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

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Dr Aniruddha Malpani
Dr Aniruddha Malpani

What every gynecologist needs to know about azoospermia - Dr Rupin Shah provides a clear guide

Health & Medicine
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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
ย 
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]
One biopsy is not enough
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, Fructose positive Clinical Examination & F.S.H. Obstructive Equivocal P.T.F.
Azoospermia, obvious PTF DI Adoption Considering ICSI Biopsy is not required for diagnosis Discuss options Genetic studies Trial TESE โ€“ multiple SST Sperm absent Sperm present Cryopreserve ๏‚ฎ wife stimulated ๏‚ฎ ICSI
Azoospermia, Fructose positive Clinical Examination & F.S.H. Obstructive Equivocal P.T.F.
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]

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