SIG Endocrinology 2019 Chairperson Madhuri Patil Abnormalities that can be present in Semen Volume Low or High Viscosity Hyperviscous Count Absent or Low Motility ID: 774635
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Slide1
Management of Male Infertility
SIG Endocrinology 2019
Chairperson – Madhuri Patil
Slide2Abnormalities that can be present in Semen
Volume –
Low or High
Viscosity –
Hyperviscous
Count –
Absent or Low
Motility –
Low or Absent
Morphology –
High TZI
Agglutination –
Antisperm
antibody
Infection
Slide3Slide4Medical Rx
Slide5High estrogen levels in combination with low T levels impair proper spermatogenesis Elevated levels of E2 lead to feedback inhibition of the HPG axis, thus decrease LH, which is necessary for the production T, and FSH to optimize sperm production Anastrozole 1 mg daily, or letrozole 2.5 mg daily) increase T, decrease estrogen levels, and inhibit the peripheral metabolism of TEffective in restoring LH, FSH, and T levels, improving semen parameters, and re-establishing fertility
Medical therapy in treatment of OligoasthenospermiaUse of Aromatase Inhibitors
Slide6Ali A.
Dabaja, Peter N. Schlegel ; Transl Androl Urol 2014;3(1):9-16
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Slide7Medical Rx
Slide8Advantage of Antioxidants
Slide9Potential harm of Antioxidants
Slide10Treatment Options for Increased DFI
Minimize exposure to gonadotoxins hyperthermiaEg – smoking, medication, saunas, hot tubs
Antibiotics for semen infection
Vitamin (Antioxidant) supplementationVitamins C, ESeleniumFolateZinc
Varicocelectomy
ICSI with testicular spermCPR 44 % ( 8/18) in patients with > 15 % sperm DNA damage
Slide11Slide12Slide13ParameterIUIIVFICSIConcentration>10 million/ml1-10 million/ml< 1 million/mlTotal motile count> 5 million/ml1–5 million/ml< 1 million/ml24 hours sperm survival> 70 %< 70 %< 70 %TZI< 1.61.6 -1.84>1.84HOS> 60 %50 - 60 %< 50 %DFI <15 %15 – 30 %>30 %>60 % TESA/ICSI
Selection of treatment modality for male sub-fertility depends on
Slide14Slide15Slide16Ej
. Vol -
Altered pH
Ej
. Vol - N
pH - N
Urine for sperms
SPZ +
SPZ -
Retrograde Ejaculation
TRUS
FNAC
Suggestive of Obstruction/Absence
Congenital or Acquired
CFTR
Primary Testicular failure
Karyotype‘Y’ microdeletion
FSH
LH, T - N
LH T – /N
FSH – N/
FNAC
FNAC
AR
Mutation
Pituitary Imaging
Hormonal Analysis for HH
-
ve
+
ve
Functional HH
Genetic Analysis
Organic HH
Microadenoma
Empty Sells Syndrome
Normal
Pathologic
Deeper Analysis
Slide17Take Home Message
Slide18