The advantages of standardized evaluation of male infertility

Abstract

Healthcare can be improved by standardization and by evaluation of diagnostic methods and treatments. In the field of andrology, in which large patient numbers are required for the evaluation of diagnostic procedures and treatments, structured data collection and multicentre studies are especially warranted. Concomitant with routine clinical practice, a large amount of clinical data are collected that may be used to evaluate andrological care. Structuring and electronic storage of data holds promise in terms of clarity and accessibility of the data and its use for validation studies. The aim of the present work was to study the merits of routine collection of a common dataset in a computer-based patient record (CPR) for standardization, quality of data and clinical research. It was studied whether the data were of sufficient quality and accessibility for much needed studies on aetiology, interventions and diagnostics in andrology. Data collection in a structured CPR promoted complete and comprehensive data. We describe the advantages, pitfalls and solutions with this approach. Data on the uniform examination of 1549 infertile men became readily accessible. Population characteristics, basal associations and original studies were enabled and provided insight into the efficiency of clinical practice. In 66% of men, a cause for their infertility was identified, which provides a better rationale for treatment than semen parameters alone. For more than 30% of the patients, a rational andrological treatment was available, which could be deployed before assisted reproductive technologies were resorted to. However, most treatments have not been properly validated. The thorough diagnostic evaluation identifies subgroups that require an evidence base for treatment and further study on aetiology and diagnosis. Structured collection of uniform patient data through a CPR was feasible and facilitated the evaluation of diagnostic and therapeutic modalities. The reported advantages, pitfalls and solutions with this approach may help other centres to decide on how to implement a CPR. Conscientious collection of a standard data set in infertility centres facilitates pooling of data and evidence-based multicentre research.

Causes of male infertility: a 9-year prospective monocentre study on 1737 patients with reduced total sperm counts

“…idiopathic infertility; >45%), varicocele (22.6%), accessory gland infection (12.4%), immunological infertility (5.4%), congenital abnormalities such as cryptorchidism (3.0%), systemic causes (2.6%) and sexual dysfunctions (2.3%). In 2000, a monocenter study was published by a tertiary referral andrology center in Rotterdam ( n  = 1549) (Pierik et al ., 2000). It also reported seminal abnormalities of unknown cause as the most frequent diagnosis (idiopathic infertility; >40%), followed by varicocele (14.2%), immunological infertility (11%), accessory gland infection (5.3%), cryptorchidism and other congenital abnormalities of the male reproductive system (9.0%) and sexual dysfunction (4.6%).…”

“…There is an apparent rising need to dissect the heterogeneous causes behind male infertility and to provide more personalized treatment of the condition. Currently, there are only a few large-scale epidemiological studies addressing this topic (WHO, 1997; Pierik et al ., 2000; Tüttelmann et al ., 2011). The published studies suffer from significant methodological shortcomings, such as insufficient efforts towards standardization of clinical and laboratory examinations, different referral levels of participating centers or missing relevant control groups.…”

Effects of Experimental Cryptorchidism on Sperm Motility and Testicular Endocrinology in Adult Male Rats

“…Plasma concentrations of inhibin B significantly decreased in the cryptorchid rats. The plasma inhibin B level is an accurate marker of the function of Sertoli cells and also of spermatogenesis [53,54], indicating that this hormone is useful in the clinical evaluation of male subfertility. Because Sertoli cell function is reflected by plasma inhibin B, the effect of cryptorchidism on Sertoli cell function can thus be evaluated.…”

“…Low inhibin B levels indicate impairment of Sertoli cell function, which is mainly responsible for the increased FSH secretion in cryptorchid rats. As a direct secretory product of the Sertoli cell, inhibin B is more sensitive than testosterone as a parameter for evaluation of spermatogenesis [53,54].…”

Sperm chromatin structure is associated with the quality of spermatogenesis in infertile patients

“…Standardized diagnostic methods in the andrological workup including medical history taking, physical examination, scrotal ultrasound, and hormonal analyses can categorize the majority of patients with male factor fertility disorders (2). Still, male factor infertility is unexplained in 44%-75% of patients (3).…”