File Name: male infertility causes and treatment .zip
His research interests include understanding the causes and developing modalities for the treatment of male infertility. His work has been recognized by a number of prestigious scientific bodies in the form of the Innovative Young Biotechnologist Award in from D. Dr Singh has more than research articles to his credit..
If you and your partner are struggling to have a baby, you're not alone.
Evaluation of male infertility is important to identify a cause and provide treatment if the etiology is correctable. If a specific treatment is not available or the origin of the male factor infertility is not correctable, other options such as assisted reproductive techniques ART may exist.
The pharmacist plays a vital role in identifying medications that contribute to male infertility, counseling the couple on medications used to treat infertility, and promoting healthy lifestyles that minimize infertility factors. The purpose of this article is to provide a broad overview of the etiology, evaluation, and treatment of male infertility. Infertility is defined as the inability to achieve conception despite one year of regular, unprotected intercourse.
The testicles contain Leydig, Sertoli, and germ cells, which are responsible for the production of sperm and the synthesis of testosterone.
The Sertoli cells line the seminiferous tubules in the testicles along with primitive germ cells. The principal role of the Sertoli cells is to provide germ cell support, initiate and sustain spermatogenesis, and regulate pituitary gland function.
Leydig cells are responsible for the production of testosterone necessary for spermatogenesis. The hypothalamic-pituitary-gonadal HPG axis is a complex system that regulates gonadal and sexual function. The hypothalamus is the integrative center for the reproductive hormonal axis; it secretes gonadotropin-releasing hormone GnRH , which releases luteinizing hormone LH and follicle-stimulating hormone FSH from the anterior pituitary. After release from the pituitary, LH interacts with receptors on the Leydig cell membrane in the testes to synthesize and secrete testosterone.
FSH binds to Sertoli cell membrane receptors to initiate and maintain spermatogenesis. Synthesis and release of gonadotropins are regulated by neuroendocrine signals from the central nervous system. Human reproduction requires fertilization of a mature ovum through introduction of sperm-containing semen via the vagina. During this event, penile erection and ejaculation are essential. The parasympathetic nervous system controls erectile function while the sympathetic nervous system is responsible for emission and ejaculation.
The seminiferous tubules, a tubular network within the testes, carry seminal fluid containing mature spermatozoa to the epididymis through the vas deferens to the ejaculatory ducts and into the urethra. Periurethral muscle contractions expel the seminal fluid out of the urethra and into the female reproductive tract.
Azoospermia is defined as the absence of spermatozoa in the seminal fluid. Causes of infertility in the azoospermic male may be categorized as pretesticular, testicular, or post-testicular. HH can arise from congenital GnRH deficiency, hemochromatosis, genetic disorders, pituitary and hypothalamic tumors, hormonal abnormalities, or medications. In addition, systemic disorders such as chronic illnesses, nutritional deficiencies, and obesity have been identified as causes of HH.
Testicular Deficiency: Testicular deficiency, sometimes referred to as nonobstructive azoospermia , is spermatogenic failure caused by conditions other than obstruction or HPG dysfunction. This category of dysfunction can be further subdivided into congenital, acquired, or idiopathic testicular failure. Congenital failure can manifest as anorchia, testicular dysgenesis, cryptorchidism, or genetic abnormalities. Acquired testicular failure can be the result of trauma, testicular torsion, orchitis, exogenous factors e.
Post-testicular Deficiency: Often referred to as obstructive azoospermia , post-testicular deficiency is due to either ejaculatory dysfunction or obstruction of sperm delivery. Semen analysis reveals a decreased number of spermatozoa, reduced sperm motility, and many abnormal forms of sperm.
These findings commonly occur together and are termed oligo-astheno-teratozoospermia or OAT syndrome. Idiopathic male infertility can be attributed to endocrine disruption due to environmental pollution, reactive oxygen species, or genetic abnormalities.
Numerous substances have been implicated as causes of infertility. Establishing cause and effect of medications is difficult due to confounding factors and small sample sizes. A number of medications have been identified as causes of male infertility including chemotherapy, antihypertensives, hormones, psychotropics, antidepressants, and antibiotics TABLE 1.
In addition, many vaginal lubricants have been shown to inhibit sperm motility and velocity potentially leading to infertility. Hydroxyethylcellulose-based lubricants, mineral oil, and canola oil lack these effects on sperm and may be recommended as alternatives. The American Urological Association AUA recommends an initial screening evaluation of the male partner of an infertile couple if pregnancy has not occurred within one year of regular, unprotected intercourse.
An earlier evaluation is reasonable if a known infertility factor exists or a male doubts his fertility potential. Men with secondary infertility are evaluated in the same manner as men who have never initiated pregnancy. The female partner should also undergo evaluation during this time period. The basic components for the evaluation of male infertility include a detailed review of patient history TABLE 2 , physical examination, at least two semen analyses, and hormonal assessment of the HPG axis.
During the physical examination, particular attention is given to body habitus and secondary sex characteristics. The scrotum, testes, and prostate are evaluated for signs of infection, obstruction, or varicocele.
Additional tests include transrectal or scrotal ultrasonography, post-ejaculatory urinalysis, and genetic testing, which are obtained on an individual basis when indicated. Semen analysis is the fundamental laboratory test in the evaluation of male infertility. These results may be compared with reference ranges and used to identify men with abnormal semen parameters who may benefit from ART such as intrauterine insemination IUI or in vitro fertilization IVF with or without intracytoplasmic sperm injection ICSI.
Men with normal semen analyses rarely have sperm that contribute to infertility. Some infertile men will have medically or surgically correctable causes, making natural conception possible with appropriate intervention.
Treatment is dependent on the underlying etiology and thus requires an accurate diagnosis for proper treatment. If a treatable or correctable infertility factor is identified, it should be corrected using appropriate medical or surgical therapies. Men with uncorrectable, untreatable, or unknown etiologies may benefit from ART. ART procedures have been used in the U. The risks associated with IVF-ICSI include ovarian hyperstimulation syndrome, multiple gestation, perinatal complications, and genetic disorders.
Pretesticular Deficiency: Hyperprolactinemia is the most common endocrine disorder of the hypothalamic-pituitary axis and is a known cause of HH. Fertility may be restored by normalizing prolactin serum concentrations.
Several drugs including dopamine antagonists, selective serotonin reuptake inhibitors, tricyclic antidepressants, and high-dose estrogen therapy cause hyperprolactinemia and should be discontinued if possible in this situation. Gonadotropins may be used to treat HH caused by hypothalamic or pituitary disease not associated with hyperprolactinemia.
Human chorionic gonadotropin hCG has biological activity similar to LH but has a longer half-life. Seminal fluid is evaluated for spermatogenesis every 2 to 4 weeks.
If sperm concentrations are unsatisfactory after 6 to 12 months of therapy, an FSH preparation should be added to hCG. Men using hCG should be warned of possible side effects such as gynecomastia, headaches, and mastalgia.
It is preferred because of similar efficacy and substantially lower costs when compared with r-hFSH. Although the hMG is generally well tolerated, headache, mastalgia, and injection site reactions have been reported. Once target testosterone levels are achieved, the dose is held constant; testicular volume and seminal fluid analyses are performed each month. Testicular Deficiency: Hypergonadotropic hypogonadism is due to dysfunctional testes and is characterized by elevated gonadotropins, low testosterone, and oligospermia or azoospermia.
This is also known as primary testicular failure. These patients rarely achieve paternity through natural conception due to seminiferous tubule damage. The treatment of varicocele has traditionally been considered controversial, and no consensus about the efficacy of interventions exists. Results from a recent randomized, controlled trial suggest that varicocelectomy in men with palpable varicocele s improves semen parameters and increases the odds of spontaneous pregnancy within 1 year when compared with observation.
IVF with or without ICSI may be considered when there is the need to treat a female infertility factor, regardless of the presence of varicocele and suboptimal semen quality. Idiopathic Infertility: There is no consensus on the correct management of idiopathic infertility. A variety of empiric medical therapies have been attempted to improve pregnancy rates TABLE 3 despite a lack of proven efficacy. According to an AUA survey of fertility specialists, clomiphene citrate, hCG, and anastrazole are the most commonly prescribed medications for idiopathic male infertility.
Infertility affects 8 million couples in the U. It is essential that both partners be thoroughly evaluated for causes to optimize treatment and minimize morbidity associated with possible underlying medical conditions. Advances in ART have improved outcomes for severely infertile couples, but further research is needed to better understand unknown causes of male infertility and to develop more effective treatments.
American Urological Association. The optimal evaluation of the infertile male: AUA best practice statement. Revised Accessed February 14, The evaluation of the azoospermic male: AUA best practice statement. Accessed February 6, European Association of Urology.
Guidelines on male infertility. Updated April Accessed November 29, Frey KA. Male reproductive health and infertility. Prim Care Clin Office Pract. Infertility: the male. In: Legato MJ, ed. Principles of Gender-Specific Medicine.
Amsterdam, Netherlands: Elsevier; An update on the clinical assessment of the infertile male. Molina PE. Chapter 8. Male reproductive system. In: Molina PE, ed. Endocrine Physiology.
Sarem Journal of Medicine
Sarem Journal of Medicine. Remember me Create Account Reset Password. Akhtarkhavari T, Behjati F. Role of Epigenetics in Male Infertility. Akhtarkhavari 1 , F. Introduction Male infertility is a complex clinical condition that involves various causes, such as anatomical forms, infections, traumatic injuries, disorders in the endocrine, immune system problems, and genetic defects. Idiopathic infertility in men refers to infertile patients who do not have previous medical history and their semen analysis is also normal.
To date, various treatments have been developed for male infertility and are steadily producing results. However, there is no effective treatment.
Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species mostly haplodiploid insects. In humans, infertility is the inability to become pregnant after one year of intercourse without contraception involving a male and female partner. Male infertility is most commonly due to deficiencies in the semen , and semen quality is used as a surrogate measure of male fecundity. Women who are fertile experience a natural period of fertility before and during ovulation , and they are naturally infertile for the rest of the menstrual cycle.
Infertility is a term doctors use if a man hasn't been able to get a woman pregnant after at least one year of trying. Causes of male infertility include.
Evaluation of male infertility is important to identify a cause and provide treatment if the etiology is correctable. If a specific treatment is not available or the origin of the male factor infertility is not correctable, other options such as assisted reproductive techniques ART may exist. The pharmacist plays a vital role in identifying medications that contribute to male infertility, counseling the couple on medications used to treat infertility, and promoting healthy lifestyles that minimize infertility factors. The purpose of this article is to provide a broad overview of the etiology, evaluation, and treatment of male infertility. Infertility is defined as the inability to achieve conception despite one year of regular, unprotected intercourse.
Please understand that our phone lines must be clear for urgent medical care needs. When this changes, we will update this web site. Please know that our vaccine supply is extremely small. Problems with either of these may mean you have infertility.
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