Professional Documents
Culture Documents
Male Infertility Presentasi
Male Infertility Presentasi
INHIBIN
FSH
LH
T PITUITARY/TESTIS
FEEDBACK SYSTEM
CONCENTRATION
T = Testosterone
LH = Leuteinizing Hormone (regulates T secretion)
FSH = Follicle Stimulating Hormone (regulates seminiferous tubule function)TIME
GnRH = Gonadotropin Releasing Hormone (regulates LH & FSH secretion)
INHIBIN from Sertoli cells feedsback on the pituitary to regulate FSH secretion
Male Reproduction:
Anatomy & Physiology
1. Sperm Production
2. Sperm Transport
SPERMATOGENESIS
1) SPERMATAGONIA
Stem cell (diploid) renewal and progression into meiosis.
2) SPERMATOCYTES
Cells enter meiosis (meiosis = a lessening) for reduction and
division ( two divisions in rapid succesion
{1 diploid cell becomes 4 haploid cells}).
Continued.
3) SPERMATIDS
After reduction & division, the diploid cells differentiate
towards becoming mature sperm, a process called spermiogenesis,
during which time they acquire a tail (flagellum) and acrosome that
develops from the Golgi body.
4) SPERM (Spermatazoa)
At completion of spermiogenesis, each spermatid dissengages
excess cytoplasm and is released into the lumen of the seminiferous
tubule (spermiation).
1) SPERMATAGONIA SPERMATOGENESIS
Ad
Stem cell renewal 16 days
4) SPERM
16d
Ap
SPERMIATION
Stem cell to SPERM (1 Day)
9d B 74 days
Spermiogenesis 25 days d
1d
Meiosis (24d)
d
MI MII Sa b c
8d
8d 2d 6d
2) SPERMATOCYTES
3) SPERMATIDS
SPERMATAGONIA Stem cell renewal
(Mitosis)
16 d
Ad
16 d
Ad 16 d
Ap Ad
SPERM
9d B
Meiosis
MI (24 d) SPERMATIDS d
1d
MII SPERMIATION
d
Sa b c
SPERMATOCYTES
8d
8d 2d 6d
Etiologic Factors in Male Infertility
Pretesticular
Endocrine Posttesticular
Erectile dysfuction Epididymal Hostility
Ejaculatory
Accessory GFland Infection
Immunologic
Testicular Vasal
Congenital Genetic
Antispermatogenic Agents Cystic Fibrosis
Vascular
Immunologic
Idiopathic
Genetic
Klinefelters Syndrome
Y Chromosome Microdeletions
Etiology of Male Infertility
Multi-factorial Prevalence
Varicocele 35%
Idiopathic 25%
Infection genito-urinary tract 10%
Genetic 10%
Endocrine 1 - 5%
Immunologic 1 - 5%
Obstruction 1 - 5%
Developmental 1 - 5%
Lifestyle: smoking, diet, heat ???%
Male Infertility: Evaluation
History
(Questionnaire)
Physical examination
Standard semen
analysis
Hormonal evaluation
Genetic counseling and
evaluation
Imaging studies
Semen Analysis:
World Health Organization Guidelines
1. A varicocele is palpable.
2. The couple has documented infertility.
3. The female has normal fertility or potentially correctable
infertility.
4. The male partner has one or more abnormal semen
parameters .
Infection
acute : smallpox, mumps, other viral
infections
chronic : TB, leprosy, prostatitis, sexually
transmitted diseases
There is a possibility infection with
mycoplasma,ureaplasma, or trichomonas, both
partners should be treated with doxycycline (100
mg orally twice a day for 10 days) or
metronidazole (2 g orally four times a day for 10
days).
Genetic
Y-chromosome
Y-chromosome
microdeletion
microdeletion
30% 30%
Endocrine