MALE

INFERTILITY

FR OM BENCH T O BEDSI DE

BY: T I A R A A Z H A R I A D N E

CHAPTER 1: INTRODUCTION

Approximately 8-15% of couples are unable to

conceive after 1 year of unprotected intercourse
A male factor is solely
responsible
in

20%

of infertile couples.

Male infertility is a common and complex

problem affecting

Male infertility can be due to a variety of conditions,

many, but not all, of which can be identified and treated

In 30-40% of cases, no male-infertilityassociated factor is found. These men

present with no previous history of diseases
affecting fertility and have normal findings on
physical examination and endocrine, genetic
and biochemical laboratory testing.

The evaluation for male infertility should expand on the

screening evaluation by including
complete medical history
physical examination

sometimes
semen analyses
endocrine evaluation
post-ejaculatory urinalysis
ultrasonography

CHAPTER 2: LITERATURE REVIEW

INFERTILITY inability of a sexually active, noncontracepting couple to achieve spontaneous

pregnancy in one year

EPIDEMIOLOGY
Infertility affects an estimated 15% of couples
globally, amounting to 48.5 million couples
A male factor is solely responsible
in

20%

of infertile couples

this number does not accurately represent all regions

of the world
unlike female infertility, male infertility is not well
reported

Males that are

reported
infertile

Couples that
are reported
infertile

Couples in which
the male factor is
one of multiple
factors involved

North America
4.5-6%a
Middle East
Unknown
Sub-Saharan Africa 2.5%-4.8%a

15%
Unknown
12.5%-16%

50%
60%-70%b
20-40%

Europe

7.5%a

15%

Australia

8%; 9%b
8%-12%

15%
20%

50% of all infertile

couples
40%
56%

Unknown
Unknown

Unknown
Unknown

37%
52%

Central/Eastern
Europe
Asia
Latin America

ETIOLOGY & RISK FACTORS

In many cases, the underlying causes are unknown (idiopathic)
Male fertility can be caused by associated factors which are :
genetic disorders
congenital or acquired urogenital abnormalities (primary spermatogenic failure,
obstructive azoospermia, varicocele)
malignancies
urogenital tract infections
hypogonadism
disorders of ejaculation

PRIMARY SPERMATOGENIC FAILURE

caused by conditions other than hypothalamic-pituitary
disease and obstruction of the male genital tract
Factors
Congenital

Causes
Anorchia
Testicular dysgenesis/cryptorchidism
Genetic abnormalities (karyotype, Y-chromosome deletions)

Acquired

Trauma
Testicular torsion
Post-inflammatory forms, particularly mumps orchitis
Exogenous factors (medications, cytotoxic or anabolic drugs,
irradiation, heat)
Systemic diseases (liver cirrhosis, renal failure)
Testicular tumour
Varicocele

Idiopathic

Surgery that may compromise vascularisation of the testes and

lead to testicular atrophy
Unknown aetiology