Assessing testicular output

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