Sabanegh / Jr. Male Infertility

Problems and Solutions
1. Auflage 2010
ISBN: 978-1-60761-193-6
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 136 Seiten

Reihe: Current Clinical Urology

Male Infertility: Problems and Solutions provides a summary of state of the art developments in male infertility for both new and experienced practitioners. Written in a clear, concise and readable style, this volume allows the reader to obtain rapid answers to this challenging medical issue. Special emphasis is placed on diagnostic and treatment algorithms. Topics covered include interpretation of semen analysis and advanced testing, endocrine and genetic evaluation, diagnosis of azoospermia as well as an up-to-date interpretation and analysis of the many new therapies available for the treatment of male factor infertility. Male Infertility: Problems and Solutions provides rapid acquisition of pertinent background and development of management plans through the use of concise discussion and treatment algorithms and thus will be of great value to general urologists, gynecologists, primary care providers and allied health providers who manage infertility in both men as well as women.

Autoren/Hrsg.

Sabanegh, Jr.

Jr.,

Inhaltsverzeichnis

1;Preface;6
2;Acknowledgments;8
3;Contents;10
4;Contributors;12
5;The Initial Consultation for Male Infertility;14
5.1;Introduction;14
5.2;Male Infertility;14
5.3;Sexual History;16
5.4;Developmental and Childhood History;17
5.5;Infection History;17
5.6;Medical History;18
5.7;Surgical History;20
5.8;Social History;20
5.9;Medications;21
5.10;Physical Exam;21
5.11;Summary;22
5.12;References;22
6;Interpretation of Basic Semen Analysis and Advanced Semen Testing;27
6.1;Introduction;27
6.2;Basic Semen Analysis;27
6.2.1;Macroscopic Parameters;28
6.2.2;Microscopic Parameters;28
6.2.3;Sperm Concentration;29
6.2.4;Sperm Motility;29
6.2.5;Sperm Morphology;29
6.2.6;Nonsperm Cellular Components;30
6.3;Sperm Motion Kinetics;30
6.4;Investigations for Antisperm Antibodies;31
6.5;Sperm Function Tests;31
6.6;Evaluation of Oxidative Stress;32
6.7;Assessment of DNA Integrity;32
6.8;Summary;33
6.9;References;33
7;Azoospermia: Diagnosis and Management;35
7.1;Introduction;35
7.2;Initial Evaluation;35
7.2.1;History and Physical Exam;35
7.2.2;Semen Analysis;36
7.2.3;Serum Hormonal Evaluation;36
7.3;Genetic Testing;37
7.3.1;Y Chromosome Microdeletions;37
7.3.2;Karyotype;37
7.3.3;CFTR Gene Mutation Screening;37
7.4;Diagnosis;37
7.5;Common Causes of Azoospermia;39
7.5.1;Obstructive Causes;39
7.5.1.1;Iatrogenic Causes;39
7.5.1.2;Ejaculatory Duct Obstruction;39
7.5.1.3;Congenital Bilateral Absence of the Vas Deferens;39
7.5.2;Nonobstructive Causes;40
7.5.2.1;Klinefelter’s Syndrome;40
7.5.2.2;Azoospermia Secondary to Cancer Therapy;40
7.5.2.3;Hypogonadotropic Hypogonadism;40
7.6;Ejaculatory Dysfunction;41
7.7;Summary;41
7.8;References;41
8;Ejaculatory Dysfunction;43
8.1;Introduction;43
8.2;Normal Ejaculation;44
8.3;Types of Ejaculatory Dysfunction;44
8.3.1;Premature Ejaculation;44
8.3.2;Idiopathic Anejaculation/Anorgasmia;44
8.3.3;Neurogenic Anejaculation;44
8.3.4;Retrograde Ejaculation;45
8.4;Evaluation of Ejaculatory Dysfunction;45
8.5;Interventions for Ejaculatory Dysfunction;46
8.5.1;Medications;46
8.5.2;Artificial Insemination for Retrograde Ejaculation;46
8.5.3;Penile Vibratory Stimulation;46
8.5.4;Electroejaculation;47
8.5.5;Surgical Sperm Retrieval;47
8.6;Choice of Sperm Retrieval Technique;47
8.7;Diagnostic and Treatment Algorithms;48
8.8;Summary;48
8.9;References;50
9;Genetic Issues with Male Fertility;51
9.1;Introduction;51
9.2;In Whom Do We Look?;51
9.3;What Are the Tests that Can Be Done?;52
9.4;What Does a Positive Result Mean?;53
9.5;What Can We Do About It?;55
9.6;Conclusion;56
9.7;References;56
10;Endocrinopathies in Male Infertility;58
10.1;Introduction;58
10.2;Physiologic Regulation of the Hypothalamic–Pituitary–Testicular Axis;59
10.3;Evaluation and Testing;59
10.4;Hyperprolactinemia;60
10.5;Hypogonadotropic Hypogonadism;60
10.5.1;Failure of Hypothalamus;60
10.5.2;Pituitary Insufficiency;60
10.5.3;Other Syndromes Leading to Hypogonadotropic Hypogonadism;60
10.5.4;Isolated Luteinizing Hormone or Follicle-Stimulating Hormone Deficiency;61
10.6;Hypergonadotropic Hypogonadism;61
10.6.1;Klinefelter Syndrome;61
10.6.2;Gonadal Toxicity;61
10.6.3;Inactivating Luteinizing Hormone–Follicle-Stimulating Hormone Receptor Mutations;61
10.7;Hypogonadism with Normal or Elevated Testosterone;62
10.7.1;Infertility Associated with Exogenous Testosterone Therapy;62
10.7.2;Androgen Receptor Defects and Androgen Insensitivity Syndromes;62
10.7.3;Congenital Adrenal Hyperplasia;62
10.7.4;Leydig Cell Tumors;63
10.8;Treatment Options;63
10.8.1;Treatment of Hyperprolactinemia;63
10.8.2;Treatment of Hypogonadotropic Hypogonadism;63
10.8.3;Treatment of the Endocrinopathy Associated with Klinefelter Syndrome;64
10.9;Conclusions;64
10.10;References;65
11;Female Fertility: Implications to Management of Male Factor;67
11.1;Evaluation;67
11.2;Ovulatory Dysfunction;68
11.3;Tubal Disease;69
11.4;Uterine Factors;70
11.5;Endometriosis;71
11.6;Unexplained Infertility;71
11.7;References;72
12;Varicocele: To Fix or Not to Fix;74
12.1;Introduction;75
12.2;Incidence;75
12.3;Etiology of Varicocele;76
12.4;Pathophysiology and Typical Testicular Histological Abnormalities in Men with Varicocele;77
12.4.1;Seminal Reactive Oxygen Species/Antioxidants Imbalance (Oxidative Stress);78
12.5;Varicocele – Is it a Reason for Infertility?;79
12.6;Diagnosis of Varicocele;79
12.7;Clinical Treatment for Varicocele – When and Which Drug?;80
12.8;Subclinical Varicocele: A Different Entity;80
12.9;Surgical Versus Embolization Approach;80
12.10;Azoospermia and Varicocele;81
12.11;Improvement in Semen Parameters After Varicocelectomy: Is There an Improvement with Assisted Fertilization?;81
12.12;Varicocele in the Adolescent;82
12.13;There Is a Benefit of Surgery for Couples with a Clear Indication of Assisted Fertilization;83
12.14;Best Patient to Benefit from Surgery;83
12.15;Conclusions;84
12.16;References;84
13;Medical Management of Male Infertility;89
13.1;Introduction;89
13.2;Endocrinopathies;89
13.2.1;Hormonal Deficiency;90
13.2.1.1;Hypogonadotropic Hypogonadism;90
13.2.1.2;Hypothyroidism;90
13.2.2;Hormonal Excess;91
13.2.2.1;Androgen Excess;91
13.2.2.2;Estrogen Excess;91
13.2.2.3;Thyroid Excess (Hyperthyroidism);91
13.2.2.4;Prolactin Excess (Hyperprolactinemia);91
13.3;Infection and Inflammation;92
13.4;Ejaculatory Dysfunction;93
13.5;Erectile Dysfunction;94
13.6;Medications and Substances That Impair Male Fertility;94
13.7;Conclusion;94
13.8;References;95
14;Surgical Reconstructions for Obstruction;97
14.1;Introduction;97
14.2;Anatomy, Physiology, and Pathology of the Excurrent Ductal System;98
14.3;Etiology of Ductal Obstruction;99
14.4;Reconstructive Procedures;99
14.4.1;Types of Reconstruction: Vasovasostomy(VV) Vs. Vasoepididymostomy(VE);99
14.4.2;Operative Planning;99
14.4.3;Modified One-Layer Vasovasostomy (Fig. 2);100
14.4.4;Multi-Layer Vasovasostomy (Fig. 3);100
14.4.5;Microscopic Vasoepididymostomy (Fig. 4);101
14.4.6;Microsurgical Reconstruction Outcomes;103
14.5;Summary;104
14.6;References;105
15;Techniques for Sperm Harvest;107
15.1;Introduction;107
15.2;Ejaculatory Dysfunction;107
15.3;Technique of Rectal Probe Electrostimulation;108
15.4;Obstructive Azoospermia;109
15.5;Percutaneous Sperm Retrieval Techniques;109
15.6;Microsurgical Epididymal Sperm Aspiration;110
15.7;Nonobstructive Azoospermia;110
15.8;Fine Needle Aspiration with mapping;111
15.9;Open Testicular Sperm Extraction;111
15.10;Processing of Testicular Tissue Samples;113
15.11;Summary;113
15.12;References;114
16;Sperm Banking: When, Why, and How?;115
16.1;Why and When Do Men Need to Bank Their Sperm?;116
16.1.1;Couples;116
16.1.2;Patients with Cancer;117
16.2;Factors That Prevent Patients from Sperm Banking;118
16.3;How Does Sperm Banking Work: Techniques of Semen Cryopreservation;118
16.3.1;Preparation and Preselection;119
16.3.2;Rapid Freezing;119
16.3.3;Slow Freezing;119
16.3.3.1;Vitrification;121
16.4;Advantages and Disadvantages of Cryoprotectants;121
16.4.1;Glycerol;121
16.4.2;TEST-Yolk Buffer;122
16.5;The Effect of Cryopreservation on Sperm Characteristics;122
16.6;ART Outcomes with Banked Semen Specimens;123
16.6.1;Advantages of ICSI and Use of Cryopreserved Spermatozoa;123
16.6.2;Challenges and Risks Associated with Cryopreservation;124
16.7;Conclusion;124
16.8;References;124
17;Assisted Reproduction and Male Factor Fertility: Which Type Is Right?;127
17.1;Intrauterine Insemination;127
17.2;IUI Outcomes;128
17.3;In Vitro Fertilization/Intracytoplasmic Sperm Injection;129
17.4;Summary;130
17.5;References;130
18;Ethical Dilemmas in Male Infertility;132
18.1;In Vitro Fertilization and Intracytoplasmic Sperm Injection;132
18.2;Posthumous Sperm Retrieval;133
18.3;Donor Insemination;134
18.4;Conclusion;135
18.5;References;135
19;Index;136