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[Audio] Male Infertility By -dr Mradulika Sharma.

[Audio] Introduction To Male Infertility Definition Of Infertility: Infertility Is Defined As The Inability Of A Couple To Conceive After 12 Months Of Regular, Unprotected Intercourse. For Men, It May Involve Issues Such As Low Sperm Count, Poor Sperm Motility, Abnormal Morphology, Or Blockages That Prevent Sperm Delivery. Differentiate Primary Infertility (no Previous Pregnancies) Secondary Infertility (difficulty Conceiving After A Previous Pregnancy)..

[Audio] Global Prevalence And Impact: Infertility Affects About 15% Of Couples Globally, With Male Factors Contributing To Approximately 50% Of Cases, Either Solely Or In Combination With Female Factors. Societal Impact Includes Cultural Stigma, Particularly In Regions Where Male Infertility Is Less Acknowledged. Emotional Consequences For Men Include Depression, Anxiety, And A Feeling Of Inadequacy, Often Leading To Relationship Challenges. Economic Burden: Infertility Treatments (art, Surgeries) Can Be Costly And Often Not Covered By Insurance In Many Countries, Creating Financial Stress For Affected Couples..

[Audio] Fertility Window Refers To The 5-6 Days In The Menstrual Cycle When Conception Is Most Likely, Peaking During Ovulation. Male Fertility Is Constant, But Sperm Quality Plays A Crucial Role In Achieving Pregnancy During This Window. Explain The Journey Of Sperm: After Ejaculation, Sperm Must Navigate The Female Reproductive Tract, Pass Through Cervical Mucus, And Travel Through The Uterus To Reach The Fallopian Tubes, Where Fertilization Typically Occurs. Sperm Characteristics Essential For Conception Include Motility (the Ability To Swim), Morphology (shape And Structure), And Concentration (quantity). Abnormalities In Any Of These Factors Can Impede Fertilization..

[Audio] Anatomy And Physiology Of The Male Reproductive System Male Reproductive Anatomy Testes: Responsible For Producing Sperm And Synthesizing Testosterone. The Seminiferous Tubules Within The Testes Are The Site Of Spermatogenesis. Scrotum: Functions As A Temperature-regulating System. The Optimal Temperature For Sperm Production Is Slightly Lower Than Body Temperature, Which Is Maintained By The Scrotum. Epididymis: Coiled Tube Located At The Back Of The Testes Where Sperm Mature And Gain Motility Over 2-4 Weeks..

[Audio] Vas Deferens: Transports Sperm From The Epididymis To The Ejaculatory Duct. It Passes Through The Inguinal Canal, Forming Part Of The Spermatic Cord. Seminal Vesicles And Prostate Gland: Seminal Vesicles Produce A Fructose-rich Fluid That Provides Energy For Sperm. The Prostate Secretes An Alkaline Fluid That Helps Sperm Survive The Acidic Environment Of The Female Reproductive Tract. Penis And Urethra: Conduits For Ejaculation, Allowing Sperm To Be Deposited Into The Female Reproductive Tract..

[Audio] Spermatogenesis Process: Begins With Spermatogonia (stem Cells) Undergoing Mitosis And Differentiation. Progresses Through Stages: Primary Spermatocytes, Secondary Spermatocytes, Spermatids, And Finally Mature Spermatozoa. The Entire Process Takes About 64-74 Days, Influenced By Hormones Like Fsh And Testosterone. Mature Sperm Are Stored In The Epididymis Until Ejaculation. ..

[Audio] Hormonal Regulation Hypothalamus: Secretes Gnrh, Stimulating The Pituitary Gland To Release Lh And Fsh. Pituitary Gland: Lh Stimulates Leydig Cells In The Testes To Produce Testosterone. Fsh Works With Testosterone To Stimulate Sertoli Cells, Essential For Spermatogenesis. Feedback Mechanism: Testosterone And Inhibin Provide Negative Feedback To Regulate Gnrh, Lh, And Fsh Levels, Maintaining Hormonal Balance.

[Audio] Causes Of Male Infertility PRE-TESTICULAR factors: CONDITIONS AFFECTING THE HYPOTHALAMUS OR pituitary GLAND CAN lead TO reduced levels OF GNRH, LH, OR FSH, resulting IN HYPOGONADOTROPIC HYPOGONADISM. EXAMPLES INCLUDE kallmann SYNDROME, pituitary tumors, A-N-D head TRAUMA. Kallmann syndrome is a condition characterized by delayed or absent puberty and an impaired sense of smell. This disorder is a form of hypogonadotropic hypogonadism, which is a condition resulting from a lack of production of certain hormones that direct sexual development. These hormones are normally made in a part of the brain called the hypothalamus. Hyperprolactinemia: Elevated Prolactin Levels Suppress Gnrh, Affecting The Release Of Lh And Fsh. Systemic Illnesses: Diabetes, Thyroid Disorders, And Severe Infections Can Also Impair Hormonal Balance. Testicular Factors: Genetic Disorders: Klinefelter Syndrome (47,xxy) Leads To Testicular Atrophy, Decreased Testosterone Levels, And Impaired Spermatogenesis. Varicocele: Enlargement Of The Pampiniform Plexus Veins Can Cause Increased Scrotal Temperature And Oxidative Stress, Which May Damage Sperm Dna And Impair Function. Infections: Mumps Orchitis Post-puberty Can Damage The Seminiferous Tubules, Leading To Reduced Sperm Production Or Azoospermia (absence Of Sperm). Testicular Trauma: Physical Injury Can Disrupt Blood Supply, Leading To Atrophy Or Obstruction. Cryptorchidism: If Untreated By Age Two, The Risk Of Infertility And Testicular Cancer Increases Significantly..

[Audio] Lifestyle And Environmental Factors: Smoking Leads To Oxidative Stress, Dna Damage, And Reduced Sperm Count And Motility. Alcohol Abuse Disrupts Hormonal Balance And Can Result In Testicular Atrophy. Obesity Increases Estrogen Levels And Scrotal Temperature, Affecting Sperm Quality. Drug Use (e G , Anabolic Steroids) Suppresses Natural Testosterone Production, Shrinking The Testes And Reducing Sperm Production. Exposure To Chemicals (pesticides, Heavy Metals) And Heat (frequent Hot Baths, Saunas) Are Linked To Sperm Abnormalities. Post-testicular Factors: Obstructive Disorders: Blockages In The Ejaculatory Ducts, Vas Deferens, Or Epididymis Can Prevent Sperm From Mixing With Ejaculatory Fluids. Vasectomy: Intentional Blockage Of The Vas Deferens For Contraception, Which Can Be Surgically Reversed, But Outcomes Depend On Time Since The Procedure. Retrograde Ejaculation: Often A Result Of Nerve Damage From Surgery, Diabetes, Or Medication, Where Semen Enters The Bladder Instead Of Exiting Through The Penis..

[Audio] How Is Male Infertility Diagnosed? A Primary Care Physician (pcp) Can Diagnose Male Infertility Or They May Refer The Patient To A Urologist Who Specializes In Male Infertility Or A Reproductive Endocrinologist A Pcp Will Perform A Complete Physical Examination To Help Determine His Overall Health And Identify Any Physical Problems That May Affect Your Fertility. They May Also Ask Him And His Partner Questions About Their Sexual Habits And Health History, Including: How Long Have You Been Trying To Get Your Partner Pregnant? Have You Gotten A Partner Pregnant In The Past? Have You Ever Tested Positive For An Sti? If So, Which Sti And When? Have You Ever Received Treatment For An Sti? Have You Used Birth Control(contraceptives)? If So, Which One(s) And When? Has A Provider Diagnosed Any Of Your Biological Family Members With Male Infertility? Do You Smoke, Drink Alcohol Or Use Recreational/nonprescription Drugs? Which Medications Do You Take? The Provider May Order Tests If The Physical Exam And Review Of Your Health History Don’t Indicate Any Apparent Cause For Male Infertility..

[Audio] Diagnosis Of Male Infertility Contd…. Semen Analysis: Volume: Normal Range Is 1.5-5.0 Ml. Low Volume Can Indicate Ejaculatory Duct Obstruction Or Hypogonadism. Concentration: Minimum Of 15 Million Sperm/ml Is Considered Normal. Motility: More Than 40% Of Sperm Should Be Motile. Morphology: At Least 4% Should Have A Normal Shape Based On Who Standards. Multiple Analyses Are Done Over Weeks To Account For Variability. Hormonal Testing: Lh And Fsh Levels Help Determine If The Problem Is Pre-testicular (hormonal) Or Testicular. High Fsh Indicates Testicular Damage, While Low Levels Suggest Hypothalamic/pituitary Issues. Testosterone And Prolactin Levels Also Assessed To Identify Hormonal Imbalances Medical History And Physical Examination: Detailed History Includes Past Medical Conditions, Surgeries, Infections (e G , Mumps), Medication Use, Lifestyle Factors, And Sexual Function (erectile Dysfunction, Ejaculation Problems). Physical Examination Focuses On The Genitalia (testicular Size, Presence Of Varicocele, Penis Structure) And Secondary Sexual Characteristics (body Hair Distribution, Gynecomastia)..

[Audio] Genetic Testing Karyotyping To Detect Chromosomal Abnormalities Like Klinefelter Syndrome. Y-chromosome Microdeletions (especially In Azfc Region) Are Tested For Genetic Causes Of Azoospermia Or Severe Oligospermia. Cystic Fibrosis Gene Mutations If Congenital Absence Of Vas Deferens Is Suspected Imaging Techniques Scrotal Ultrasound: Visualizes Structural Abnormalities Like Varicocele Or Testicular Masses. Doppler Ultrasound: Measures Blood Flow Abnormalities, Important For Varicocele Diagnosis. Transrectal Ultrasound (trus): Assesses The Prostate And Ejaculatory Ducts For Obstruction. Mri: Used For Detailed Imaging Of Pituitary And Hypothalamic Structures If Hormonal Disorders Are Suspected. Testicular Biopsy Indicated For Azoospermia To Distinguish Between Obstructive And Non-obstructive Causes. It Assesses The Presence Of Spermatogenesis At Different Levels Of The Seminiferous Tubules.

[Audio] Management Of Male Infertility Medical Treatments Clomiphene Citrate And Aromatase Inhibitors (e G , Anastrozole) Are Used To Increase Testosterone Levels And Sperm Production In Cases Of Mild Hypogonadism. Hormonal Therapy, Such As Hcg Injections, Can Stimulate Endogenous Testosterone Production In Hypogonadotropic Hypogonadism Medications For Erectile Dysfunction (e G , Pde5 Inhibitors) If Sexual Dysfunction Is A Contributing Factor..

[Audio] Hypothalamic Or Pituitary Deficiency Treatment With Hcg With Or Without Rhfsh Is Often Called "gonadotropin Treatment." It Involves Getting Injections Of Hcg Three Times Per Week Under The Skin For At Least Six Months And Usually One To Two Years. Blood Tests Are Used To Monitor Blood Testosterone Levels And To Adjust The Dose If Necessary. In A Small Percentage Of Cases (2 To 5 Percent), Male Infertility Is Due To Problems In The Hypothalamus And Pituitary Gland. In This Situation, Treatment With Human Chorionic Gonadotropin (hcg) That Acts Like Lh, Often In Combination With Recombinant Human Follicle-stimulating Hormone (rhfsh), Is Given. The Goal Is To Achieve Normal Blood Hormone Levels So The Body Can Produce Sperm. If Sperm Cells Do Not Appear In Semen After Six Months Of Treatment, Rhfsh Injections May Be Added. While The Success Rate For This Therapy Is High, It Can Take One To Two Years Of Treatment (and Sometimes Even Longer) To Achieve Normal Fertility..

[Audio] Gonadotrpoins The treatment of male infertility in men with pituitary insufficiency (for example, pituitary adenoma, systemic diseases such as hemochromatosis and sarcoidosis) is based on the use of gonadotropins, human chorionic gonadotropin (rec-hCG), F-S-H (rec-hFSH) and LH (rec-hLH) or highly purified urinary gonadotropins are used. Initially, hCG is administrated alone. After several months of treatment, if no sperm is detected but adequate serum T levels are achieved, then treatment with F-S-H is introduced (13). Gonadotropins are self-administered subcutaneous injections with dosages ranging between 75-150 IU of F-S-H or human menopausal gonadotropin (hMG) two to three times weekly plus 1500-2500 IU of hCG twice weekly. The duration of treatment may vary from 6-24 months or more and typically continues until sperm appears in the ejaculate and/or when pregnancy is achieved. Several factors correlate with the response to treatment. Cryptorchidism, small testicles, elevated B-M-I--, and extreme gonadotropin insufficiency are generally considered a negative prognostic indicator for treatment with gonadotropins.

[Audio] GnRH Is very effective in inducing spermatogenesis as early as four months after the start of therapy . Pulsatile GnRH therapy induces spermatogenesis in about 85% of patients, and on average 60% of couples will achieve pregnancy after nine months of treatment, and can take up to two years (9). Some men who receive GnRH will see an improvement in their sexual characteristics such as increase in the testicular volume, and other features like pubic hair growth. These changes can be used as clinical markers to monitor treatment. Increase in testicular size, normalization of gonadotropin and T levels, maturation of secondary sexual characteristics, normal baseline inhibin B levels, and absence of cryptorchidism are positive predictors of treatment success When pulsatile GnRH treatment fails to mount a clinical response, the method of administration, effectiveness of the dose, or other causes such as formed anti-GnRH antibodies should be evaluated as part of the differential diagnosis. Despite the great outcomes that are experienced in pulsatile GnRH treatment, its use is limited by availability, inconvenience of delivery by carrying a pump, and the need to regularly change subcutaneous needles..

[Audio] Dopamine Agonist For men presenting with infertility and hyperprolactinemia, prolactin-secreting pituitary adenoma (most common functional tumors) should be considered as the underlying cause. Elevated levels of prolactin inhibit the pulsatile secretion of GnRH, men will present with hypogonadism and infertility, and they might also experience headaches or visual field changes secondary to the pituitary tumor compression. In this setting, dopamine agonists are indicated for the treatment of infertility and the pituitary tumor. Both bromocriptine and cabergoline have been used in the past. However, there is evidence that cabergoline is more effective than bromocriptine in suppressing prolactin production, and has been shown to normalize prolactin levels in 70% of bromocriptine-resistant patients . Therefore, cabergoline (0.125-1.0 milligrams twice weekly) is the preferred choice because it has the highest efficacy in normalizing prolactin levels and shrinking prolactin-secreting tumors. Patients that fail cabergoline or dose modification are recommended to undergo surgery..

[Audio] Aromatase inhibitor (A-I---) therapy (A-I )s (anastrozole 1 milligrams daily, or letrozole 2.5 milligrams daily) increase T, decrease estrogen levels, and inhibit the peripheral metabolism of T The intent is to reduce the estrogenic effect on spermatogenesis. High estrogen levels in combination with low T levels have been shown to impair proper spermatogenesis (28). More importantly, elevated levels of estrogen will lead to feedback inhibition of the H-P-G axis, and the end result is a decrease in the LH necessary for the production T, and F-S-H to optimize sperm production (29). The activity of aromatase inhibition regardless of patient B-M-I suggests that aromatase activity in the Leydig cells is responsible for the T to estradiol (E).

[Audio] Selective estrogen receptor modulators (SERMs) serms are a class of compounds that act on the estrogen receptor as agonists or antagonists. CC, like other serms, inhibits central estrogen feedback (39) and up regulates the production of LH and F-S-H--, leading to induction of spermatogenesis. Randomized controlled trials in men with oligospermia or azoospermia examining the efficacy of tamoxifen (20 milligrams daily) or toremifene and raloxifene (60 milligrams daily) have reported improvements in semen parameters and pregnancy rates following three months of treatment..

[Audio] Antioxidant Increased rates of infertility have been found in men with seminal fluid containing high levels of reactive oxygen species (R-O-S--) (48). These R-O-S are associated with sperm dysfunction, germ cell D-N-A damage with the possibility of impaired fertility, but the exact mechanism is not completely understood. These associations have led clinicians to treat infertile men with antioxidant supplements..

[Audio] Table 1. Reviewed Medical Treatment Of Male Infertility Substance Administration Dosage And Frequency Current Availability Gnrh Subcutaneous Infusion Pump 25-200 Ng/kg Per Pulse Every 2 Hours Only In Specialty Centers Or Part Of Clinical Trials Human Chorionic-gonadotropin (hcg) Subcutaneous/intramuscular 1500-3000 Iu 2 Times/week Available, Fda Approved For Treatment Of Infertility Due To Gonadotropin Deficiency Human Menopausal Gonadotropin (hmg) Subcutaneous/intramuscular 75 Iu 2-3 Times/week Available, Fda Approved For Treatment Of Infertility Due To Gonadotropin Deficiency Highly Purified Or Recombinant Human Follicle-stimulating Hormone (rhfsh) Subcutaneous/intramuscular 100-150 Iu 2-3 Times/week Available, Fda Approved For Treatment Of Infertility Due To Gonadotropin Deficiency Dopamine Agonist Oral Cabergoline (0.5-1 Mg Twice Weekly), Bromocriptine (2.5-5.0 Mg Twice Weekly) Fda Approval For Treatment Of Hyperprolactinaemia.

[Audio] Aromatase Inhibitors oral Anastrozole 1 Mg/day Off Label Use Letrozole 2.5 Mg/day Off Label Use Testolactone Not Available In The Usa Selective Estrogen Receptor Modulators (serms) Oral Clomiphene Citrate Titrate To 50 Mg/day Off Label Use Tamoxifen 20 Mg/day, Toremifene 60 Mg/day, Raloxifene 60 Mg/day Off Label Use.

[Audio] Conclusions Understanding the H-P-G axis a, the goal of infertility treatment in all men is to optimize LH levels to stimulate T production from the Leydig cells, F-S-H levels to stimulate Sertoli cells and spermatogenesis, and eliminate any estrogen excess. How ever its seen,pharmacologic therapy is only effective in a handful of known causes of male infertility where the causes are relatively well-defined and understood. Based on current data, hormonal therapies in general should not be used indiscriminately for the treatment of idiopathic male infertility due to questionable efficacy and restrictive cost..

[Audio] Surgical Treatments Varicocelectomy: Microsurgical Procedure For Varicocele Repair; Improves Sperm Parameters And Testosterone Levels. Vasectomy Reversal (vasovasostomy): Reconnection Of The Vas Deferens, With Success Rates Dependent On Time Elapsed Since Vasectomy. Sperm Retrieval Techniques: Tese (testicular Sperm Extraction): Small Biopsies Taken Directly From The Testes For Sperm Retrieval. Mesa (microsurgical Epididymal Sperm Aspiration): Retrieval Of Sperm From The Epididymis In Cases Of Obstructive Azoospermia. Assisted Reproductive Technologies (art): Iui: Sperm Is Washed And Concentrated Before Being Injected Into The Uterus, Bypassing Cervical Mucus. Ivf: Eggs And Sperm Are Combined In A Lab To Create Embryos, Which Are Then Implanted In The Uterus. Icsi: Particularly For Severe Male Infertility; A Single Sperm Is Injected Directly Into The Egg, Often Used In Cases Of Poor Sperm Morphology Or Motility. Divided the patients into groups based on total motile sperm count : I-C-S-I candidates I-V-F candidates (1.5-5 million) I-U-I candidates (5-20 million) natural birth candidates (>20 million).

[Audio] Lifestyle And Male Fertility Impact Of Diet And Exercise: A Balanced Diet Rich In Antioxidants (e G , Vitamins C And E, Selenium) Helps Reduce Oxidative Stress, Which Can Damage Sperm Dna. Omega-3 Fatty Acids Found In Fish Oil Have Been Shown To Improve Sperm Motility And Morphology. Diets High In Processed Foods, Trans Fats, And Sugary Beverages Are Linked To Poor Semen Quality. Exercise Improves Cardiovascular Health And Testosterone Levels, But Excessive, Intense Exercise Can Increase Oxidative Stress And Lead To Hormone Imbalances That Negatively Impact Fertility. Weight Management: Obesity Is Associated With Lower Testosterone Levels And Increased Estrogen, Leading To Poor Sperm Production. Losing Weight Through Diet And Moderate Exercise Can Restore Hormonal Balance..

[Audio] Environmental Toxins And Occupational Risks Exposure To Endocrine-disrupting Chemicals (e G , Phthalates, Bisphenol A) Found In Plastics Can Affect Testosterone Production And Sperm Quality. Pesticides And Herbicides Are Known To Have Toxic Effects On Sperm Production And Dna Integrity. Men Working In High-heat Environments (e G , Welders, Bakers) Or Those Frequently Using Saunas/hot Tubs May Have Elevated Scrotal Temperatures, Which Can Impair Spermatogenesis. Radiation Exposure, Particularly From Medical Or Industrial Sources, Can Damage Sperm Dna And Reduce Sperm Count. Psychological And Emotional Factors Stress, Anxiety, And Depression Can Affect Hormonal Balance (e G , Increasing Cortisol Levels, Which May Suppress Testosterone Production) And Lead To Reduced Sexual Desire Or Erectile Dysfunction. Psychological Stress Has Also Been Linked To Increased Oxidative Stress In Sperm, Potentially Impacting Fertility Outcomes. Counseling, Therapy, And Stress-reducing Techniques Such As Meditation, Yoga, Or Support Groups May Help Men Manage The Emotional Impact Of Infertility And Improve Treatment Outcomes..

[Audio] Genetic Counseling And Ethical Considerations Genetic Causes Of Male Infertility: Genetic Mutations Can Cause Conditions Like Y-chromosome Microdeletions (particularly In The Azf Regions) That Directly Affect Spermatogenesis. Men With Klinefelter Syndrome (47,xxy) May Present With Hypogonadism, Small Testes, And Infertility Due To Impaired Sperm Production. Congenital Absence Of The Vas Deferens (cavd) Is Associated With Mutations In The Cftr Gene, Commonly Linked To Cystic Fibrosis. Genetic Counseling Is Crucial For Men With These Conditions, As The Implications Extend To Offspring And Family Planning. Counseling Includes Discussing The Chances Of Genetic Transmission And Available Reproductive Options (e G , Icsi, Preimplantation Genetic Diagnosis)..

[Audio] Ethical Issues In Sperm Donation, Art, And Surrogacy Sperm Donation: Ethical Considerations Include The Anonymity Of The Donor, The Right Of Offspring To Know Their Genetic Origins, And Informed Consent Regarding The Use Of Genetic Material. Art: Issues Such As The Selection Of Embryos (e G , Based On Sex Or Genetic Characteristics) Raise Ethical Questions About Eugenics And The Manipulation Of Natural Selection. Surrogacy: Ethical Concerns Involve The Rights Of The Surrogate, Intended Parents, And The Child. In Some Regions, Legal Regulations May Restrict Commercial Surrogacy Or Enforce Specific Conditions. Legal Considerations Regarding Sperm Storage And Art: Legal Regulations Vary By Country Regarding The Duration Of Sperm Storage, The Use Of Stored Sperm After The Donor’s Death, And Consent Requirements For Partners Using Sperm In Art Procedures. In Cases Where The Individual Storing Sperm Passes Away, Laws Determine The Conditions Under Which The Stored Sperm Can Be Used By A Spouse Or Partner. The Legal Parentage Of Children Born Via Art Procedures And The Rights Of Donors, Recipients, And Surrogates Are Also Important Considerations..

[Audio] Future Directions And Research In Male Infertility Advances In Diagnostic Technologies: Artificial Intelligence (ai): Ai-based Tools Are Being Developed To Enhance Semen Analysis Accuracy, Including Automated Sperm Morphology Assessment And Motility Analysis, Reducing Human Error. Molecular Diagnostics: Emerging Technologies Focus On Identifying Molecular Markers Of Sperm Quality (e G , Sperm Dna Fragmentation, Reactive Oxygen Species Levels) That Provide A More Precise Diagnosis Beyond Standard Semen Parameters. Microfluidic Systems: Microfluidic Technology Allows The Sorting Of High-quality Sperm With Better Motility And Morphology, Improving Outcomes For Art Procedures Like Icsi. Novel Treatments: Stem Cell Therapy: Research Is Ongoing Into The Use Of Spermatogonial Stem Cells To Restore Fertility In Cases Where Spermatogenesis Is Impaired Due To Testicular Injury Or Chemotherapy. Gene Therapy: Crispr-cas9 Technology Is Being Explored To Correct Genetic Mutations (e G , Y-chromosome Deletions) Responsible For Male Infertility. This Approach Could Potentially Restore Normal Spermatogenesis In Men With Genetic Causes Of Infertility. Hormonal Male Contraceptives: Research Into Male Contraceptives Includes Hormonal Combinations (testosterone And Progestin) That Suppress Spermatogenesis While Maintaining Normal Testosterone Levels For Libido And Muscle Mass..

[Audio] Non-hormonal Options Methods Such As Risug (reversible Inhibition Of Sperm Under Guidance), A Reversible Vas-occlusive Technique, Are Being Investigated As Alternatives To Hormonal Methods. Implications For Fertility: As New Contraceptive Methods Become Available, Considerations Include The Potential For Delayed Return To Fertility, Effectiveness, And Long-term Impact On Reproductive Health..

[Audio] Case Studies And Practical Applications 1.Mr x is a 38 years old male with a past medical history of obesity and type 1 diabetes. He and his 28 year old spouse have been trying unsuccessfully to conceive for the last 1.5 years. What would you like to do next? Recommended Evaluation History Physical Exam Semen Analysis x 2 Labs – FSH, LH, T History Mr Ely reports that he has never fathered a child and his wife has never been pregnant. They have routine vaginal intercourse using an ovulation predictor kit to determine when she is most fertile. Neither he nor his wife have any family history of infertility. No history of childhood illnesses or trauma. He takes insulin for his diabetes. He works as a college math professor. Physical Exam No acute destress, obese Normal secondary sex characteristics Testicles: normal size (average 20 mL), no masses bilaterally Epididymis: present and normal Vas: palpable bilaterally Varicocele: grade 2 on left Penis: circumcised, o Semen Analysis Initial testing Semen analysis x 2 Separated by ≥1 month (preferred) 2-3 day abstinence Vol: 3.8 ml Concentration: 7.2 million/ml pH: 8.0 Motility: 24% What treatment would you offer? Varicocelectomy A repeat semen analysis 6 months after the procedure shows: Vol: 3.5 ml Concentration: 33.7 million/ml pH: 8.0 Motility: 56% Morphology: 4% 9 months after procedure you get a message from the patient that his wife is 20 weeks pregnant!.

[Audio] Case Studies And Practical Applications 2, Patient concerns: An apparently healthy 27-year-old man with a body mass index (B-M-I--) of 23.31 kg/m2 had a 2-year history of primary infertility. Diagnoses: The semen analysis of the patient showed a sperm concentration of 0/mL in 6.5 mL of semen. The patient was diagnosed with N-O-A by performing the comprehensive examinations including a detailed medical history, physical examination, chromosome analysis, Y-chromosome microdeletions, semen analysis, and hormone profiles. Interventions: The couple received artificial insemination by donor (A-I-D--) and a healthy girl was born after the embryo transfer..

[Audio] Case Studies And Practical Applications 3. The male had a history of bilateral inguinal hernia repair due to congenital bilateral absence of the vas deferens. Diagnostic assessments confirmed azoospermia. Microscopic epididymal sperm aspiration (M-E-S-A-) was performed for sperm retrieval due to its efficacy and reduced postoperative pain, testicular atrophy, and decreased testosterone levels. The retrieved sperm was processed using SpermMobil media for intracytoplasmic sperm injection. Following successful fertilization, embryo transfers resulted in a positive pregnancy test..

[Audio] Case History 32-years-old female A-N-D male 4 years of infertility, Good A-M-H--, Low Semen analysis USG – B/L ovaries normal, Uterus normal size Previous history – Ovulation induction with intrauterine insemination (I-U-I--) – 6 cycles Treatment Correct diagnosis Counseling of couple Suggested treatment: IVF ICSI Positive pregnancy test in first cycle Transvaginal ultrasonography – Intrauterine single live pregnancy!.

[Audio] Case History 27-year-old couple 2 years of infertility, Good A-M-H--, No Sperms in semen analysis Previous treatment – Husband took lot of medications for 1 year. DIAGNOSIS –OA BY TRUS Treatment Correct diagnosis Testicular Biopsy of husband – Sperms found Started IVF ICSI treatment Positive pregnancy test after 2 weeks of embryo transfer Transvaginal ultrasonography – Intrauterine single live pregnancy!.

[Audio] CASE-A 31-year-old man was admitted to the hospital because of sterility. The patient was the oldest of three normal siblings born to consanguineous healthy parents. He had normal phenotypic features with unremarkable medical history. He had tall stature (height, 193 centimeters; weight, 74 kilograms) with an arm span of 206 centimeters. Endocrinological testing demonstrated increase in the F-S-H and LH levels (26.5 and 16.9 mIU/mL, respectively), and a very low level of testosterone (1.8 ng/mL). Seminal analysis revealed azoospermia. Case 2 ampere 30-year-old man visited our outpatient clinic complaining of infertility of 4 years' duration. There was no family history of similarly affected members. The parents were cousins. Physical examination revealed a normal male with a height of 187 centimeters and a weight of 71 kilograms. Both testicular volumes were 14 ml. Measurement of serum hormone levels demonstrated normal values for LH (4.2 mIU/mL) and testosterone (6.8 ng/mL) with elevated level of F-S-H (21.3 mIU/mL). Seminal analyses revealed severe oligozoospermia with a sperm concentration of 0.7 × 106/ml (4.9 × 106/ejaculate), 24% motility, and 5% normal morphology. Case 3 ampere 30-year-old man with 4 years of primary infertility due to oligozoospermia 1.3 × 106/ml (8.5 × 106/ejaculate), 18% normal motility and 4% normal morphology. He is the first boy born to non consanguineous parents with two normal brothers. No family history of similarly affected members. Blood work results included high F-S-H and LH, (19.3 and 17.3 mIU/ml, respectively), and low testosterone (2.8 ng/ml)..

[Audio] Case 4 ampere 40-year-old man presented with 3 years of primary infertility. He is the youngest boy born of non consanguineous marriage with two normal brothers. There were no relevant findings regarding his past history and habits. The family history was unremarkable. Results on physical examination and ultrasound analysis of his genitourinary system were normal, with normal testicular volume. Results on hematologic and biochemical parameters were normal. Levels of F-S-H and LH were high (14.5 and 18.6 mIU/ml, respectively) and testosterone level was within low normal limit (3.6 ng/ml). Two semen analyses demonstrated oligozoospermia with a sperm count of 2.5 × 106/ml (8 × 106/ejaculate), 25% normal motility and 4% normal morphology. Cytogenetic features Chromosomes studies with conventional cytogenetic analysis revealed numerical chromosomal abnormalities in the above mentioned four patients. The GTG-banding revealed the abnormal non-mosaic 47,XYY karyotype in metaphase cells in all four patients . The presence of extra Y chromosome was confirmed by fish analysis, using fluorescence-labeled X and Y centromeric probes..

[Audio] In general, 47,XYY is not inherited, but usually occurs as a random error in chromosome separation during the formation of sperm cells, leading to formation of sperm cells with an extra copy of the Y chromosome. If one of these peculiar sperm cells contributes to the genetic makeup of a child, the child will have an extra Y chromosome in each of the body's cells [9]. In some cases, the addition of an extra Y chromosome results from nondisjunction during cell division during a post-zygotic mitosis in early embryonic development. This can produce 46,XY/47,XYY mosaics [9]. Men with a 47,XYY karyotype are generally fertile and there is no evidence of transmission of the extra Y chromosome to their progeny because the supernumerary Y-chromosome is eliminated during meiosis. So here the diagnosis was of 47 xyy chromosomal anomaly with severe oligo or azoospermis was the underlying cause of infertility , Treatment would be-u can put some trials of icsi with ivf. Or can opt for donor sperm if no sperms found in tese ..

[Audio] C-A-S-E -A 29-year-old man and a 26-year-old woman came to an infertility center in Maharashtra, India, after three years of marriage. They had been trying to conceive for the past three years without using any contraception. The primary concern of the couple was seeking infertility treatment, and they denied donor sperm or oocytes. There were no particular symptoms regarding infertility in the woman. They received a description of all treatments, benefits, and drawbacks, and informed consent was obtained. Clinical history The couple had a history of a failed in vitro fertilization (I-V-F--) cycle in 2022. The female partner had regular menstruation cycles of ±28 days and no documented problems with conception, indicating that the problem was probably associated with the male partner’s fertility. The male had a history of bilateral inguinal hernia repair over five years. He was diagnosed with congenital bilateral absence of the vas deferens (C-B-A-V-D) by a urologist, and the transrectal ultrasonography (T-R-U-S-) report showed the absence of a vas deferens. Urologists also recommended sperm cell retrieval techniques. They did not have any sexually transmitted diseases. There was no significant history of inherited conditions in immediate family members. The male patient consumed tobacco products and drank alcohol occasionally. The female partner led a healthy life..

[Audio] The patient’s semen analysis revealed a sperm concentration of 0/mL in 1.4 mL of semen. Multiple samples of semen from the patient were found to be free of spermatozoa. The fructose test was recommended to the patient to verify azoospermia. The test indicating the presence of fructose in the ejaculate The male patient was diagnosed with C-B-A-V-D based on the results of the semen-related examination and T-R-U-S-, which showed the absence of a vas deferens. SO HerE TREATMENT would BE IVF with I-C-S-I using tese OR mesa..

[Audio] tese is one of the most popular sperm retrieval techniques for azoospermia, including OA, because it requires no surgical skill. However, tese may cause some complications, such as postoperative pain, as well as testicular atrophy and reduced testosterone levels,Sperms can also be extracted using the mesa technique; non-motile spermatozoa were occasionally recovered. The micropuncture technique can be used to obtain a large quantity of uncontaminated sperm for I-C-S-I using mesa .MESA typically yields more sperm than tese, allowing for excess cells to be stored for future I-C-S-I cycles. tese should only be performed for men with OA when virtually no epididymal spermatozoa are present..

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