Male Infertility

Spermatogenesis - Male reproductive physiology

Spermatogenesis is a complex process by which primitive, totipotent stem cells divide to either renew themselves or produce daughter cells that become spermatozoa. These processes occur within the seminiferous tubules of the testis. In fact, 90% of testis…    

Male reproductive physiology - Meiosis and Mitosis

Basic Processes

Somatic cells replicate by mitosis, in which genetically identical daughter cells are formed. Germ cells replicate by meiosis, in which the genetic material is halved to allow for reproduction. Meiosis and sexual reproduction…    

Male reproductive physiology

The Hypothalamic-Pituitary-Gonadal Axis

The physiology of the hypothalamic-pituitary-gonadal (HPG) axis plays a critical role in each of the following processes, the last 2 of which are relevant for reproduction:

1. Phenotypic gender development during…    

Male Infertility

Introduction
Infertility is defined as the inability to conceive after 1 year of unprotected sexual intercourse. Infertility affects approximately 15% of couples. Roughly 40% of cases involve a male contribution or factor, 40% involve a female…    

Male Infertility - Assisted Reproductive Technologies

If neither surgery nor medical therapy is appropriate for male infertility treatment, assisted reproductive techniques can be used to achieve a pregnancy.

Intrauterine Insemination

Intrauterine insemination (IUI) involves the placement of a washed…    

Male Infertility - Empiric Medical Therapy

In at least 25% of infertile men, no identifiable cause can be attributed to the problem. Because the pathophysiology is ill-defined, this is termed idiopathic infertility. There is a second group of men in whom a cause of…    

Nonsurgical Treatments of Male infertility

Specific Therapy

Specific therapy seeks to reverse known pathophysiologic effects to improve fertility. For the most part, they are cost-effective treatments.

A. Pyospermia
The presence of elevated numbers of leukocytes in semen…    

Orchidopexy - Surgical Treatments of Male infertility

An undescended testis occurs in 0.8% of male infants at 1 year of age. Spontaneous descent into the scrotum is unlikely after 1 year. Although the most important reason for orchidopexy is to make testicles with a higher…    

Electroejaculation - Surgical Treatments of Male infertility

A complete failure of emission and ejaculation occurs most commonly from spinal cord injury (10,000 cases/ year in the United States) and as a result of deep pelvic or retroperitoneal surgery that injures the pelvic sympathetic nerves. With…    

Ejaculatory Duct Obstruction - Surgical Treatments of Male infertility

For over 20 years, transurethral resection of the ejaculatory ducts (TURED) has been used to relieve pain due to ejaculatory duct obstruction. More recently, it has become obvious that ejaculatory duct obstruction causes infertility in 5% of azoospermic…    

Treatment of Male infertility

Surgical Treatments

The role of surgery in the treatment of male infertility is well established and cost-effective when compared to high-technology approaches. Surgery also attempts to reverse specific pathophysiologic effects and may allow for conception at…    

Vasovasostomy - Surgical Treatments of Male infertility

About 35,000 men per year undergo vasectomy reversal in the United States. The most common reason is remarriage and the desire for more children. Occasionally, an unfortunate individual will have lost a child and desire another. Infection, deformities,…    

Disorders of Coitus - Causes of Male infertility

A. Impotence
Sexual dysfunction stemming from low libido or impotence is a frequent cause of infertility. The male hormonal evaluation can detect organic reasons for such problems. Most cases of situational impotence, in which the stress…    

Disorders of Sperm Function or Motility

A. Immotile Cilia Syndromes
Immotile cilia syndromes are a heterogeneous group of disorders (1:20,000 males) in which sperm motility is reduced or absent. The sperm defects are due to abnormalities in the motor apparatus or axoneme…    

Posttesticular Causes of Male infertility

POSTTESTICULAR

(Table 42-14)

Reproductive Tract Obstruction

The posttesticular portion of the reproductive tract includes the epididymis, vas deferens, seminal vesicles, and associated ejaculatory apparatus.