PREVENTION OF MALE INFERTILITY

1. PREVENTION
OF MALE
INFERTILITY
Aboubakr Elnashar
Benha university
hospital, Egypt
ABOUBAKR ELNASHAR

2. 1. INTRODUCTION
 Prevention
Better than cure.
An ounce of prevention is worth a pound of cure
Of infertility: neglected
Important in
developing countries
developed countries.
{Infertility tt including ARTs are expensive and their
availability is limited}
ABOUBAKR ELNASHAR

3. Significant proportion of infertility could be
prevented through
(WHO, 2011)
Standard public health measures
Prevention of infections
Prevention of iatrogenic infertility
(Schoysman R and Segal L, 1989)
ABOUBAKR ELNASHAR

4. Iatrogenic infertility
infertility caused by a physician’s actions: prescribed drugs, medical or
surgical procedure
(Serour et al, , 1997)
.
In Western Europe: 5%
(Schoysman R and Segal L, 1989)
In Egypt: 15.5%
(Serour et al, 2002)
ABOUBAKR ELNASHAR

5. 1. High prevalence of folk methods of infertility
2. High rates of medical malpractice
3. Unregulated private practices
offer considerable potential for making large profits from
infertile women, and this can attract doctors who are
more interested in wealth than ‘good practice’
4. lack of proper training of doctors in new
techniques
(Serour et al, 2002)
ABOUBAKR ELNASHAR

6. Level Definition Example
Primary
Methods to avoid
occurrence of disease by
1. eliminating disease
agents
2. increasing resistance to
disease.
1. Immunization
2. Healthy diet
3. Exercise
4. Avoiding smoking
Secondary
Methods to detect and
address an existing
disease prior to the
appearance of symptoms.
1. TT of
hypertension(risk
factor for CVD)
2. Cancer screenings
Tertiary
Methods to reduce
negative impact of
symptomatic disease:
disability or death, through
rehabilitation and tt.
Surgical procedures that
halt the spread or
progression of disease
 Levels of prevention
ABOUBAKR ELNASHAR

7. 2. PREVENTION OF MALE FACTOR
INFERTILITY
1. Environmental pollutants (oestrogens):
increasing rates
Cryptorchidism
Hypospadias
Germ cell tumours
Decline in sperm concentrations over the past
20–50 years.
Increase in maternal beef consumption inversely
related to sperm count.
ABOUBAKR ELNASHAR

8. ABOUBAKR ELNASHAR

9. 2. Undescended testes
40% rate of epididymal and vasal abnormalities,
compared with 0.5%–1% in the normal population.
Unilateral:
most are fertile but with a reduced sperm count.
Bilateral:
very poor prognosis for fertility.
Carcinoma in situ
Testicular germ cell cancer
Early orchidopexy, before the age of 5 y:
decrease this risk.
Retractile testes
IM (hCG): descend but not the cryptorchid testis
ABOUBAKR ELNASHAR

10. 3. Orchidopexy
Prevent recurrent testicular torsion.
4. Surgery in the inguinal region:
avoid injury of:
vas deferens or
testicular vessels
ABOUBAKR ELNASHAR

11. 5. Prophylactic Mumps, Measles, Rubella
Vaccination
 Protects against the development of mumps
orchitis: significantly affect spermatogenesis.
Chickenpox: severe orchitis.
ABOUBAKR ELNASHAR

12. 6. Orchitis
 Minimise testicular atrophy {raised intratesticular
pressure}.
Steroids (prednisoone at 40–60 mg/d): No
response: surgery to relieve pressure necrosis by
placing incisions in the tunica albuginea.
ABOUBAKR ELNASHAR

13. 7. Sexually Transmitted Diseases
Gonorrhoea:
irreversible obstruction of the spermatic ducts
Chlamydia trachomatis:
urethritis and epididymitis
condoms
ABOUBAKR ELNASHAR

14. 8. Trauma to the testes:
Permanent damage
Increase production of antisperm antibodies.
Men wear appropriate protection when
participating in contact sports.
ABOUBAKR ELNASHAR

15. 9. Varicocele Ligation
In male infertility: Controversy
In childhood or adolescence:
No justification for prophylactic ligation
ABOUBAKR ELNASHAR

16. 10. Occupational Factors
Toxic to spermatogenesis.
Metals:
Lead, cadmium and mercury
Pesticides:
dibromochloropropane, chlordecone and ethylene
dibromide
Inks, paint and adhesives:
Glycol ethers
ABOUBAKR ELNASHAR

17. 11. Drugs
Reversible effects
Permanent effects
Sulfasalazine Azulfidine (used in tt of inflammatory bowel
disease).
Alternative: Olsalazine (Dipentum)
β-blockers, methyldopa, captopril: impotence
Alternative: calcium channel blockers
ABOUBAKR ELNASHAR

18. 12. Before Chemotherapy and Radiotherapy
Alkylating agents
cyclophosphamide, procarbazine and cisplatin
Freezing sperm
Cryopreservation of spermatogenic stem cells
taken from the testes of prepubertal boys with
cancer: controversial {difficulties in taking informed
consent}
ABOUBAKR ELNASHAR

19. CONCLUSIONS
Prevention of male infertility
1.Reduce estrogenic pollutants
2.Early orchidopexy for undescended testis
3.Orchidopexy for recurrent testicular torsion.
4.Surgery in the inguinal region: avoid injury to the
vas deferens or testicular vessels
5.Prophylactic Mumps, Measles, Rubella
Vaccination: Protects against the development of
mumps
6.TT of Orchitis
ABOUBAKR ELNASHAR

20. 7. TT of STD
8. Avoid trauma to the testes
9. No justification for prophylactic ligation in
childhood or adolescence
10. Avoid Occupational Factors
11. Avoid Drugs affecting spermatgenesis
12. Sperm storage before Chemotherapy and
Radiotherapy
ABOUBAKR ELNASHAR