An update on the clinical assessment of the infertile male

Abstract

Male infertility is directly or indirectly responsible for 60% of cases involving reproductive-age couples with fertility-related issues. Nevertheless, the evaluation of male infertility is often underestimated or postponed. A coordinated evaluation of the infertile male using standardized procedures improves both diagnostic precision and the results of subsequent management in terms of effectiveness, risk and costs. Recent advances in assisted reproductive techniques (ART) have made it possible to identify and overcome previously untreatable causes of male infertility. To properly utilize the available techniques and improve clinical results, it is of the utmost importance that patients are adequately diagnosed and evaluated. Ideally, this initial assessment should also be affordable and accessible. We describe the main aspects of male infertility evaluation in a practical manner to provide information on the judicious use of available diagnostic tools and to better determine the etiology of the most adequate treatment for the existing condition.

Association of progesterone receptor gene polymorphism with male infertility and clinical outcome of ICSI

“…While the laboratory classification of oligozoospermia and normozoospermia is based on the sperm counts with a cutoff of 15 million/ml [42], the correlation of these counts to fertility is often poor and an individual can father a child even at sperm concentrations lower then this cutoff [13,40]. Thus, the fertility status is often a misleading parameter for association based studies and it is recommended to compare the data with sperm counts.…”

“…Clinically representing as azoospermia (no sperm in the semen) or oligozoospermia (<15×10 6 spermatozoa/mL of ejaculate); male factor subfertility is a frequently observed medical problem [13,42]. Several factors like; cryptorchidism, environmental toxins, infections, drugs, alcohol, radio/chemotherapy are known to reduce sperm counts; in about one third of the cases, the cause of impaired spermatogenesis is unknown and is often referred to as idiopathic infertility [13,22]. Identification of the etiology in these cases is necessary for accurate diagnosis and designing rational therapies for male infertility.…”

Engaging Practicing Gynecologists in the Management of Infertile Men

“…Physicians treating infertile couples should exercise circumspection when interpreting the results of routine SA because it is only a tool among several others for determining clinical care. The male infertility evaluation has to be complemented with a proper physical examination, a comprehensive history taking, and relevant endocrine, genetic, and other investigations [46,47].…”

“…However, in cases with AZFc microdeletion, sperm can be retrieved in 50-71 % of patients [84]. Clinical pregnancy rates are virtually the same as those of idiopathic azoospermic patients [87]. However, the offspring of a father with YCMD will inherit the same genetic trait.…”

Obstetric and perinatal outcome of babies born from sperm selected by MACS from a randomized controlled trial

“…Currently, routine semen analysis is carried out to evaluate male factor infertility and is based on parameters such as sperm concentration, motility, and morphology [1]. Nevertheless, normal semen results do not guarantee fecundity, so it is important to acknowledge the limitations of semen analysis results in predicting the health and functional capacity of the male reproductive organs and cells [2].…”