1. MALE INFERTILITY AND IMPOTENCE

2. INCIDENCE OF INFERTILITY
50% are due to the female factor.
30% are due to the male factor.
20% are due to combined factors.

3. MALE FACTOR EVALUATION
History.
Physical
examination.
Laboratory
evaluation.
Imaging.

4. HISTORY
Infertility history
Sexual history
Childhood and development
Medical history
Surgical history
Drug history
Environmental history

5. PHYSICAL EXAMINATION
Inguinal
scars
varicocele
Presence of
vas
deferens
Epididymal
examination
Testicular
examination
Digital rectal
examination

6. ENDOCRINE EVALUATION
FSH
LH
Prolactin
Testosterone.

7. 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.

8. ULTRASOUND EVALUATION
Paratesticular
evaluation
Testicular
evaluation
Evaluation of the
seminal
vesicle,ejaculatory
ducts and vasal
ampulla

9. ETIOLOGY OF MALE INFERTILITY
Pretesticular
causes
(endocrine)
Testicular
(genetic)
Post-
testicular
(obstruction)

10. TREATMENT OF MALE INFERTILITY
• Specific therapy
• Replacement hormonal therapy.
• Empirical therapy
• Antiestrogens
• HCG
• HCG and FSH
• Steroids
• Kallikrein
• Pentoxyfylline
• antioxidants
Medical

11. SURGICAL TREATMENT
Varicocelectomy
Vasovasostomy
TUI of the ejaculatory ducts
ICSI
ICSI/TESE

12. ERECTILE DYSFUNCTION
 Incidence:
 52% of adult males between 40-70 years.

13. ANATOMY OF ERECTION

15. PHYSIOLOGY OF ERECTION
Sexual
stimulation
NO
cGMP
Sinusoidal wall
relaxation
Increase in
blood flow
Trapping of the
emissary veins
Rigid erection

16. ETIOLOGY OF ERECTILE DYSFUNCTION
Psychogenic Arteriogenic Venogenic
Hormonal Systemic drugs

17. DIAGNOSIS OF ERECTILE DYSFUNCTION
• Medical
history
• Sexual history
History

18. PHYSICAL EXAMINATION
General
Local
Penis
Testes
DRE

19. INVESTIGATIONS
 Laboratory
Imaging
Penile duplex study
Cavernosometry
Arteriography
 Others
rigiscan
Intracavernosal injection

20. TREATMENT
Managing modifiable causes
Oral drugs
Vacuum erection devices
Intracavernosal injection of vasoactive substance
Intrathecal injection of a vasodilator pillet
Penile implants(prosthesis)

21. VACUUM ERECTION DEVICE

22. PENILE PROSTHESIS