Male Infertility: A Clinical Approach

254 Pages·2017·5.21 MB·English

by  Karthik Gunasekaran

Karthik Gunasekaran
N Pandiyan
Editors
Male Infertility
A Clinical Approach
123
Male Infertility
Karthik Gunasekaran (cid:129) N Pandiyan
Editors
Male Infertility
A Clinical Approach
Editors
Karthik Gunasekaran N Pandiyan
Metromale Clinic, Department of Andrology and Reproductive
Gunasekaran Hospital Pvt Ltd Medicine
Chennai Chettinad Hospital and Research Institute
India Chennai
India
ISBN 978-81-322-3602-3 ISBN 978-81-322-3604-7 (eBook)
DOI 10.1007/978-81-322-3604-7
Library of Congress Control Number: 2016953337
© Springer India 2017
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Pref ace
Infertility in men is an important cause of barren marriage. Male infertility is on the
rise and the world wide prevalence of male infertility now stands at 7 %, an incidence
even more than diabetes mellitus. Yet sadly, we, the medical community at large, have
chosen to ignore this problem. Until a few decades ago, this area was wide open with
almost all medical practitioners handling the fi eld. Besides urologists, gynecologists,
and embryologists who are probably the rightful inheritors of the fi eld, specialists in
venereology, dermatology, endocrinology, and internal medicine were also practicing
male infertility with very little or formal training in the fi eld. Universities offering
training in this branch of reproductive medicine were also few.
The advent of assisted reproductive technologies and intracytoplasmic sperm
injection (ICSI) made a paradigm change in the management of male infertility.
However, an increase in failed ICSI procedures and declining male fertility have
made physicians dwell deep into the realm of male infertility. Many hitherto
unproven therapies have fallen into disrepute. Many conditions untreatable few
decades ago have become treatable now with the introduction of ICSI and sperm
retrieval techniques. There is an urgent need for good understanding of the princi-
ples and practice of male infertility. This book hopes to fulfi ll this need.
The chapters in this book have been hand-picked to provide the gynecologists,
urologists, endocrinologists, and fertility specialists in-depth information about
male infertility and aim to serve as a reference point with detailed descriptions and
practical analysis by leading practitioners in the fi eld of men’s health.
W e would like to thank our teachers, our patients, the andrology fellows, our
contributing authors, and all other research staff, without whom this book would not
have been possible. We specially acknowledge the great contribution rendered by
Dr. C. Siddharth, Embryologist and Andrologist, in the initial phase of the project.
We value your feedback; this will help us improve the future editions of the
book.
Chennai , India Karthik Gunasekaran
Chennai , India N. Pandiyan
v
Acknowledgments
The Editors gratefully acknowledge the help rendered by many people to make this
book a reality.
Dr. Shah Dupesh Khan, Chief Consultant in Andrology and Men’s Health,
Women’s Center, Chennai, has been a source of continuous, constant, and great sup-
port in getting this book to the present shape. Besides contributing chapters in time,
he also helped immensely in the numerous correspondences with the authors and in
editing this book.
Authors from various parts of the world contributed chapters, mostly on time,
despite their numerous professional commitments, thus helping the timely release
of this book.
Our publisher, Springer and its dynamic executives: Ms. Eti has been instrumen-
tal for the launch of this book; Mr. Kumar and Mr. Mahesh gently but constantly
prodded us and helped in completion of this book by their continuous reminders to
all of us.
Chennai , India Karthik Gunasekaran
Chennai , India N. Pandiyan
vii
Contents
1 Anatomy and Development of the Male Reproductive System . . . . . . . . 1
Sneha Guruprasad Kalthur and Guruprasad Kalthur
2 Physiology and Endocrinology of Spermatogenesis . . . . . . . . . . . . . . . . . 17
R. Bharath
3 Ultrastructure of Human Spermatozoa . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Priya Kannan
4 A Clinical Approach to Male Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . 41
N. Pandiyan and Shah Dupesh Khan
5 Interpretation of Semen Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Satya Srini Vasan
6 Azoospermia: Diagnosis and Management . . . . . . . . . . . . . . . . . . . . . . . 85
Satya Srini Vasan
7 Management of Infertile Men with Nonobstructive Azoospermia
due to Spermatogenic Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Sandro C. Esteves
8 Management of Infertility in Klinefelter Syndrome . . . . . . . . . . . . . . . 135
Ranjith Ramasamy and Affan Zafar
9 Varicocele . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Karthik Gunasekaran
10 Sperm DNA Damage: Causes and Laboratory Detection . . . . . . . . . . . 155
Satish Kumar Adiga and Guruprasad Kalthur
11 Sexually Transmitted Infections and Impact on Male Fertility . . . . . . 167
Gulfam Ahmad , Stefan S. du Plessis , and Ashok Agarwal
12 Ionizing Radiation and Male Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Gulfam Ahmad and Ashok Agarwal
13 Aging and Male Reproduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Shah Dupesh Khan
ix
x Contents
14 Cryopreservation of Human Semen . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Sasikala Natarajamani
15 Fertility Preservation in Men and
Prepubertal Boys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Shubhashree Uppangala , Guruprasad Kalthur ,
and Satish Kumar Adiga
16 Sexual Dysfunction and Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Narayana Reddy , Varsha Swamy , N. Pandiyan , and Shah Dupesh
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
About the Editors
Karthik Gunasekaran graduated from Madras Medical College in General Surgery
with a gold medal in Urology. Interest in Pelvic Floor Dysfunction made him pursue
a Fellowship in Urogynecology from the Cleveland Clinic Foundation, USA. On his
return, he founded the Indian Urogynecological society, the fi rst society for
Urogynecology and Pelvic Floor Dysfunction in India. An avidly sought after
speaker and surgical demonstrator, he pioneered the use of mesh in pelvic fl oor
surgery in India.
Men’s health, a fi eld which spawned his interest, was yet a nascent area in medi-
cine in India, and Dr. Karthik began his training with Prof. Pandiyan at the Chettinad
Hospital and Research Institute in Chennai. Preceptorships in male infertility at the
Turek Clinic in the United States under Dr. Paul Turek and sexual health in San
Diego Sexual Medicine under Prof. Irwin Goldstein followed. A certifi cation in
sexual health training was obtained when Dr. Karthik completed his FECSM from
Oxford University, UK. He is of the fi rm belief that men’s health is taking a back
seat in India, especially in fertility and sexual health. He founded the Metromale
Clinic, a fi rst of its kind all male clinic for male fertility and sexual health in Chennai.
His weekly live talk show, Dr. X, on the Sun Network, is critically acclaimed and
has over a million hits on YouTube. He currently serves as Director of Metromale
Clinic and is also the Managing Director of Gunasekaran Hospitals Pvt Ltd in
Chennai.
He lives in Chennai with his wife Manu and children Sara and Arav.
Prof. Dr. N. Pandiyan currently is the Head of the Department and Chief Consultant
in Andrology and Reproductive medicine, Dept. of Andrology and Reproductive
medicine, Chettinad Super Specialty Hospital, Kelambakkam, Chennai, and the
Chief Editor of Chettinad Health City Medical Journal. He has had a long and dis-
tinguished academic and professional career. He won many gold medals and prizes,
during his undergraduate and postgraduate medical courses. He was awarded fi rst
rank in the University of Madras for excellence in Post Graduate Diploma and
Degree in Obstetrics and Gynaecology. He scored fi rst rank at All India level in
MNAMS examination. He was the only Scholar from India in Gynaecology for the
prestigious Commonwealth scholarship programme in 1985, which earned him
Fellowship in Male and Female infertility at University of Nottingham, UK, for
xi
xii About the Editors
2 years. Upon his return to India, he established the fi rst joint Infertility Clinic in
Government General Hospital, Chennai, in 1987, earning the unique distinction of
pioneering the beginning of Andrology and Reproductive Medicine, the new sub-
specialty of Obstetrics and Gynaecology, in the country.
D r. Pandiyan was also responsible for setting up of Infertility Centres in many
private institutions and trained numerous aspiring gynaecologists from all over
India. On the academic side, he held many prestigious posts as Head of Departments
in Chennai and Brunei Darussalam; Examiner for many local, national, and interna-
tional level examinations; invited speaker for many national and international con-
ferences; serving on the expert committees of ICMR and Department of Science
and Technology; one among the doyens in this specialty to formulate National
Guidelines for the practice of ART; and author of several publications and books
related to human reproduction. The Tamil Nadu Dr. MGR Medical University rec-
ognized his yeoman services in this fi eld and awarded him with “Life time achieve-
ment award”. He is still continuing his academic mission of training young medical
graduates in all aspects of human reproduction, motivating research and innovative
thinking in this sub-specialty.