male%20infertility
MALE INFERTILITY

Infertility is the inability to conceive despite regular unprotected sexual intercourse for one year.

Male infertility as the sole cause accounts for 20% & 30-40% as a contributory factor to infertility in couples.

Causes include: hypothalamic pituitary disease, primary testicular disease, disorders of sperm transport, genetic disorders, idiopathic infertility, infections, immune system disorders, iatrogenic causes, and chronic illness.

Surgical Intervention

  • Should be considered in men w/ obstructive azoospermia, as studies have shown that surgical management offers restoration of patency
Procedures recommended for epididymal obstruction
  • Vasectomy reversal
  • Tubulovastomy
  • Scrotal exploration w/ microsurgical epididymal sperm aspiration & cryopreservation
  • Microsurgical reconstruction
    • Microsurgical intussusception tubulovasectomy is preferred for epididymal obstruction
Varicocelectomy
  • Considered for patients w/ varicocele w/ oligozoospermia, infertility of >2 years duration, or unexplained infertility
  • May be able to reverse sperm DNA damage, prevent further testicular function damage & androgen deficiency, improve spermatogenesis & semen quality, & enhance Leydig cell function
  • Studies have shown significant improvements in sperm analysis by as much as 60-80% after varicocelectomy, w/ confirmed pregnancy rate of 35-44% 1 year post-procedure
Sclerotherapy
  • Antegrade & retrograde sclerotherapy may be considered for patients w/ varicocele
Transurethral Resection of the Ejaculatory Ducts (TURED)
  • Used for large post-inflammatory obstruction & ducts emptying into an intraprostatic midline cyst
  • For obstructions due to intraprostatic midline cysts, intraoperative transrectal ultrasound may be used to incise or unroof the cyst
Orchidopexy/Orchiopexy
  • Surgical procedure used to treat undescended testis in both adults & children
  • Studies have shown that this procedure can successfully induce spermatogenesis in previously azoospermic men
  • Treatment w/in the first 2 year of life results in better spermatogenesis
Vasectomy Reversal
  • Involves reanastomoses of the vas to reverse vasectomy
  • Produces better results than MESA w/ IVF or ICSI in men w/ previous vasectomy
  • Microsurgical vasectomy reversal is required in patients w/ post-vasectomy proximal vasa obstruction
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Erectile dysfunction (ED) is a common condition defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance.1 It is one of the most common complaints in men’s sexual medicine, affecting both physical and psychosocial health and having a significant impact on the patient and partner’s quality of life.1 Moreover, ED is commonly associated with other comorbid conditions, including hypertension, dyslipidaemia and diabetes mellitus.1

Evaluation of ED should include a detailed medical and sexual history of the patient. 1 A discussion of the patient and partner’s preference and treatment goals is essential to better tailor treatment and improve patient satisfaction and adherence to treatment.2 Lifestyle modification and management of risk factors should precede pharmacotherapy, while first-line treatment with oral phosphodiesterase type 5 inhibitors (PDE5i) is well established for the management of patients with ED.1