Malady Wise

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Male Infertility 2024

HPMI Update

Male Infertility - Dr Andrew Hedges

Overview

  • 2nd largest cause of infertility in couples

  • 1 in 20 men = low sperm

  • 1 in 100 = no sperm

Why

  • Blocked / absent vas deferens

  • Low production / poor movement

How sperm

  • Pre-testes (Pit / Hypo) - LH / FSH

  • Testes (Genes, Undescended, Mumps)

  • Post-testes (Vasectomy, Infection, Cysts, Age)

History

  • Developmental + Puberty

  • Medical, surgical and reproductive

    • Trauma

    • Torsion

    • Undescended

  • Infections

    • STD, Respiratory (CF), Urinary

  • Medications

    • Anabolics, Chemotherapy

  • Occupation and habits

  • Family reproductive history

Lifestyle

  • Smoking

    • Toxic

    • Cadmium binds to sperm DNA within 30s = very toxic

    • Transgenerational evidence that DNA damage may cause greater burden of disease in offspring

    • Low chance of successful IVF pregnancy

  • Alcohol

    • Hard to quantity acceptable safe lower limit

    • Binge drinking = Formaldehyde measurable in semen the following day

    • Today’s sperm affected by habits over last 8 to 10 weeks

    • Leads to obesity

  • BMI

    • Insulin resistance > hormonal changes

    • Higher fat tissue = converting androgens to oestrogens

    • Obesity = inflammation = oxidative stress + sperm damage

  • Steroids

    • Anabolic = Inhibit sperm production

    • Stopping anabolics = hard, lead to fatigue

  • Environmental

    • Herbicides / fungicides

    • Vigilence with PPI for spray weeds etc

    • Fungicides e.g. mildrew treatment in fruit trees

    • MDF banned as causes cancers

    • Fuels, thinners, oils, coal dust

    • Heat

    • Non-ionising radiation

      • Cancer treatments

      • Mobile phones = reduces sperm count

    • Over exercise

Exam

  • Secondary sex characteristics

  • Penis, urethral meatus

  • Palpate testes and measure size, testicular consistency for cancers

  • Varicocoele

  • Presence of vas and epididymus

Semen Analysis

  • Normal

    • Volume > 1.5mL

    • pH > 7.2

    • Conc > 15 million / mL

    • Total > 39 mil

    • Motility > 32% progressive

    • Morphology > 47%

    • Antisperm AB < 50%

  • Minimum x 2 samples

    • Abstain 2 to 5 days

    • Collection to analysis 30 minutes

  • pH

    • Prostatic fluid acidic

    • Seminal vesicles alkalive

  • Non sperm cells

    • RBC

    • Leukocytes = inflammation

Results

  • Normal

  • No sperm

  • Low sperm

  • Significant abnormality

Investigations

  • Blood tests

    • Testosterone, LH, FSH, TFT, PRL

    • Genetic testing

      • CF

      • Karyotype

      • Y-Chromosome gene deletion

  • Ultrasound

    • Tumour and blockage

Sperm

  • Small

  • Limited repair mechanisms

Typical

  • Older men

  • Chronic medical issues

  • Obese

  • Oxidative stress

Treatment

  • No sperm

    • Hormonal therapy

      • Gonadotrophins

      • Androgens

      • Aromatose inhibitors

    • Antioxidants

      • CoQ10

      • Selenium

    • ICSI

    • Freeze for back up

    • Extended sperm search

Vasectomy reversal

  • Best results under 8 years

Donor sperm

  • Own

  • Donor pool

Referral

  • Semen analysis x 2 if able

  • Genetic test if you want