1. Male Infertility and Impotence
Hussein lafta
urologist

2. Male infertility
inability of the male to cause pregnnancy in a fertile women.
40-50% of infertility,
7%of all men are infertile.

3. Causes: I pretesticular - hypogonadal hypogonadism . -coeliac disease.
-drug ,alcohol.
-strenuous riding{bicycle,horse riding}.
-medications e.g chemotherapy, anabolic steroids,cimitidine,spironlactone,nitrofuratoin.
-genetic abn.
- tobacco smoking.

4. II-testicular factors;
- varicocele present in 15% of normal men and 40 % of infertile men,15% of primary infertility and of secondary infertilty.
-age.,
-genetic defect on y-chromosomes,klinffelter syndromes.,
-neoplasm. ,
-idiopathic test.failure.
-cryptorchidism.,
-trauma.,
-hydrocele.,
-mumps.,
-radiation.

5. III-post testicular causes:
-vas deferens obstruction.,
- absence of vas deferens e,g cystic fibrosis.,
-infections.e.g prostatitis.,
-retrograde ejaculation e.g D.M.,
-Ejaculatary duct obstruction.,
-hypospadius.,
-impotence.

6. DIAGNOSIS: Hx., Ex., lab. S.F.A: -abestinence for 3 dys.,
-volume 1-5 cc.,
-Number more than 15 milions.,
-motility
-morphology

7. Blood test - antisperm anti body titer.,
-hormonal analysis {serum testesterone,F.SH.,L.H.}.,
kariotyping.
Ultrsound:
Scrotal us for dx of varicocele.,test. dysgenesis, test. Cancer, congental absence of V.D, obstruction of E.D.,

8. TREATMENT
-Treat the cause., If it is untreatable then : intra utrine insemination {I.U.I}., in vitro fertilization { I.V.F}., intra cytoplasmic sperm injection{I.C.S.I}., I.U.I using donar sperm.

9. IMPOTENCE
Inability to develop or maintain an erection during sexual activity.
about 40% of male suffer from some sort of erectile dysfunction or impotence.

10. Causes of E.D{impotence}
Drugs e.g anti-depressant and nicotine.
Neurogenic disorder.
Cavernosal disorder{Peyronie disease}.
Psychological causes perfomance anxiety,stress,and mental disorder.
Surgery e.g radical prostectomy.
Aging.
Renal failure.
D.M.
Multiple sclrosis.
Life style smoking,drinking and bicycling.
Spinal cord injury.

11. Diagnosis Hx. Ex. Lab. Hormonal e.g prolactine testesterone. F.SH,L.H.
- US especially dopler us to evaluate blood flow,venous leak,sign of atherosclerosis and scarring and calcification{usually done after prostaglandine injection}.
-Penile nerves function:
bulbocavernosus reflex.
-Nocturnal penile tumescence{normally men have 5-6 erection during sleep especially during rapid eye movement.}
-cavernosography for dx of venous leak.

12. treatment The goal of treatment is directed toward the cause of E.D.
-oral medication eg phosphdisesterase type 5 inhibitors[PDE 5].
sildenafil{viagra}.,
vardenafil{levitra}.,
tadalafil{cialis}.
-topical medication. e.g alprostadil.
-injected medication include intracavernosal injection of prostaglandin,papaverine and phentolamine.
-vacuum consitriction device.
-penile implant semirigid or inflatable