Male infertility

Question 1

Basic investigations in infertile couple

Answer 1

Serum Progesterone on D22
Semen analysis
Tubal patency - HSG on D7-10

In female above 35 y/o - ovarian reserve

Question 2

Definition & Mx of unexplained infertility

Answer 2

Normal basic investigations

Mx - CC + IUI

Question 3

Causes of Male infertility

Answer 3

Mcc - abnormal spermatogenesis due to testicular causes

Mc reversible - Varicocele

PRE TEST

Endocrine - gonadotropin deficiency, thyroid dysfunction, hyperPRLemia

Psychosexual - Impotence, ED

Drugs - Anti-HTN, antipsychotics

Genetic

TESTICULAR

Immotile cilia syndrome
Cryptorchidism
Mumps orchitis
Toxins
RT
Primary test. failure
Sertoli cell only syndrome
Oligoasthenoteratozoospermia

POST TESTICULAR

Vasectomy
Congenital absence of vas
Young’s synd
Retrograde ejac
Bladder neck sx

Question 4

Test for quality of sperms

Answer 4

Sperm DNA Fragmentation Test

Question 5

Semen Analysis parameters

Answer 5

1.4 mL
16 mill/mL
39 mill/ejac
7.2 pH
4% morphology (STRICT TYGERBERG)
42% total motility
30% progressive motility
54% viability

Question 6

Pathway of sperm

Answer 6

Testis
Epididymis
Vas def
Seminal vesicle
Prostate
Bulbourethral

Thru ejac duct

Question 7

IUI

Answer 7

Pre requisite - 10 mill/mL
14% morphology

Swim up
Swim down
Density centrifugation
Glasswool filtration

Done in:
Cervix anomalies
Ejac abnormalities

Indications:

Oligospermia (less than 16 mill/mL)
Ejac causes - hypospadias
Retrograde ejaculation

Vaginismus
Anti sperm Antibodies in cx
Mild endometriosis

Question 8

IVF Indications

ICSI Indications

Answer 8

Oligospermia
Tubal cause of infertility
POI
Surrogacy in Mullerian agenesis

ICSI in SEVERE Oligospermia (less than 5mil)
Asthenospermia
Azoospermia