Male Factor Infertility

Embryology/ MED 1104
Lecturer: Dr. Harris
Name: Jonelle James

Registration #: 13/0531/1046

. especially Jermaine James who assisted me in finding schematic representations of the development of the male reproductive system.Acknowledgement I would like to thank everyone who assisted me in the successful completion of this Embryology assignment.

TDF causes the primary sex cords to proliferate. The urogenital folds form the penile raphe. grow deeper into the mesenchyme. and become testis cords. and the labioscrotal swellings Schematic diagrams showing the form the scrotum. Somatic cells and primordial germ cells are found in the testis cords. 17. ductus deferens. and complete mesonephric and paramesonephric ducts lie side by side. The mesonephric ducts form the epididymis (which stores mature sperm). 11. proliferating mesenchyme around the cloacal membrane causes the overlying ectoderm to bulge so that three structures are visible externally – the phallus. lose their attachment to the surface epithelium. The testis cords are separated from the surface epithelium by the tunica albuginea (green). primordial germ cells (which migrate from the yolk sac and are of the XY genotype) infiltrate both gonadal ridges and are incorporated into the primary sex cords. primordial germ cells and sex cords are present in the cortical and medullary regions of the undifferentiated gonad. The somatic cells differentiate into Sertoli cells. In both sexes. The mesoderm between the seminiferous cords gives rise to Leydig cells. In the 6th week. This eventually proliferates and plays a part in the formation of various lobules of the testes.  Development of the External Genitalia Early in the fourth week. External genitalia are stimulated to form by DHT Development of the Male Reproductive (dihydrotestosterone) which is produced from testosterone. The sex of a baby can be determined at the 12th week. up until the seventh week. seminal vesicle and ejaculatory duct. tubuli recti and rete testis are formed from the testis cords (at puberty. bulbourethral gland/ Cowper’s gland and the prostate gland). which ensures that the mesonephric duct (Wolffian) does not regress. and 19 and the X chromosome (which play a part in THE gonadal development of males)). ridge-like protrusions are formed in the 5th week through the proliferation of the coelomic epithelium (forming primary sex cords) and the thickening of the underlying mesenchyme (which is part of the urogenital ridge). urogenital folds and the labioscrotal swellings. which are responsible for nourishing the spermatozoa and secreting antimüllerian hormone (which promotes the atrophy of the paramesonephric duct (Müllerian)). The rete testes are formed from the linking of the seminiferous cords and bind with the mesonephric tubules. These bilateral.The Development of the Male Reproductive System Migration of PGCs to gonadal ridges(10) Incorporation into primary sex cords(2) Growth of medullary sex cords due to TDF(2) Regression of paramesonephric duct due to MIF (4)  Development of the Testis and Genital Ducts The first indication of the development of the reproductive system is the appearance of the gonadal ridges (extend from the heart region to near the cloaca). They produce testosterone. The phallus is composed of the genital tubercle (forms the glans penis) and the urogenital sinus (forms the corpus spongiosum. The sex determining region of the Y chromosome (SRY gene) codes for testis-determining factor (the SRY gene acts as a master switch that controls the cascade of several gene activations on autosomes 9. System . the seminiferous cords will canalize and form the seminiferous tubules). The seminiferous cords.

   Underdeveloped Male Reproductive System (Congenital) Gonadal Abnormality Undescended Testes: the testes may fail to descend from the abdomen to the scrotum. cause erectile dysfunction and decrease sperm production. Gonorrhea and syphilis can also cause scarring that blocks the passage of sperm.  Absence of vas deferens/ other ducts involved in ejaculation  Abnormal epididymis – this is the site where sperm is stored until ejaculation. Antibodies that attack sperm: the body may produce anti-sperm antibodies that target sperms. Gonadal Agenesis: occurs when a child is born without gonads and as such will be unable to produce sperm. several factors may result in infertility: 1.  Urethral stricture – narrowing of the urethra. Causes of Male Infertility  Fully Developed Male Reproductive System Even though the genital system may have developed properly. some ulcer drugs and the prolonged use of marijuana and cocaine can impair sperm production. Certain medication/drugs: long-term anabolic steroid use. tuberculosis. Retrograde Ejaculation: semen is ejaculated into the bladder rather than out through the urethra because the bladder sphincter does not close during ejaculation. this is linked to infertility. This condition arrests sperm development.  1. Infections/ Diseases: infections can sometimes cause testicular atrophy (this is indicated by a shrinkage of the testes.high concentrations of the hormone reduce sperm production. Environmental causes: exposure to industrial chemicals.Male Factor Infertility Developing and transporting sufficient healthy and functional sperm depends on a specific sequence of events occurring in the male reproductive tract. poor testicular function and may disturb libido. 9. sperm may not upon the vagina upon ejaculation. reduces libido and may cause impotence. 3.  Hypothyroidism: 
 low thyroid hormone levels. poor sperm production and poor sperm health).  Hypogonadotropic hypopituitarism: 
 low pituitary gland output of LH and FSH.  Tobacco smoking  Emotional Stress – stress can influence hormone levels.lowers LH and FSH levels. Genetic Diseases o Klinefelter’s Syndrome: men with this syndrome have one Y and two X chromosomes. 4. Duct System Abnormality  Hypospadias/ Epispadias: conditions in which the opening of the urethra is not located at the tip of the penis. Many disturbances can occur along that path. influenza. premature ejaculation and ejaculatory incompetence. Problems with sexual intercourse: impotence. 7. 2. 3. External Genitalia Abnormality  Penile Agenesis: a birth defect in humans. gonorrhea.can cause poor semen quality. Varicocele: a varicocele is a swelling of the veins that drain the testicle. occurring about once in 5–6 million male births. certain antifungal medications.drinking alcohol can lower testosterone levels. 5. Reduced sperm count and fewer moving sperm results from this condition as there is impaired cooling of the testicle. 6.  Microphallus: a normally formed yet abnormally short penis. hormones that are needed to stimulate spermatogenesis. smallpox. 10. Tumors: cancers and nonmalignant tumors can affect the male reproductive organs directly or can affect the glands that release reproductive hormones.  Panhypopituitafism: 
 complete pituitary gland failure. The scrotum is usually normal but the testes are often small and undescended. As such. cancer medications. heavy metals and excessive radiation can reduce sperm production. . 8. resulting in male infertility (the inability of a male to achieve pregnancy in a sexually-mature female of the same specie). Causes linked to lifestyle  Alcohol use. Hormonal Imbalance  Hyperprolactinemia: 
 elevated prolactin. This results in peanut-sized testicles. Mumps. in which a male child is born without a penis. typhoid. and syphilis can cause testicular atrophy. 2.

Male infertility is generally indicated by a sperm count of zero/ a low sperm count and sperm with poor morphology and/or poor motility. In addition.Intra-cytoplasmic Sperm Injection (ICSI) Question: What is intra-cytoplasmic sperm injection? Answer: Intra-cytoplasmic sperm injection is an in vitro fertilization procedure in which a single sperm is injected directly into an egg for the purpose of fertilizing it. Screening It is recommended that men with a low sperm count undergo genetic testing before they proceed with ICSF. 2. as in the case of IVF. The fertilized egg is then transferred to the woman’s womb. Generally. sperm are selected from the sample and a single sperm is injected directly into each egg. they are surgically removed from a testicle. Question: Why is this procedure necessary? Answer: Intra-cytoplasmic sperm injection is generally performed when there is male infertility. Sperm can also be retrieved directly from the epididymis.  There is retrograde ejaculation. instead of fertilisation taking place in a dish. through a small incision. Sperm Collection Sperm for ICSI is usually collected via masturbation.  There was either failure of fertilisation or an unexpectedly low fertilisation rate at previous attempts at in vitro fertilisation. Question: How exactly is ICSI done? Answer: The procedure for intra-cytoplasmic injection is similar to that for in-vitro fertilisation. This method of sperm retrieval is done when there is a blockage that prevents sperm from being ejaculated. using a fine syringe. ICSI gives couples a chance of conceiving their own child when other options are closed to them. This process is known as ‘testicular sperm aspiration’ or TESA.the sperm are retrieved from the urine. If sperm cannot be collected by means of masturbation.  The male partner has had a vasectomy and sperm have been collected from the epididymis. Men with diabetes often experience this. Sperm Collection . a process known as ‘percutaneous epididymal sperm aspiration’ or PESA. the sperm is often examined under a microscope to determine if ICSF would increase a man’s chance of becoming a father. 1. intra-cytoplasmic sperm injection is recommended if:  The male partner has had problems obtaining an erection and ejaculating. In ICSI.

3. the dosage may change based on the oestrogen levels and ultrasound results. by the use of ultrasound. the incubation period lasts for 6 days ( in which cause a blastocyst is placed in the uterus). After the first week. At home. Several eggs may be fertilized in this way. A human chorionic gonadotropin (hCG) injection is usually given to stimulate the follicles to mature. a full day is spent at the hospital for the egg and sperm retrieval procedures. After culturing in the laboratory overnight. . In some cases. Ovulation and Egg Retrieval Fertility drugs are usually taken for 2 weeks before egg retrieval. Two to four are placed in the uterus using a thin flexible tube (catheter) that is inserted through the cervix. The remaining embryos may be frozen (cryopreserved) for future attempts. eggs are checked for evidence of fertilization. using needle aspiration guided by ultrasound through the abdomen to the ovaries. it is check to see whether eggs are maturing in the follicles. Sperm Selection The best sperm (excellent morphology and motility) are selected for injection into mature ova after performing specific tests. The mature eggs are collected 34 to 36 hours after the administration of hCG. the female partner is injected with folliclestimulating hormone (FSH) to stimulate the ovaries to produce multiple eggs (superovulation). a holding pipet (made of glass) is used to hold an egg in place. The embryo transfer procedure occurs two to six days later. 4. Sperm Injection Summary of the Process of IntraCytoplasmic Sperm Injection Question: How long does one cycle of intra-cytoplasmic sperm injection last? Answer: One cycle of ICSI takes between four weeks and six weeks to complete. the blood oestrogen level is measured and also. Usually. A microscopic glass tube containing sperm (injection pipet) is used to penetrate and deposit one sperm into the egg. After the incubation period (2-3 days). 5. the eggs that have been successfully fertilized (zygotes) are selected. Sperm Injection and Transfer Under high-power magnification. During the second week.

Multiple pregnancies are high-risk for both a mother and her fetuses. While ICSI treatment carries a slightly increased risk of birth defects.2% for women aged under 35 27. . which resulted in a live birth. Question: Does ICSI have any other disadvantages? Answer:  ICSI has been in use for a shorter time than IVF. There is some increased risk of a male baby having fertility problems in the future (this is because male infertility may be passed on genetically). the percentage of ICSI cycles for women using their own fresh eggs. It should be noted though that these occur in less than 1% of babies conceived using ICSI. Even is fertilization takes place. nausea and vomiting. the embryo may stop growing. Intra-cytoplasmic sperm injection (ICSI) success rates are very similar to in vitro fertilisation (IVF) rates. Question: If the first cycle of ICSI fails. and sex chromosome abnormalities. So experts are still learning about its possible effects.an ectopic pregnancy can still occur with eggs fertilized by ICSI.a mild reaction to fertility drugs may involve hot flushes. The ICSI procedure fertilises 50% to 80% of eggs.5% to 3% risk of major birth defect.the risk of a miscarriage after ICSI is no higher than after a natural conception.  Multiple births. Question: Is ICSI safe for the baby? Answer: A normal pregnancy comes with a 1. nor is the risk lower.  Ectopic Pregnancy. headaches and restlessness. are:       32. stomach pains.approximately 35% of births in the United States that result from assisted reproductive technologies such as ICSI produces pregnancies with twins or more. generally.  Drug Reaction.0% for women aged between 43–44 1. hypospadias. the higher her chances of success. Some birth defects that have an increased risk with ICSI include Angelman syndrome.7% for women aged between 35–37 20. irritability. Symptoms usually disappear after a short time. the younger a woman is. what steps should be taken? Answer: ICSI can be tried again or some other method of assisted reproductive technology.Based on figures from 2010. It can cause symptoms such as a swollen stomach. Success Rates.Question: What are the chances of success with intra-cytoplasmic sperm injection? Answer: Female fertility diminishes with age.8% for women aged between 38–39 13.9% for women aged 45 and over Question: How is the mother at risk when ICSI is used? Answer: Risks related to ICSI are the same as for in vitro fertilization.6% for women aged between 40–42 5.  Superovulation with hormone treatment can cause severe ovarian hyperstimulation syndrome.  ICSI is a more expensive procedure than IVF. they are generally rare.  Miscarriage.

the sperm is injected directly into the egg. With this procedure. Intracytoplasmic sperm injection is an assisted reproductive technology used in cases of male infertility. .Conclusion Male infertility occurs when a male is unable to achieve pregnancy in a female. There may be several reasons for this inclusive of hormonal imbalances. congenital defects in the male reproductive system. exposure to different environmental factors and also lifestyle factors.

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