Male Infertility Karthik Gunasekaran • 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

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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. We 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 medicine 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. Dr. 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 international 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.