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

Male Factor InfertilityMr Ted McDermott, Consultant Urologist

Male Factor Infertility

Definiton: Inability to achieve pregnancy after one year

of unprotected intercourse

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

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

Pathophysiology

Hypothalamus GnRH

GnRH Pituitary

Pituitary FSH + LH

FSH Sertoli cells for

sperm

LH Leydig cells for

testosterone + inhibin

Mr Ted McDermott, Consultant Urologist

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

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

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

Age

Reduced fertility with age

50% of sperm lost by 50 years

Mr Ted McDermott, Consultant Urologist

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

Physical Examination

Body Habitus

Secondary sexual characteristics

Penis Abnormalities

Testes for position

Size: 3-4cm

Vas

Varicocele

Mr Ted McDermott, Consultant Urologist

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

Testosterone

Diurnal pattern

Higher in the morning

Excessive levels inhibit GnRH

Intratesticular is a separate issue

Mr Ted McDermott, Consultant Urologist

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

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

Mr Ted McDermott, Consultant Urologist

Mr Ted McDermott, Consultant Urologist

Mr Ted McDermott, Consultant Urologist

Mr Ted McDermott, Consultant Urologist

Introducing the UroLift® System

20

The Prostatic Urethral Lift

Compress encroaching lateral lobe

Deliver UroLift® implant to hold in place

Typically ~4 implants deliveredMr Ted McDermott, Consultant Urologist

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

Where Does UroLift® Fit?

Mr Ted McDermott, Consultant Urologist

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

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

Mr Ted McDermott, Consultant Urologist