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			Concern Treatment Pregnancy Experiences Concern Evaluating Your Fertility Understanding Fertility Maximise Your Fertility Infertility: An Introduction Infertility in Females Infertility in Males Sperm Disorders Absence of Sperm Reduced Sperm Sperm Abnormalities Antisperm Antibodies Anatomical Implications of Infertility Questions to Ask Your Doctor		Sperm Abnormalities Hypogonadism   Male hypogonadism may be caused by a disease of the testes, or by a disorder of the pituitary gland, which results in deficient production of gonadotrophic hormone. Pituitary disorders can be congenital (e.g. Kallman’s syndrome) or may be acquired following a pituitary adenoma (e.g. prolactinoma, craniopharyngioma) or as a result of radiation treatment. In men, hypogonadism causes the symptoms and signs of androgen hormone deficiency. The effects of this vary according to whether the deficiency develops before or after puberty. Typical effects include lack of body hair and beard growth, smooth skin, a high-pitched voice, reduced sexual drive and performance, underdevelopment of the genitalia and poor muscle development. Hypothalamic-hypophysis disease    Hyper- and/or hypo-secretion of hypothalamic or pituitary hormones are an uncommon cause of infertility. Where it is the cause of infertility, the results of profertility treatment are often excellent. Two syndromes are recognised: Hypergonadotrophic hypogonadism Hypogonadotrophic hypogonadism     Hypergonadotrophic hypogonadism    This disorder is characterised by very high levels of circulating gonadotropins, but the testes do not respond to the stimulation. These findings usually occur in patients with primary testicular failure. The chances of fertility are remote, but empirical hormonal treatment with testosterone is very occasionally effective. Hypogonadotrophic hypogonadism    In these patients, pituitary secretion of gonadotropins is insufficient to stimulate normal testes. The defect may be at the level of the pituitary itself, or at the level of the hypothalamus. A very large number of, mostly rare, endocrine abnormalities, as well as trauma, infections or tumours can result in absence or reduced levels of gonadotropins. It is possible to differentiate between primary failure of pituitary secretion or pituitary failure secondary to a hypothalamic defect, with reduced secretion of HnRH. In the case of primary pituitary failure, the treatment is replacement therapy by administration of exogenous gonadotropins. Where the defect is at the hypothalamic level, specific treatment is by administration of native GnRH. Chromosomal abnormalities    Abnormal numbers of sex chromosomes can result in disorders of the male reproductive tract. For example, infertility almost always arises as a result of Klinefelter’s syndrome. This condition occurs because of a chromosomal abnormality in which a male has one or more extra X chromosomes in his cells. Klinefelter’s syndrome affects about one in every 500 male infants born and the chances of a baby having the condition increase with the age of the mother. Klinefelter’s syndrome is almost always associated with azoospermia. The extra X chromosome seems to have little effect on the structure of the seminiferous tubule before puberty, but at puberty progressive, overwhelming destruction of the seminiferous epithelium takes place. Some patients with Klinefelter’s do, in fact, have significant growth of the testes early in puberty, followed by subsequent shrinkage. Breast enlargement also occurs. There is no cure for Klinefelter’s syndrome, although hormonal treatment may be used to induce secondary sex characteristics, such as growth of facial hair. Men with an extra Y chromosome have various degrees of spermatogenic impairment, ranging from normal spermatogenesis to spermatogenic arrest. There are a number of other rare chromosomal abnormalities that also result in inability to produce sperm. Disturbances in sperm-oocyte fusion    It has been shown that complementary adhesion molecules are located on the surface of oocytes and spermatozoa. These molecules interact and lead to fusion of the (fertilisation). The function of this system seems important not only for fusion but also for prevention of polyspermy (fertilisation of an ovum by more than one spermatozoon). Abnormalities in the adhesion molecules on the gamete surface, or other abnormalities which affect sperm-oocyte fusion, are recognised causes of infertility.
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