Male Infertility
• What is it?
• Why Evaluate
20% sole male factor
30% a shared factor
50% with a male factor
Male Infertility
Why evaluate?
• Improve chances naturally
• Improve chances with IUI or IVF
• Improve chances of future pregnancy
• Improve overall health
Male Infertility
-Why Evaluate?
• 2-5% have significant pathology
Male Infertility
-Why evaluate?
• Assess risk to offspring
Male Infertility
-Why evaluate?
• 28% of men with zero or low counts
had genetic abnormalities
• Y chromosome deletions always
transmitted
Male Infertility
-Why evaluate?
• It may be treatable- 70% of cases
are!
Male Infertility
-Why evaluate?
• There may be a cost saving
• Marginal cost:
Vasovasotomy $20,921
TESA/ICSI $73,146
Varicocelectomy $26,268
IVF/ICSI (47%) $62,260
Male Infertility
When?
• Timing
-After six months of timed intercourse
-At time of presentation
Male Infertility
How?
• What should be done?
•History- reproductive, sexual, medical, surgical,
family, infectious, toxic, pharmacologic, childhood,
traumatic
•Exam- weight, height, body hair, thyroid, cardiac,
lungs, abdomen, genitalia, testes, prostate,
neurologic
•Testing- Two semen analysis, gonadotropins, ASA,
WBC’s, SPA, SCSA, ultrasound, genetics
Male Infertility
Evaluation
Semen analysis
Male Infertility
How?
• Make a diagnosis
• Choose a treatment plan
Male Infertility
Common Diagnoses
• Varicocele
Male Infertility
Common Diagnoses
• Obstruction
Male Infertility
Common Diagnoses
• Genetic
•Y Deletions
•Klinefelters
•Translocations
•Cystic Fibrosis
Male Infertility
Common Diagnoses
• Hormonal
• Toxins
• Obesity
• Neurologic
• Idiopathic
Male Infertility
Treat
• Non surgical
• Surgical
Male Infertility
Treatment: Surgical
Vasal reconstruction
Male Infertility
Treatment: Surgical
Sperm retrieval
Male Infertility
Treatment: Surgical
Ejaculatory duct resection
Male Infertility
Treatment: Surgical
Electroejaculation
Male Infertility
Treatment: Surgical
Varicocele Ligation
Male Infertility
Treatment: Non surgical
Hypogonadotropic
hypogonadism
Male Infertility
Treatment: Non surgical
Hyperprolactinemia
Male Infertility
Treatment: Non surgical
Immunologic infertility
Male Infertility
Treatment: Non surgical
Ejaculatory/Erectile
disorders
Male Infertility
Treatment: Non surgical
Non specific
Gondadotropins
Antiestrogens
Aromatase inhibitors
Male Infertility
Treatment: Non surgical
Miscellaneous
L Carnitine
Nutrition
Vitamins
Male Infertility
Conclusion