Male Reproductive Dysfunction SC Basu
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1Male Reproductive Dysfunction
2Male Reproductive Dysfunction
SC Basu FRCS (Edin. and Eng), FICS, FACS Senior Consultant Surgeon and Uro-Andrologist
3 Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Male Reproductive Dysfunction
© 2005, SC Basu
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher.
This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under Delhi jurisdiction only.
First Edition: 2005
9788180614712
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd, Sector 60, Noida
4 The book is dedicated to my mother
Mrs Baruna Basu
And
to the memory of my late father
Dr Suresh Chandra Basu
Preface
5Reproductive function of a male broadly encompasses three interrelated and synergistic steps, the spermatogenesis (formation of sperms), and regulation of the male reproductive functions and performance of the male sexual act. Various hormones and other factors regulate the primary reproductive functions. The male sex hormones also exert their influence on the accessory sexual organs, cellular metabolism and on other functions of the body.
Fertilisation– a union normally of a single out of many a million sperms of a male with the egg or ovum of a female remains an intriguing phenomenon. A comprehensive explanation of each of these steps, especially the necessity of so many millions of sperms to create an environment for the effective fertilisation still eludes us. For the said union a male sperm has to be formed in the male reproductive system and be deposited to the female reproductive system. Broadly, there is a manufacturing unit that is provided by the testes, a storage unit provided mainly by the vas and its dilated part or the ampulla and a delivery unit that involves the ejaculatory ducts and urethra, which in a male is a common urinary and genital passage. Each of these units has some overlapping functions.
Function of the primary sex gland in the males (testis) is controlled by a complex neuro-humoral mechanism with its epicentre at the hypothalamic-pituitary axis. Erection and ejaculation, which constitute the delivery system, are controlled by the lumbo-sacral part of the spinal cord with complementary actions of sympathetic (L-1, 2) and parasympathetic nervous systems (S-2, 3 & 4). Successful delivery of the sperms from testes to the vagina naturally presupposes its unhindered and safe passage through vas deferens (commonly known as vas running from the testes to the seminal vesicles), and through the ejaculatory ducts passing through another secondary sex gland or prostate to the prostatic part of the male urethra.
However, successful union of ovum and the sperm does not guarantee normal development of the zygote. The sperms have two different constituents- one with “X” and another with “Y” chromosomes and chromosomal abnormalities could lead to faulty development of the unborn child in the forms of Klinefelter's and Down's syndromes. Thus, there is the proverbial many a slip between the cup and the lip- each slip in the absence of synergy of these functional units would cause a diseased condition.
This book deals with the abnormalities or dysfunctions of the male reproductive system with emphasis on common conditions in the sub-continental perspective. Outlines of the basic anatomy and physiology including the endocrinology have been included, so that the pathology of dysfunctional or diseased conditions is easily understood. The management, which includes diagnosis and treatment of these conditions, has been dealt with based on my own experience spreading over three decades and collating other experts’ knowledge.
I am aware of the stupendous task of writing a monograph on any subject single-handedly. The book without doubt shows a bias of an andrologist or physician dealing with male factors in infertility. Some of us over the years have developed special skill in the management of many of these conditions. They justifiably could have put their authoritative stamp in the respective chapters of a multi-author publication. But I believe that a single-author monograph could ensure a free flow and lucidity in dealing with the subject, as the writing styles of different authors could not be the same. Moreover, it is often difficult to avoid repetition in some chapters, a task that is never easy to mend for the editor of a multi-author monograph.
All said and done, even in the first decade of the twenty first century, the treatment of male infertility because of its innate nature, still has a long way to go to achieve the same level of excellence and success of medicine in other fields. The results of surgery or other therapies at times are capricious, and the success is 6never guaranteed. Assisted reproductive technology especially the intracytoplasmic sperm injection has inddeed made great promise in recent times. Unfortunately, in the subcontinent and perhaps in many developing countries, its accessibility is limited to the big cities, and only to a very few rich. Hopefully, future would unearth newer methods and open new vistas to solve the vexed problem of reproductive dysfunction, and they would be cost-effective and universally affordable.
I have deliberately mentioned the websites and e-mail numbers in the reference. I sincerely believe that with the astounding progress of the internet, these should now form part of the reference as much as the journals.
SC Basu
Acknowledgements
7Firstly, I am really grateful to my long time friend Prof PK Basu, who went through the manuscript more than once, and made invaluable suggestions.
I must also acknowledge inspiration I derived from Prof FH Comhaire, whom I never met. Yet his edited book on Male Infertility published by Chapman and Hall, London provided me with a lot of data, which I have referenced frequently in many chapters. I am also grateful to Prof Shafik of Cairo, who communicated me through electronic mail, and permitted me to use his diagrams.
I take this opportunity to thank Prof Sima Mukherjee and Dr Sanjay Thulkar, Department of Radio-diagnosis of AIIMS for making available published data and diagrams in the book. I also thank Dr R Rattan, Bahrain and Dr R Sachdeva, New Delhi for the diagrams they provided.
I am also indebted to my numerous patients, who suffered silently, yet enriched my knowledge and insight to tackle the subject of infertility. It would be rewarding if the book helps health care providers to ameliorate sufferings of future patients.
The list of acknowledgement would be incomplete without the mention of the publisher of the book, M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, particularly Mr JP Vij, Chairman and Managing Director, who reposed faith in me, and Mr Tarun Duneja, General Manager (Publishing), who helped me at every step during publication of the book.
Lastly, I am grateful to my family members, particularly my wife Dr Ira Basu, who had patiently maintained the family peace, while I devoted my attention in writing, editing and going through the proof.