Endocrinee causes of male infertility.pptx

Endocrine causes of male infertility is an important aspect.

1. Endocrine causes of male infertility Presented By: Lawal Maryam. A June, 12,2024 160248

2. Table of contents Introduction Epidemiology Overview of endocrine system’s role in male infertility Classification Diagnosis Treatment approach Conclusion References Questions

3. Introduction Infertility is defined as the inability of a couple to become pregnant after one year of unprotected intercourse.
Male infertility is defined as the inability of a male to achieve conception with a fertile female after one year of regular, unprotected intercourse. Endocrine disorders remain an important etiology of male infertility to understand and identify because they are generally correctable

4. Epidemiology Approximately 15% of couples have difficulty conceiving. Of these couples, a male factor is present in almost 60% (a contributory cause in 40% and a sole factor in 20%)
Based on the epidemiological study published in 2015, the World Health Organization estimates that nearly 190 million people suffer from infertility worldwide. More than half of cases were attributed to male factor

5. Brief overview of the endocrine system’s role in male fertility Male fertility is dependent upon an intact hypothalamic–pituitary–testicular axis to initiate and maintain quantitatively and qualitatively normal spermatogenesis,maintain normal secondary sex gland function,and sexual function. The hypothalamus is the command center which secretes gonadotropin-releasing hormone which in turn stimulates the anterior pituitary.

6. Contd The anterior pituitary produces FSH&LH. LH Stimulates the Leydig cells in the testes to produce testosterone. FSH Works with testosterone to stimulate the Sertoli cells in the testes, which support spermatogenesis. Leydig cells also produce and secrete estradiol and dihydrotestosterone .

7. The testes produce testosterone, the primary male sex hormone, which is essential for the development of male reproductive tissues, the maintenance of secondary sexual characteristics, and the production of healthy sperm. This system is controlled by feedback inhibition to prevent overproduction of sex steroids. Testosterone and estradiol inhibit secretion of LH and GnRH . Sertoli cells produce inhibin that inhibits secretion of FSH.

8. Classification Primary
Secondary

9. Primary Endocrine Disorders Affecting Male Fertility HYPOGONADISM Primary ( Hypergonadotropic Hypogonadism) This condition arises from insufficient or nonexistent function of the testicles, leading to elevated gonadotropin levels due to the lack of negative feedback from testicular hormones (testosterone, estradiol, and inhibin B). It results in impaired spermatogenesis, testicular shrinkage, fibrosis, and reduced germ cell numbers.

10. Contd. Hypergonadotropic hypogonadism can be caused by genetic or acquired factors. Genetic factors: Kleinfelter's syndrome, Acquired: Viral orchitis , gonadotoxin exposure,such as chemotherapeutic agents, trauma, torsion, and anorchia .

11. Contd. Secondary (Hypogonadotropic hypogonadism) This is a condition characterized by reduced testosterone production due to low levels of gonadotropins and estradiol. It can be caused by a variety of factors, classified into congenital and acquired GnRH deficiency. Congenital Causes: Kallmann Syndrome,CAH . Acquired Causes: Exogenous steroids, tumors, surgery, stroke, or infiltrative diseases.

12. Contd. Kallman’s syndrome: A genetic form of HH occurring in an X-linked recessive manner. It presents with features such as facial deformities, anosmia (loss of smell), neurologic abnormalities, and renal agenesis. The condition results from a failure of GnRH -secreting neurons to migrate properly, leading to absent GnRH secretion and consequently low gonadotropin levels. This can cause delayed puberty and infertility.

13. Secondary Endocrine Disorders Affecting Male Fertility Hyperprolactinemia: This can cause male infertility due to its inhibitory effects on hypothalamus. As a result, the hypothalamus is unable to secrete gonadotropins, which in turn affects testosterone production and spermatogenesis. Hyperprolactinemia can be caused by hypothyroidism, liver illness, stress, and the use of certain drugs (such as phenothiazines and tricyclic antidepressants),functional pituitary adenomas.

14. Contd. 2. Thyroid disorders: Hypothyroidism can disrupt the balance of reproductive hormones, including lowering testosterone levels, which are crucial for sperm production.
Hyperthyroidism can increase levels of sex hormone-binding globulin (SHBG), which binds to testosterone and reduces its availability, impacting sperm production.

15. Contd. 3. Diabetes Mellitus: can affect male fertility via multiple routes Hormonal Imbalance: Diabetes can disrupt the hypothalamic-pituitary-gonadal (HPG) axis, resulting in reduced testosterone production (hypogonadism). This leads to decreased libido, erectile dysfunction, and poor sperm quality. Additionally, diabetes can affect the secretion of gonadotropins (LH and FSH), which are essential for normal testicular function and spermatogenesis.

16. Contd. Other routes by which DM affects infertility includes; erectile dysfunction, sperm quality, genital tract infinfection , retrograde Ejaculation 4.Obesity and Endocrine Disruption: Obesity can lead to increased estrogen and decreased testosterone levels, disrupting the hormonal balance necessary for sperm production.

17. Contd. 5.Cushing syndrome: Elevated cortisol levels can suppress the HPG axis, leading to reduced levels of gonadotropins (LH and FSH) and testosterone, which are crucial for spermatogenesis
In addition, Cushing’s syndrome often results in metabolic disturbances such as insulin resistance, obesity, and hypertension, which can further impair sperm production and quality. Cushing's syndrome may cause an increase in prolactin levels, direct testicular damage

18. Diagnosis of Endocrine Causes of Male Infertility A. Medical history and physical examination
B. Hormonal evaluations
1. Serum testosterone
2. FSH and LH levels
3. Prolactin levels
4. Thyroid function tests (TSH, T3, T4)

19. Contd. 5. Adrenal function tests
C. Imaging studies
1. Pituitary MRI
2. Testicular ultrasound
D. Genetic testing (if indicated)

20. Treatment Approaches A. Hormone Replacement Therapy
1. Testosterone replacement
2. Gonadotropin therapy
B. Medical Management
1. Dopamine agonists for hyperprolactinemia
2. Thyroid hormone replacement
3. Medications for adrenal disorders
C. Surgical Interventions
1. Pituitary surgery for tumors

21. Treatment approaches 2. Varicocelectomy D. Assisted Reproductive Technologies (ART)
1. In vitro fertilization (IVF)
2. Intracytoplasmic sperm injection (ICSI)
E. Lifestyle and Nutritional Interventions
1. Weight management
2. Nutritional supplements
3. Avoidance of endocrine disruptors

22. Conclusion Although endocrinopathies are not often seen in infertile men, these disorders are clinically significant; they often have potentially serious medical significance, regardless of fertility issues. Male fertility is critically dependent upon a normal hormonal milieu. The HPG axis is quite sensitive to disruption by endocrine disorders and other generalized medical disorders. Correction of these disorders represents a possible way to restore normal fertility for the male partner

23. References Jarow 2003 Medscape https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8779600/ https://www.cambridge.org/core/books/infertility-in-the-male/endocrine-causes-of-male-infertility-diagnosis-and-treatment/1340AB8F1BBA40B1A8DECAB1387F0D53 https://academic.oup.com/jcem/article/98/9/3532/2833061 https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1232646/full

24. Questions!!! 1.A 32-year-old male presents with concerns about infertility. He and his wife have been trying to conceive for over a year without success. He reports decreased libido and erectile dysfunction. On physical examination, he has a decreased testicular size and gynecomastia. Blood tests reveal low testosterone levels, elevated prolactin levels, and low luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. A. What is the most likely endocrine disorder in this patient? A) Primary hypogonadism
B) Secondary hypogonadism
C) Hyperprolactinemia
D) Hyperthyroidism

25. Questions!!! B. Which of the following is the best next step in the management of this patient? A) Testosterone replacement therapy
B) MRI of the pituitary gland
C) Clomiphene citrate therapy
D) Thyroid function tests

26. Questions!!! 2. A 20-year-old male presents with concerns about delayed puberty and infertility. He reports that he has never experienced a spontaneous erection or any secondary sexual characteristics development. Additionally, he mentions an inability to smell since childhood. Physical examination reveals a lack of facial hair, underdeveloped testes, and a eunuchoid body habitus. Laboratory tests show low levels of testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH).

27. Questions!!! What is the most likely diagnosis A) Kallmann syndrome
B) Klinefelter syndrome
C) Primary hypogonadism
D) Androgen insensitivity syndrome

28. Questions!!! B. What is the primary pathophysiological mechanism underlying Kallmann syndrome? A) Testicular failure B) Defective androgen receptor C) Hypogonadotropic hypogonadism due to GnRH deficiency D) Excessive estrogen production