The testis cords are separated from the surface epithelium by the tunica albuginea (green). The seminiferous cords. 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. 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. primordial germ cells and sex cords are present in the cortical and medullary regions of the undifferentiated gonad. proliferating mesenchyme around the cloacal membrane causes the overlying ectoderm to bulge so that three structures are visible externally – the phallus. tubuli recti and rete testis are formed from the testis cords (at puberty. System . The sex of a baby can be determined at the 12th week.  Development of the External Genitalia Early in the fourth week. The urogenital folds form the penile raphe. These bilateral. They produce testosterone. the seminiferous cords will canalize and form the seminiferous tubules). The rete testes are formed from the linking of the seminiferous cords and bind with the mesonephric tubules. 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). seminal vesicle and ejaculatory duct. bulbourethral gland/ Cowper’s gland and the prostate gland). and 19 and the X chromosome (which play a part in THE gonadal development of males)). TDF causes the primary sex cords to proliferate. This eventually proliferates and plays a part in the formation of various lobules of the testes. In the 6th week. The mesonephric ducts form the epididymis (which stores mature sperm). 17. 11. and become testis cords. which ensures that the mesonephric duct (Wolffian) does not regress. The mesoderm between the seminiferous cords gives rise to Leydig cells. Somatic cells and primordial germ cells are found in the testis cords. urogenital folds and the labioscrotal swellings. External genitalia are stimulated to form by DHT Development of the Male Reproductive (dihydrotestosterone) which is produced from testosterone. grow deeper into the mesenchyme. which are responsible for nourishing the spermatozoa and secreting antimüllerian hormone (which promotes the atrophy of the paramesonephric duct (Müllerian)). The somatic cells differentiate into Sertoli cells. and the labioscrotal swellings Schematic diagrams showing the form the scrotum.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). lose their attachment to the surface epithelium. up until the seventh week. In both sexes. and complete mesonephric and paramesonephric ducts lie side by side. ductus deferens. The phallus is composed of the genital tubercle (forms the glans penis) and the urogenital sinus (forms the corpus spongiosum.

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

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

. using needle aspiration guided by ultrasound through the abdomen to the ovaries. the eggs that have been successfully fertilized (zygotes) are selected. the incubation period lasts for 6 days ( in which cause a blastocyst is placed in the uterus). After the incubation period (2-3 days). After the first week. 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. In some cases. Several eggs may be fertilized in this way. the dosage may change based on the oestrogen levels and ultrasound results. The embryo transfer procedure occurs two to six days later. it is check to see whether eggs are maturing in the follicles. A human chorionic gonadotropin (hCG) injection is usually given to stimulate the follicles to mature. The mature eggs are collected 34 to 36 hours after the administration of hCG. a holding pipet (made of glass) is used to hold an egg in place. 4.3. Ovulation and Egg Retrieval Fertility drugs are usually taken for 2 weeks before egg retrieval. At home. A microscopic glass tube containing sperm (injection pipet) is used to penetrate and deposit one sperm into the egg. 5. by the use of ultrasound. Sperm Injection and Transfer Under high-power magnification. Two to four are placed in the uterus using a thin flexible tube (catheter) that is inserted through the cervix. Sperm Selection The best sperm (excellent morphology and motility) are selected for injection into mature ova after performing specific tests. Usually. a full day is spent at the hospital for the egg and sperm retrieval procedures. the blood oestrogen level is measured and also. eggs are checked for evidence of fertilization. During the second week. The remaining embryos may be frozen (cryopreserved) for future attempts. After culturing in the laboratory overnight. the female partner is injected with folliclestimulating hormone (FSH) to stimulate the ovaries to produce multiple eggs (superovulation).

Symptoms usually disappear after a short time.approximately 35% of births in the United States that result from assisted reproductive technologies such as ICSI produces pregnancies with twins or more.  Miscarriage. So experts are still learning about its possible effects. generally. irritability. headaches and restlessness. Even is fertilization takes place.  Multiple births.  ICSI is a more expensive procedure than IVF.a mild reaction to fertility drugs may involve hot flushes.  Drug Reaction. Intra-cytoplasmic sperm injection (ICSI) success rates are very similar to in vitro fertilisation (IVF) rates. Success Rates.6% for women aged between 40–42 5.5% to 3% risk of major birth defect. It should be noted though that these occur in less than 1% of babies conceived using ICSI. the higher her chances of success. Question: Does ICSI have any other disadvantages? Answer:  ICSI has been in use for a shorter time than IVF. Question: If the first cycle of ICSI fails. The ICSI procedure fertilises 50% to 80% of eggs.an ectopic pregnancy can still occur with eggs fertilized by ICSI. 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).Question: What are the chances of success with intra-cytoplasmic sperm injection? Answer: Female fertility diminishes with age. While ICSI treatment carries a slightly increased risk of birth defects. the embryo may stop growing. are:       32.Based on figures from 2010. nausea and vomiting. nor is the risk lower. what steps should be taken? Answer: ICSI can be tried again or some other method of assisted reproductive technology.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. stomach pains. the percentage of ICSI cycles for women using their own fresh eggs. . which resulted in a live birth.2% for women aged under 35 27. and sex chromosome abnormalities.  Ectopic Pregnancy. the younger a woman is.  Superovulation with hormone treatment can cause severe ovarian hyperstimulation syndrome.0% for women aged between 43–44 1. Multiple pregnancies are high-risk for both a mother and her fetuses. they are generally rare.7% for women aged between 35–37 20.the risk of a miscarriage after ICSI is no higher than after a natural conception. It can cause symptoms such as a swollen stomach. Question: Is ICSI safe for the baby? Answer: A normal pregnancy comes with a 1. hypospadias.8% for women aged between 38–39 13. Some birth defects that have an increased risk with ICSI include Angelman syndrome.

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

com/od/ivf/a/icsi_ivf.ch: http://www. Human Fertilisation Embrology Authority. September 15). January 7). from Embryology. M. from About.html Healthwise Staff. Lausanne and Bern. (2013.webmd. 2013.com/infertility-and-reproduction/guide/intracytoplasmicsperm-injection-for-infertility .). R. Gurevich.mayoclinic. (n. (2011). from WebMD: http://www. Philidelphia: Lippincott Williams& Wilkins. Retrieved October 30. 2013.Bibliography University of Maryland.d. R. December 17). 2013. Retrieved November 1. Retrieved October 30. Male Inderftilty: Causes.uk/ICSI.embryology. Testes differentiation. Intracytoplasmic Sperm Injection. BRS Embryology. 2013.gov. Infertility in Men. (2010. 2013. from http://www. (2012. Intracytoplasmic Sperm Injection for Infertility.html Clinic. 2013. (2013. (2012.edu/health/medical/reports/articles/infertility-in-men Universities of Fribourg. from http://www.ch/anglais/ugenital/diffmorpho02.htm Human Fertilisation Embrology Authority.com/health/male-infertility/DS01038/DSECTION=causes Dudek.about. Retrieved November 2.com: http://infertility. Retrieved October 31. from http://umm. March 19). Retrieved November 1.hfea. September 14).