Zero sperm count what the gynecologist should know by dr rupin shah, md

Management of Azoospermia -what every gynecologist should know Rupin Shah M.S., M.Ch.(Urology) Consultant Andrologist & Microsurgeon Lilavati Hospital & Research Centre, Mumbai 54 th AICOG, 2011

Basic questions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Not every ejaculate is semen ,[object Object],[object Object],[object Object]

Not every ejaculate is semen ,[object Object],[object Object],[object Object],[object Object],[object Object]

Azoospermia does not always mean azoospermia ,[object Object],[object Object],[object Object],[object Object],[object Object]

Fructose matters ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Test for fructose ,[object Object],[object Object]

Normal FSH does not necessarily mean normal spermatogenesis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Its all in the genes ,[object Object],[object Object],[object Object],[object Object]

Testicular failure need not mean no sperm ,[object Object],[object Object],[object Object],no sperm many sperm f e w spe r m

Testicular failure need not mean no sperm

Testicular failure need not mean no sperm ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

New approach to testicular biopsies in the ICSI era ,[object Object],[object Object],[object Object],[object Object]

Testicular Biopsy : NAB technique ,[object Object],[object Object],[object Object]

No Vasography ,[object Object],[object Object]

Microsurgical VEA ,[object Object],[object Object],[object Object],VAS EPID.

ICSI for obstructive azoospermia ,[object Object],[object Object],[object Object],[object Object]

Obstructive Azoospermia - VEA or PESA-ICSI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Varicocele matters - sometimes ,[object Object],[object Object],[object Object],[object Object],[object Object]

Azoospermia, Fructose positive Clinical Examination & F.S.H. Obstructive Equivocal P.T.F.

Azoospermia, obvious obstructive Direct exploration - VEA/VVA - no prior vasography - vas patency checked during surgery Needle biopsy Proceed with VEA or PESA-ICSI Needs confirmation of spermatogenesis

Azoospermia, obvious PTF DI Adoption Considering ICSI Biopsy is not required for diagnosis Discuss options Genetic studies Trial TESE – multiple SST Sperm absent Sperm present Cryopreserve  wife stimulated  ICSI

Azoospermia, Equivocal findings T.B. is needed for differential diagnosis Normal P.T.F. - No Sperm TESE-ICSI (fresh biopsy at time of ICSI) Bilateral, multiple, micro- biopsies proper interpretation PTF - Focal sperm VEA (or ICSI ) DI Adoption

In Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Zero sperm count what the gynecologist should know by dr rupin shah, md

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Zero sperm count what the gynecologist should know by dr rupin shah, md