Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male &...

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Male Factor Infertility Mr Ted McDermott, Consultant Urologist

Transcript of Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male &...

Page 1: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Male Factor InfertilityMr Ted McDermott, Consultant Urologist

Page 2: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Male Factor Infertility

Definiton: Inability to achieve pregnancy after one year

of unprotected intercourse

Mr Ted McDermott, Consultant Urologist

Page 3: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Incidence

15% of couples

30% male factor only

20% male & female factor

Male factors: 70% diagnosed by non-invasive cost

efficient investigations

Mr Ted McDermott, Consultant Urologist

Page 4: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Treatment

Depends on underlying aetiology

Optimizing sperm production

Surgery may be individually optimized

More complex problems may need IVF/ICSI

Mr Ted McDermott, Consultant Urologist

Page 5: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Pathophysiology

Hypothalamus GnRH

GnRH Pituitary

Pituitary FSH + LH

FSH Sertoli cells for

sperm

LH Leydig cells for

testosterone + inhibin

Mr Ted McDermott, Consultant Urologist

Page 6: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Incidence

15% of couples BUT

23% conceive within 2 years

10% more conceive within 4 ½ years

7.6% conceive with counts <2million

Mr Ted McDermott, Consultant Urologist

Page 7: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Global sperm count trend

113 million/cc in 1940

66 million/cc in 1990

? Patients presenting

Counting techniques

Toxins in environment

Geographic presentation

Mr Ted McDermott, Consultant Urologist

Page 8: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Morbidity and Mortality

Associated with;

Pituitary Adenoma

Testicular Cancer

Liver Failure

Renal Failure

Increased overall lifetime risk of cancer of 2.2% vs 1.1%

Mr Ted McDermott, Consultant Urologist

Page 9: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Age

Reduced fertility with age

50% of sperm lost by 50 years

Mr Ted McDermott, Consultant Urologist

Page 10: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Patient Evaluation

History:

Duration of infertility

Previous Fertility

Sexual History

Childhood Urological Procedures

PMHx:

Testis Cancer

Diabetes

Other Cancer

Obesity

Respiratory Diseases STD

Medication: Testosterone

Social History:

Excessive sporting activity, Hash,

Alcohol, Emotional Stressors,

Environmental exposures

Drugs:

Chemotherapy, Tetracycline,

Nitrofurantoin

Mr Ted McDermott, Consultant Urologist

Page 11: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Physical Examination

Body Habitus

Secondary sexual characteristics

Penis Abnormalities

Testes for position

Size: 3-4cm

Vas

Varicocele

Mr Ted McDermott, Consultant Urologist

Page 12: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Diagnosis

Semen analysis

pH 7.05 – 7.8

Density 15 million/cc

Motility – 40% normal movement

Morphology – 4% upwards

Infection – round or white cell elevation

Antisperm antibody

Blood

Hormone and genetic typing

FSH, LH, Prolactin, Testosterone

Mr Ted McDermott, Consultant Urologist

Page 13: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Testosterone

Diurnal pattern

Higher in the morning

Excessive levels inhibit GnRH

Intratesticular is a separate issue

Mr Ted McDermott, Consultant Urologist

Page 14: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Sperm Production

74 days

16 steps

Spermatids (Stage 6 used for ICSI)

Epididymis (Sperm maturation to

allow egg penetration)

Ejaculatory Content – Seminal

vesicles 40-80% including fructose

Prostate Gland 10 – 30%

Sperm 5%

Cowper Glands 2-5%

Mr Ted McDermott, Consultant Urologist

Page 15: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Correctable Causes

Varicocele

15% males, left side, right side suggests secondary pathology

Repair results in 40-70% improved semen parameters

Surgery versus Embolization in Radiology

Low Testosterone

Treat with Clomid

Stimulates GnRH release

Vasectomy

60-70% success at 5 years

Anejaculation

Vibrator

Electroejaculation

ICSI

Retrograde Ejaculation

Sudafed

Collection of retrograde sample

IVF and ICSI have covered the gaps in our treatment options

Mr Ted McDermott, Consultant Urologist

Page 16: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Mr Ted McDermott, Consultant Urologist

Page 17: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Mr Ted McDermott, Consultant Urologist

Page 18: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Mr Ted McDermott, Consultant Urologist

Page 19: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Mr Ted McDermott, Consultant Urologist

Page 20: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Introducing the UroLift® System

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Page 21: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

The Prostatic Urethral Lift

Compress encroaching lateral lobe

Deliver UroLift® implant to hold in place

Typically ~4 implants deliveredMr Ted McDermott, Consultant Urologist

PM11861_Rev_B-US.wmv
Page 22: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Immediate UroLift® Effect

Mechanically opens prostatic urethra

Result is visible under cystoscopy

Implants are anterolateral, away from NV bundles or dorsal venous complex

PRE POST

Mr Ted McDermott, Consultant Urologist

Page 23: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Where Does UroLift® Fit?

Mr Ted McDermott, Consultant Urologist

Page 24: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

All BPH/LUTS Patients Should be Considered!

Men Who:

Are frustrated by side-effects or daily hassle of

medication

Have modest symptomatic relief from medications

Previously declined surgery

Want to preserve their sexual function Mr Ted McDermott, Consultant Urologist

Page 25: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Urolift Summary

Rapid relief

IPSS reduced 10-12 points, Qmax increased 4 mLs

Significant improvement by 2 weeks

Adverse effects mild/moderate resolve by 2-4 weeks

Preserves ejaculatory and erectile function

Well tolerated under local anesthesia

Durability to 5 years established

Consistent performance across global studies

Mr Ted McDermott, Consultant Urologist

Page 26: Mr Ted McDermott, Consultant Urologist...Incidence 15% of couples 30% male factor only 20% male & female factor Male factors: 70% diagnosed by non-invasive cost efficient investigations

Mr Ted McDermott, Consultant Urologist


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