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ANDROLOGY

ANDROLOGY. Dr hab. Rafał Kurzawa CLINIC of REPRODUCTION and GYNECOLOGY POMERANIAN ACADEMY of MEDICINE. Epidemiologia niepłodności. Symptomatology of male infertility. TYPE I – erection problems (0,3-7%) TYPE II – azoospermia (0,9%-16%) TYPE III – immunological infertility (3,4%-25%)

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ANDROLOGY

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  1. ANDROLOGY Dr hab. Rafał KurzawaCLINIC of REPRODUCTION and GYNECOLOGY POMERANIAN ACADEMY of MEDICINE

  2. Epidemiologia niepłodności

  3. Symptomatology of male infertility • TYPE I – erection problems (0,3-7%) • TYPE II – azoospermia (0,9%-16%) • TYPE III – immunological infertility (3,4%-25%) • TYPE IV – abnormal seminal quality (23%-48%) • TYPE V – idiopathic sperm dysfunction (0-25%)

  4. Diagnosis • General examination • Semen analysis • Other diagnostic tests: • USG • Hormonal diagnostic • Diagnostic tests for Assisted Reproductive Technology

  5. TYPE I – erection problems (0,3-7%) • Normal ejaculation • Hypospermia (semen volume < 2,0 ml) – chronic prostatitis • Impotence • Retrograde ejaculation • Neurogenic– DM, SM • Anatomical • Jatrogenic – drugs, operations • disejaculation • Functional – anorgazmia • Neurogenic – spinal injury • Jatrogenic – drugs, chemiotherapy, radiotherapy, operations

  6. TYPE II – azoospermia (0,9%-16%) • Pre-testicular causes • Hypothalamic or pituitary disorder – LH, FSH deficiency, Kallman syndrome, trauma, tumors, inflammation, meningitis • Testicular causes • Primary testicular failure • Congenital – 47XXY, del Y, AZF • Acquired- mumps, testicular torsion, castration • Jatrogenic – radiotherapy, chemiotherapy • Post-testicular causes • Congenital – CBAVD, CF • Acquired – inflammations (gonorrhea) • Jatrogenic – vasectomy, hernia operation

  7. Diagnostic tests for Assisted Reproductive Technology- ICSI • FSH • If < 12IU – sperm biopsy is effective in 80-90% • Blocked ejaculatory duct (Micro-Epidydymal Sperm Aspiration –MESE) • Other (Testicular Sperm Extirpation- TESE, Testicular Sperm Aspiration- TESA)

  8. TYPE III – immunological infertility (3,4%-25%) • antisperm antibodies – the immune system may produce antibodies that attack and weaken or disable sperm • Auto-immunological diseases • Concequences of testicular trauma

  9. Congenital Undescended testicles Sexually transmitted disease (gonorrhoea) or testicular infection (mumps) Vascular Testicular torsion Varicocoeles Diseases: Thyroid faiure; Addison disease, hepar diseases; DM, auto-immunological diseases; Environmental factors Drugs (sulfasalazine, T, chemiotherapy) Temperature Other factors (X-rays, lead, cigarette smoke, alcohol; marijuana, frequently wearing tight-fitting pants and underwear) Immunological Testitis Genetic del Y, aberrations (count and structure of chromosomes) Idiopathic [46%] TYPE IV – abnormal sperm quality (23%-48%)

  10. Obraz morfologiczny

  11. Treatment • Risk factor elimination • Give up smoking • Testicular temperatue decrease • Regular sexual intercourses (2-3 per week) • Antioxydants • Vitamin E, C, Zinc • Tetracicline • Chlamydia Trachomatis infection

  12. Treatment (pharmacotherapy) • Risk factor elimination • Hormonal treatment • Testosterone • hCG • FSH • C.C, tamoxyphen

  13. Varicose veins in the spermatic cord • Physical examination • I Valsalva test examination ( or during cough) • II large veins during palpation • III visible varicouse veins • Other diagnostic test • Semen analysis (SA) • USG • Treatment • Operation • ART.: IUI, IVF, ICSI

  14. Diagnostic and therapeutic algorithm (female) Sperm analysis IUI Treatment: operation, CC, hMG (FSH) O, A, T, OA, OT, TA, OAT grave O, A, T, OA, OT, TA, OAT ICSI azoospermia Testicular cells? TESE, MESA

  15. Sperm analysis- recommendation by WHO • General female infertility diagnostic test- SA • sterility • sample should be delivered to laboratory in 60 min. after ejaculation • abstinence min. 48 hours max. 7 days • the next semen analysis between 7 days and 3 months

  16. liquefaction viscosity volume color pH smell Sperm count Sperm motion analysis WBC count (pyospermia) Spermatozoa count Antisperm antibodies Sperm morphology Microbiology Seminal quality, cytology and sperm quantitation

  17. Semen analysis • Microscope • Makler counting chamber • Immunobead test (IgG, IgA or IgM) • CASA (computer-assisted sperm analysis)

  18. Sperm motion analysis 0- immotile 1- weak movement with no forward progression 2- weak to moderate forward progression 3- good forward progression; active tail movement 4- rapid forward progression; vigorous tail movement

  19. Seminal quality- ranges • Liquefaction < 60 minutes • Volume > 2 ml • Color- gray to white opalescent fluid • pH 7,2 – 8,0

  20. IMMUNOBEAD TEST Microscopic polyacrylamide spheres, ranging in size from 2 to 10 um, coated with anti-human immunoglobins against human IgG, IgA or IgM

  21. Normal sperm range • Motility >50% 4 or 3 ; or >25% 4 • Sperm count >20·106/ml • WBC count <106/ml • Spermatozoa <5·106/ml • Autoagglutinating <10% • Immunebead test <10% • Sperm morphology >30% normal forms (WHO); 5-14% strict criteria (Kruger)

  22. Definitions of „abnormal” counts • Normozoospermia • Oligozoospermia <20·106/ml • Astenozoospermia <50% 4 or 3 ; or <25% 4 • Teratozoospermia <30% • Azoospermia no sperm

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