MALE INFERTILITY AND IMPOTENCE

INCIDENCE OF INFERTILITY

50% are due to the female factor.

30% are due to the male factor.

20% are due to combined factors.

MALE FACTOR EVALUATION

History.Physical

examination.Laboratory evaluation.

Imaging.

HISTORY

Infertility history

Sexual history

Childhood and development

Medical history

Surgical history

Drug history

Environmental history

PHYSICAL EXAMINATION

Inguinal scars

varicocele

Presence of vas deferens

Epididymal examination

Testicular examination

Digital rectal examination

ENDOCRINE EVALUATION

FSH

LH

Prolactin

Testosterone.

SEMEN ANALYSIS

Ejaculate volume: 1.5-5 cc

Sperm density (count): >20 million/cc

Motility>60%

Forward progression>2(scale 1-4)

Insignificant sperm agglutination

Insignificant pyospermia or hematospermia

No hyperviscosity.

ULTRASOUND EVALUATION

Paratesticular evaluation

Testicular evaluation

Evaluation of the seminal

vesicle,ejaculatory ducts and vasal ampulla

ETIOLOGY OF MALE INFERTILITY

Pretesticular causes (endocrine)

Testicular (genetic)

Post-testicular (obstruction)

TREATMENT OF MALE INFERTILITY

•Specific therapy•Replacement hormonal therapy.•Empirical therapy•Antiestrogens•HCG•HCG and FSH•Steroids•Kallikrein•Pentoxyfylline•antioxidants

Medical

SURGICAL TREATMENT

Varicocelectomy

Vasovasostomy

TUI of the ejaculatory ducts

ICSI

ICSI/TESE

ERECTILE DYSFUNCTION

Incidence: 52% of adult males between 40-70 years.

ANATOMY OF ERECTION

PHYSIOLOGY OF ERECTION

Sexual stimulation

NO

Increase in blood flow

ETIOLOGY OF ERECTILE DYSFUNCTION

Psychogenic

Arteriogenic

Venogenic

Hormonal

Systemic

drugs

DIAGNOSIS OF ERECTILE DYSFUNCTION

History•Medical history•Sexual history

PHYSICAL EXAMINATION General Local

Penis Testes DRE

INVESTIGATIONS Laboratory Imaging

Penile duplex study Cavernosometry Arteriography

Others rigiscan Intracavernosal injection

TREATMENTManaging modifiable causes

Oral drugs

Vacuum erection devices

Intracavernosal injection of vasoactive substance

Intrathecal injection of a vasodilator pillet

Penile implants(prosthesis)

VACUUM ERECTION DEVICE

PENILE PROSTHESIS