
15% males, left side, right side suggests secondary pathology
Repair results in 40-70% improved semen parameters
Surgery versus Embolization in Radiology
Low Testosterone
Treat with Clomid
Stimulates GnRH release
Vasectomy
60-70% success at 5 years
Anejaculation
Vibrator
Electroejaculation
ICSI
Retrograde Ejaculation
Sudafed
Collection of retrograde sample
IVF and ICSI have covered the gaps in our treatment options
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Introducing the UroLift® System
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The Prostatic Urethral Lift
Compress encroaching lateral lobe
Deliver UroLift® implant to hold in place
Typically ~4 implants deliveredMr Ted McDermott, Consultant Urologist
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Immediate UroLift® Effect
Mechanically opens prostatic urethra
Result is visible under cystoscopy
Implants are anterolateral, away from NV bundles or dorsal venous complex
PRE POST
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Where Does UroLift® Fit?
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All BPH/LUTS Patients Should be Considered!
Men Who:
Are frustrated by side-effects or daily hassle of
medication
Have modest symptomatic relief from medications
Previously declined surgery
Want to preserve their sexual function Mr Ted McDermott, Consultant Urologist
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Urolift Summary
Rapid relief
IPSS reduced 10-12 points, Qmax increased 4 mLs
Significant improvement by 2 weeks
Adverse effects mild/moderate resolve by 2-4 weeks
Preserves ejaculatory and erectile function
Well tolerated under local anesthesia
Durability to 5 years established
Consistent performance across global studies
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Mr Ted McDermott, Consultant Urologist