Male Infertility

In this chapter from the publication "Recent Advances in Endocrinology and Diabetes 1", my co-authors and I report on the main contributory factors to male infertility, and discuss the most appropriate ways in which to manage those suffering.

The semen microbiome and its impact on sperm function and male fertility: A systematic review and meta-analysis

Male factor is attributable in up to 50% of cases of infertility. In vitro studies demonstrate that bacteria can negatively impact sperm function. The use of next-generation sequencing techniques has provided a better understanding of the human microbiome.

Burdens and awareness of adverse self-reported lifestyle factors in men with sub-fertility: A cross-sectional study in 1149 men

There are no current pharmacological therapies to improve sperm quality in men with sub-fertility. Reducing the exposure to lifestyle risk factor (LSF) is currently the only intervention for improving sperm quality in men with sub-fertility.

Should the current guidelines for the treatment of varicoceles in infertile men be re-evaluated?

Published in March 2019, this review comprehensively evaluates the current indications for varicocele treatment, and it is proposed that these should be redefined in contemporary guidelines to reflect current advances in male fertility research.

Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility

Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage.

A Comparison between two assays for measuring seminal oxidative stress and their relationship with sperm DNA fragmentation

Oxidative stress (OS) is a significant cause of DNA fragmentation and is associated with poor embryo development and recurrent miscarriage. The aim of this study was to compare two different methods for assessing seminal OS and their ability to predict sperm DNA fragmentation and abnormal semen parameters.

The role of sperm aneuploidy as a predictor of the success of intracytoplasmic sperm injection?

It has long been recognized that chromosomal abnormalities are more frequent in sperm from subfertile men than in the general population with a consistent finding in the published literature of a predominance of sex chromosomal anomalies.

Novel use of COMET parameters of sperm DNA damage may increase its utility to diagnose male infertility and predict live births following both IVF and ICSI

Male infertility has become the most common cause of a couple’s difficulties in conceiving a child and is reported to be the most common cause of fertility cycles being carried out, yet, most men presenting with infertility are not thoroughly investigated before they embark on infertility treatment.

A Global Survey of Reproductive Specialists to Determine the Clinical Utility of Oxidative Stress Testing and Antioxidant Use in Male Infertility

Globally, infertility impacts 15% of couples trying to conceive. The incidence of male infertility has been increasing over the past several decades, ranging from 20% to 70% worldwide. The male partner is found to be solely responsible in 20%–30% of cases, and contributes to couple infertility in approximately 50% of cases

Microdissection testicular sperm extraction for men undergoing cancer treatment

Where cryopreservation of a good quality semen sample is not possible or was not offered prior to initiation of treatment, microdissection testicular sperm extraction (mTESE) offers a potential route to biological fatherhood. This review explores current evidence supporting the use of mTESE in patients treated for cancer, as well as some of the barriers and questions that still remain before this technique can form part of routine practice.

Sperm Vitality and Necrozoospermia: Diagnosis, Management, and Results of a Global Survey of Clinical Practice

perm vitality testing is a basic semen examination that has been described in the World Health Organization (WHO) Laboratory Manual for the Examination and Processing of Human Semen from its primary edition, 40 years ago.

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Mixed Sertoli cell only histology and NOA

Likelihood of sperm retrieval is increased four-fold when Sertoli-cell only histology is observed in combination with another histological pattern during microdissection testicular extraction (mTESE) for non-obstructive azoospermia.

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A Comprehensive Guide to Sperm Recovery in Infertile Men with Retrograde Ejaculation

Retrograde ejaculation (RE) is a condition defined as the backward flow of the semen during ejaculation, and when present can result in male infertility. RE may be partial or complete, resulting in either low seminal volume or complete absence of the ejaculate (dry ejaculate). RE can result from anatomic, neurological or pharmacological conditions. The treatment ap- proaches outlined are determined by the cause. Alkalinizing urinary pH with oral medications or by adding sperm wash me- dia into the bladder prior to ejaculation may preserve the viability of the sperm. This article provides a step-by-step guide to diagnose RE and the optimal techniques to retrieve sperm.

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Global Practice Patterns and Variations in the Medical and Surgical Management of Non- Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendations

Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This sur- vey evaluates contemporary global practices related to medical and surgical management for patients with NOA.

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Idiopathic male infertility – what are we missing?

Couple’s infertility is a rising issue worldwide affecting approximately 15% of couples. In 50% of the couples, a male factor infertility can be identified. Moreover, 30% of the men exhibit reduced sperm quality without any identifiable reason, thereby delineating the condition of idiopathic male infertility (IMI). Despite numerous improvements in the diagnosis and treatment of male infertility over the last decades, idiopathic forms are still the most challenging clinical dilemmas. The aim of this article is to describe the comprehensive diagnostic work-up that each idiopathic infertile man should follow. Moreover, potential new pathophysiological mechanisms and suggested treatment options are discussed. A detailed medical history and an extensive physical examination are mandatory to investigate potential treatable causes of MFI. Similarly, standard semen analysis has been proven to be limited in capturing the fecundability of the spermatozoa itself, therefore more advanced examinations, such as sperm DNA fragmentation (SDF) and oxidative stress measurement, are becoming important in clinical practice for IMI. In terms of diagnostic tools, imaging and genetic investigations are useful to classify idiopathic infertile men, however, epigenetic changes have demonstrated to have a role in sperm production and a prognostic value in fertility outcomes. Antioxidant treatment for IMI has been found to be a valid option to counteract ROS action, while gonadotropins are used to improve sperm quality and SDF. Artificial intelligence is promising to better manage idiopathic infertile men in terms of diagnosis and treatment options.

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