Accessory Glands and Infertility - PowerPoint Presentation

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Accessory Glands and Infertility

E.Mangoli

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Seminal vesiclesThe seminal vesicles are paired, elongate, and highly folded tubular glands located on the posterior wall of the urinary bladder, parallel to the ampulla of the ductus

deferens.

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Seminal vesiclesThe secretion of the seminal vesicles is a whitish yellow, viscous material. It contains:

fructose, which is the principal metabolic substrate for sperm

amino acids,

ascorbic acid,

prostaglandins: E, A, B, F

coagulating factor

semenogelin

1: sperm motility inhibitor, which is cleaved by PSA (

proteolytic enzyme) after ejaculation

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Contraction of the smooth muscle coat of the seminal vesicles during ejaculation discharges their secretion into the ejaculatory ducts and helps to flush sperm out of the urethra. The secretory function and morphology of the seminal vesicles are under

the control of testosterone.

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Prostate The prostate is the largest accessory sex gland of the male reproductive system. The gland is located in the pelvis, inferior to the bladder, where it surrounds the prostatic part of the urethra.

The prostate is composed of approximately 70% glandular elements and 30%

fibromascular

stroma

.

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ProstateIt consists of 30 to 50 tubuloalveolar glands arranged in three concentric layers:

an inner mucosal layer,

an intermediate

submucosal

layer,

a peripheral layer containing the main prostatic glands.

The glands of the mucosal layer secrete directly into the urethra; the other two layers have ducts that open into the prostatic sinuses located on either side of the urethral crest on the posterior wall of the urethra.

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Prostate The adult prostatic parenchyma is divided into four anatomically and clinically distinct zones:peripheral zone

central zone

transitional zone

periurethral

zone

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Prostate The prostate gland secretes: prostatic acid

phosphatase

(PAP),

fibrinolysin

, (serves to liquefy the semen)

citric acid,

prostate-specific antigen (PSA). (a serine protease)

polyamines: proliferation and growth

calcium, phosphate ion, clotting enzyme,

Profibrinolysin

,

zinc.

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Prostate The elevated levels of PSA are directly related to increased activity of the prostatic cancer cells. Increased blood levels of both PAP and PSA are used as markers of the presence and progression of the disease.

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Bulbourethral GlandsThe bulbourethral

glands secrete

preseminal

fluid

The paired

bulbourethral

glands (Cowper's glands) are pea-sized structures located in the

urogenital

diaphragm.The duct of each gland passes through the inferior fascia of the urogenital diaphragm and joins the initial portion of the penile urethra. The glands are compound tubuloalveolar glands that structurally resemble mucus secretory glands.

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Bulbourethral GlandsThe clear, mucuslike glandular secretion contains considerable amounts of :

galactose

and

galactosamine

,

galacturonic

acid,

sialic

acid, methylpentose. Sexual stimulation causes release of the secretion, which constitutes the major portion of the

preseminal

fluid and probably serves to

lubricate

the penile urethra.

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Seminal vesicleThe secretion from seminal vesicles contribute approximately 50-80 % of the ejaculate volume, with an average volume of 2.5 ml and a pH in neutral to alkaline range.

The average volume of semen: 3 ml (2-6)

Seminal vesicle: 1.5-2 ml

Prostate: 0.5 ml (15-30%)

Bulourethral

and

littre

glands: 0.1-0.2 ml

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The initial portion of the ejaculate contains the highest number of spermatozoa; is rich in acid phosphatase

, citric acid, and zinc; and has a lower pH due to prostatic fluid. The remainder of the ejaculate largely comprises seminal vesicle fluid, which contains a high concentration of fructose and has a higher

pH.

Normal pH

of collected semen ranges from

7.2 to 7.7

and becomes more alkaline after ejaculation and as time passes.

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Most seminal plasma is produced by the prostate and seminal vesicles, while the testis and epididymis contribute less than 5% of the total semen volume.A low ejaculate volume reflects abnormality of the prostate or seminal vesicles.

Fructose is produced by the seminal vesicles; thus the absence of fructose indicates either ejaculatory duct obstruction or

seminal vesicle

aplasia

/

hypoplasia

or

cogenital bilateral absence of the vas deferens.16

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Function of the Seminal VesiclesThis adds greatly to the bulk of the ejaculated semen, and the fructose and other substances in the seminal fluid are of considerable

nutrient value for the ejaculated sperm

until one of the sperm fertilizes the ovum.

Prostaglandins are believed to aid fertilization in two ways:

reacting with the female cervical mucus to make it more receptive to sperm movement

possibly causing backward, reverse peristaltic contractions in the uterus and fallopian tubes to move the ejaculated sperm toward the ovaries (a few sperm reach the upper ends of the fallopian tubes within 5 minutes).

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Function of the Prostate GlandA slightly

alkaline characteristic

of the prostatic fluid may be quite important for successful fertilization of the ovum, because the fluid of the vas deferens is relatively acidic owing to the presence of citric acid and metabolic end products of the sperm and, consequently, helps to inhibit sperm fertility.

Also, the vaginal secretions of the female are acidic (pH of 3.5 to 4.0). Sperm do not become optimally motile until the pH of the surrounding fluids rises to about 6.0 to 6.5.

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Obstructive AzoospermiaApproximately 10% of infertile men have blockages in the genital tract causing absence of sperm in the semen.

There are four major groups of causes of male genital tract blockages:

disorders of development of the

epididymis

, vas and seminal vesicles,

post inflammatory

epididymal

obstructions (especially from gonorrhea),

vasal obstructions (vasectomy) ejaculatory duct obstructions.

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A 20- 30% pregnancy rate can be expected from surgical treatment in which the obstruction is removed endoscopically, and 70% of men who undergo the procedure will achieve a significant improvement in semen quality.

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Examination of the prostate gland and seminal vesiclesExamination of the prostate

gland is by

rectal examination

preferentially with the man in the knee-elbow position.

The seminal vesicles are not normally palpable. If they are palpable and/or painful upon pressure this usually indicates inflammation. In general, seminal

vesiculitis

is accompanied by prostatitis.

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MALE ACCESSORY GLAND INFECTIONMale accessory gland infection (MAGI) is a general denominator for infection/inflammation of the prostate glands, seminal vesicles, and/or

epididymis

.

MAGI may result from infection by sexually transmitted pathogens (e.g., Chlamydia

trachomatis

) or, more commonly, trivial urinary pathogens such as E. coli, Proteus species,

enterococci

, or Pseudomonas species.

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MAGI and male infertilityInclude: prostatitis, orchitis,

epididimytis

,

urethritis

Potentially

curable

cause of male infertility

Controversy: Are these disease have a negative effect on sperm quality and male infertility

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epididymitis

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prostatitis

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MAGIDepending on the severity and the duration of the disease and on the site of infection, the effects on sperm quality and fertility are largely variable.

The prevalence of MAGI among infertile men is different (In Europe and in North America 8–10%).

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Clinical manifestations1- Urethritis

2- Epididymitis

3-

Prostatovesiculitis

4- Silent inflammation

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Causative micro-organisms1- Gonorrhea

2- Chlamydia

Trichomatis

3-

Mycoplasma

spp.

4-

Ureaplasma

Urealyticum5- E. Coli, 6- Proteus species, 7- Enterococci

,

8- Pseudomonas species.

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Effect of infection on fertility1- Direct damage

2- Inflammation

3- Increase ROS production

4-Obstruction of seminal ducts

5- Antibody formation

6- Ejaculatory dysfunction

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MAGIThe effects of MAGI on the fertilizing capacity of spermatozoa :

decreased ejaculate volume

increased viscosity

abnormal biochemical composition of the seminal fluid,

poor sperm motility,

low sperm concentration

high concentration of ROS, diminished production of antioxidants by the

epididymides

damage the sperm membrane with decreased acrosomal reactivity and poor capacity to fuse with the oocyte membrane and cause DNA damage.

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MAGISemen analysis may reveal: subnormal ejaculate volume,

increased viscosity,

alkaline pH,

low concentration of citric acid and of other markers of prostate function

below normal alpha-

glucosidase

activity in case of

epididymal

damage. poor sperm motility, low sperm count,

poor sperm morphology:

high number of round cells.

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MAGIThe diagnosis of MAGI is based on: medical history,

the physical examination,

echography

cytological and bacteriological analysis of urine and blood.

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MAGIMAGI should be treated for reasons of ‘‘good medical practice,’’ but the effects of treatment on sperm quality and fertility are limited.

Indeed, in the majority of cases, the function of the accessory sex glands is

irreversibly

damaged.

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Male accessory gland infection has different deleterious effects on fertility, depending on the site that is affected. Antibiotic treatment has little advantage for fertility, but is indicated for reasons of good medical practice if signs and symptoms of actual infection are found.

Complementary prescription of a specific combination of natural

antioxidants

and

anti-inflammatory

substances can help to correct some of the damage to spermatozoa caused by MAGI.

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THANCKS

FOR YOUR ATTENTIONS