1. Assessing Testicular Output
Dr Anand K. Shinde
M.D (OBGYN)
 Center for Assisted Reproduction
 Andrology OPD
At Deenanath Mangeshkar Hospital,
Pune - 4
Tel: 4023395

2. Assessing Testicular Output
Dr Anand K.Shinde
What is the need?
B. 1 in 20 male has Infertility problem
C. Besides Fertility issue he may
have problems related to
i) Androgen Deficiency
ii) Infections including
tuberculosis, HIV, STD’s
iii) Impotence, Rapid
ejaculation

3. Assessing Testicular Output
Dr Anand K.Shinde
How to Assess ?
3. History
4. Physical Examination
5. Lab Semen tests
Blood tests
7. USG
8. Other - Ct scan
- scrotal explorations etc

4. Assessing Testicular Output
Dr Anand K. Shinde
Clinical history of male partner
• Length of Infertility
• Any previous conception ?
• P/H medical – mumps, MAGI etc
P/H Surgical – Orchiopexy, Hernia, etc
• Occupation – exposure to heat/ toxins / radiation
• Drugs – Antihypertensives, salazopyrine etc
• Sexual history

5. Assessing Testicular Output
Dr Anand K.Shinde
Physical Examination of the male
• Height, Weight
• Adiposity, Sec. Sexual Characteristics
• Penis
• Testes
• Epididymes
• Vasa
• Variococoele + -

6. Semen Analysis
W.H.O Manuals 2000
Reference Values
Volume 2.0ml or more
Ph 7.2 or more
Sperm Conc. 20 x 106 sp/ml or more
Total sperm count 40 x 106 sperm/ejaculate or more
Motility 50% or more with progressive motility
or 25% or more with rapid linear
progression
Morphology upto 70% abnormal
Vitality 75% or more live
WBCs less than 1 x 106/ml
Immuno bead test less than 50% motile sperms
with beads attached
MAR test less than 50% with particles attached

7. Assessing Testicular Output
Dr Anand K.Shinde
The Testis : Compartments
• Seminiferous Tubules : Output = spermatozoa & Inhibin
2. Leydig’s Cells : Output = Testosterone

8. Control of Testicular Output
Positive Loop
FSH stimulates Spermatogenesis
LH stimulates Testosterone
Negative Loop
Testosterone levels suppress GnRH
LH Inhibin suppresses FSH levels.

9. Interlinking Two Compartments
Sertoli Cells : Nourish gametogenesis
: Produce Inhibin
: Produce Androgen Binding Protein (ABP)
Both FSH & high testosterone levels necessary for
Spermatogenesis
Thin basement membrane of the tubules & presence of
ABP allow 100 times more build-up of Testosterone in the
S. tubules.
Disturbances in the above harm sperm output

10. Seminiferous Tubule
• Understanding Maturation/ arrest
• Understanding Johnson score
• Understanding Blood-Testis Barrier

11. Testicular Output : Bon Voyage!
From Testis to Urethra : Single long tube which
adds secretions, stores sperms & maintains
blood- testis barrier till ejaculation.

12. THANK YOU !!!
Dr ANAND K. SHINDE M.D.(GYN)
Centre for Assisted Reproduction
Deenanath Mangeshkar Hospital
Pune-1