Post on 25-May-2015
Dr Anand K. ShindeDr Anand K. ShindeM.D (OBGYN)M.D (OBGYN)
Center for Assisted ReproductionCenter for Assisted Reproduction Andrology OPD Andrology OPD
At Deenanath Mangeshkar Hospital,At Deenanath Mangeshkar Hospital,
Pune - 4Pune - 4
Tel: 4023395Tel: 4023395
Assessing Testicular Output
Assessing Testicular Output Dr Anand K.ShindeDr Anand K.Shinde
What is the need?What is the need?
A.A. 1 in 20 male has Infertility problem1 in 20 male has Infertility problem
B.B. Besides Fertility issue he may Besides Fertility issue he may have problems related tohave problems related to
i) Androgen Deficiencyi) Androgen Deficiency
ii) Infections including ii) Infections including tuberculosis, HIV, STD’stuberculosis, HIV, STD’s
iii) Impotence, Rapid iii) Impotence, Rapid ejaculationejaculation
iv) Emotional problemsiv) Emotional problems
How to Assess ?
1. History2. Physical Examination3. Lab Semen tests
Blood tests1. USG2. Other - Ct scan
- scrotal explorations etc
Assessing Testicular Output Dr Anand K.Shinde Dr Anand K.Shinde
Assessing Testicular Output Dr Anand K. ShindeDr Anand K. Shinde
Clinical history of male partnerClinical history of male partner• Length of InfertilityLength of Infertility• Any previous conception ?Any previous conception ?• P/H medical – mumps, MAGI etcP/H medical – mumps, MAGI etc P/H Surgical – Orchiopexy, Hernia, etcP/H Surgical – Orchiopexy, Hernia, etc• Occupation – exposure to heat/ toxins / radiationOccupation – exposure to heat/ toxins / radiation• Drugs – Antihypertensives, salazopyrine etcDrugs – Antihypertensives, salazopyrine etc• Sexual history Sexual history
Assessing Testicular Output Dr Anand K.ShindeDr Anand K.Shinde
Physical Examination of the male• Height, Weight• Adiposity, Sec. Sexual Characteristics• Penis• Testes• Epididymes• Vasa• Variococoele + -
Volume 2.0ml or morePh 7.2 or moreSperm Conc. 20 x 106 sp/ml or moreTotal sperm count 40 x 106 sperm/ejaculate or moreMotility 50% or more with progressive motility
or 25% or more with rapid linear progression
Morphology upto 70% abnormalVitality 75% or more liveWBCs less than 1 x 106/mlImmuno bead test less than 50% motile sperms
with beads attachedMAR test less than 50% with particles attached
W.H.O Manuals 2000Reference Values
Semen Analysis
Assessing Testicular Output Dr Anand K.ShindeDr Anand K.Shinde
The Testis : Compartments
1. Seminiferous Tubules : Output = spermatozoa & Inhibin
2. Leydig’s Cells : Output = Testosterone
Control of Testicular OutputControl of Testicular Output
Positive LoopPositive Loop
FSH stimulates SpermatogenesisFSH stimulates Spermatogenesis
LH stimulates TestosteroneLH stimulates Testosterone
Negative LoopNegative Loop
Testosterone levels suppress GnRHTestosterone levels suppress GnRH
LH Inhibin suppresses FSH levels.LH Inhibin suppresses FSH levels.
Sertoli CellsSertoli Cells : Nourish : Nourish gametogenesisgametogenesis
: Produce : Produce InhibinInhibin
: Produce : Produce Androgen Binding Protein (ABP)Androgen Binding Protein (ABP)
Both FSH & high testosterone levels necessary forBoth FSH & high testosterone levels necessary for
SpermatogenesisSpermatogenesis
Thin basement membrane of the tubules & presence of Thin basement membrane of the tubules & presence of
ABP allow 100 times more build-up of Testosterone in theABP allow 100 times more build-up of Testosterone in the
S. tubules.S. tubules.
Disturbances in the above harm sperm output Disturbances in the above harm sperm output
Interlinking Two Compartments
Seminiferous TubuleSeminiferous Tubule
• Understanding Maturation/ arrestUnderstanding Maturation/ arrest• Understanding Johnson scoreUnderstanding Johnson score• Understanding Blood-Testis BarrierUnderstanding Blood-Testis Barrier
Testicular Output : Bon Voyage!Testicular Output : Bon Voyage!
From Testis to Urethra : Single long tube which From Testis to Urethra : Single long tube which adds secretions, stores sperms & maintains adds secretions, stores sperms & maintains blood- testis barrier till ejaculation.blood- testis barrier till ejaculation.
THANK YOU !!!THANK YOU !!!
Dr ANAND K. SHINDE M.D.(GYN)Dr ANAND K. SHINDE M.D.(GYN)Centre for Assisted ReproductionCentre for Assisted Reproduction
Deenanath Mangeshkar HospitalDeenanath Mangeshkar HospitalPune-1Pune-1