University of Dundee The diagnosis of male infertility (original) (raw)
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Impact of the New WHO Guidelines on Diagnosis and Practice of Male Infertility
The World Health Organization (WHO) has established new reference values for semen characteristics in its 5th edition manual which are lower than those previously reported. Several questions arise after a careful examination of the proposed new values, especially regarding the implications of these references for diagnosis and treatment of male infertility. Despite the notable advance of using controlled studies involving couples whose time to pregnancy was less than 12 months to generate the new limits, reference studies are limited with regard to the population analyzed and the methods used for semen evaluation. As such, it seems unreasonable to assume that reference values represent global semen characteristics of fertile men as proposed in the 5 th edition WHO manual. Caution should be exercised to not overinterpret the new reference values as they may fail to accurately discriminate populations of fertile and infertile men. Properly performed semen analyses coupled with an adequate examination of the man can give valuable information related to the organs producing "semen", a highly complex fluid, and thus help in better understanding of the physiology of the reproductive organs and the causes of their dysfunctions. The present commentary discusses concerns related to the publication of the new reference values for semen parameters such as the impact on patient referral, diagnosis, treatment of recognized conditions such as varicocele and indications of assisted reproductive modalities. We conclude that more debate is needed before the adoption of the proposed WHO current reference values by andrology laboratories around the world. For those considering to adopt them, a better approach would be the presentation of reference values by percentiles rather than solely the lower cutoff limits. The time has come for technological developments that bring robust and costeffective clinically useful sperm function tests to replace, at least partially, the shortcomings of routine semen analysis.
Evidence-based infertility Male infertility Pregnancy
2010
Background: Randomized controlled trials (RCTs) addressing varicocele treatment are scarce and have conflicting outcomes. Objective: To determine whether varicocele treatment is superior or inferior to no treatment in male infertility from an evidence-based perspective. Design, setting, and participants: A prospective, nonmasked, parallel-group RCT with a one-to-one concealed-to-random allocation was conducted at the authors ’ institution from February 2006 to October 2009. Married men 20–39 yr of age who had experience infertility 1 yr, had palpable varicoceles, and with at least one impaired semen parameter (sperm concentration <20 million/ml, progressive motility <50%, or normal morphology <30%) were eligible. Exclusions included subclinical or recurrent varicoceles, normal semen parameters, and azoospermia. Sample size analysis suggested 68 participants per arm. Intervention: Participants were randomly allocated to observation (the control arm [CA]) or subinguinal micro...
Causes and Risk Factors for Male Infertility: A Scoping Review of Published Studies
International Journal of General Medicine
Background: Despite the evidence of declining sperm counts worldwide and the increasing prevalence of male infertility, there has been limited documentation of the potential causes and risk factors for male infertility. With limited methods of primary treatment of male infertility, understanding the causes and risk factors will pinpoint specific lines of prevention. Objective: We reviewed published studies on causes and risk factors for male infertility and identify gaps in the literature enabling more focused research and innovations. Design/Setting: The study was a scoping review. The review included studies on the causes and risk factors of male infertility published in scientific/academic publications. It was not limited to any region or date. The following databases were searched: Cumulative Index to Nursing and Allied Health Literature, Wiley online, HINARI, Science Direct, PubMed/Medline, Google Scholar, African Journals Online, and the WHO Repository. In total, 1295 articles were identified. After removing 357 duplicates, 938 articles were screened, and 71 articles were identified for inclusion, while 60 articles met the inclusion criteria. Results: Four broad causes and risk factors of male infertility identified were 1) biological/physiological/genetic causes, 2) behavioral/lifestyle risk factors, 3) environmental factors, and 4) socio-demographic risk factors. However, no substantive results on actual causes under each category were identified, leaving gaps for further research and experimentation. Conclusion: The results indicate limited knowledge of the actual causes of male infertility in published studies. The gaps in knowledge that need to be bridged to enable a fuller understanding of the actual causes of male infertility were highlighted.
Cells, 2020
Infertility is a devastating experience for both partners as they try to conceive. Historically, when a couple could not conceive, the woman has carried the stigma of infertility; however, men and women are just as likely to contribute to the couple’s infertility. With the development of assisted reproductive technology (ART), the treatment burden for male and unexplained infertility has fallen mainly on women. Equalizing this burden requires reviving research on male infertility to both improve treatment options and enable natural conception. Despite many scientific efforts, infertility in men due to sperm dysfunction is mainly diagnosed by a semen analysis. The semen analysis is limited as it only examines general sperm properties such as concentration, motility, and morphology. A diagnosis of male infertility rarely includes an assessment of internal sperm components such as DNA, which is well documented to have an impact on infertility, or other components such as RNA and centri...
Male Infertility: Causes and Optimal Evaluation
2020
Objective: To find out the optimum evaluation tools for male infertility. Methods: Hinari database were searched for articles related to male infertility for review to find out how a male infertile patient can be evaluated optimally.EUA guidelines on Male Infertility and AUA best practice statement on Optimal Evaluation of the Infertile Male updated on 2010 were also considered for review. Results: Initially thirty five articles were obtained and finally twenty eight articles were considered for review. Some cross references were considered to be cited in the reference section. We have mentioned in this review the evaluation tools those are necessary for male factor infertility at the optimum. Conclusion : As male infertility problem are increasing so optimum evaluation should be carried out to diagnose every possible underlying cause.
Male Infertility: A Growing Global Health Issue
2016
Male infertility is a worldwide population health concern. According to an estimate there are 48.5 million couples with infertility globally. 1 According to a study infertility affects 15% of couples that have unprotected intercourse. 2 Unlike female infertility, male infertility is not well reported in general but especially in countries where cultural contrasts and male dominant societies may prevent accurate statistics from being reported. The female partner is often blamed for infertility in Northern Africa and Middle East and men, therefore, do not usually agree to do fertility evaluation that results in underreporting of male infertility. Male infertility has never been defined as a disease that has resulted in sparse statistics. Demographic and clinical studies vary in epidemiological definition of infertility. While many clinical studies have scrutinized infertility over the passage of a year, numerous demographic studies examine infertility over a five-year span. 3 According to a study, 50% of infertility cases are due to an exclusively female factor, male factor accounts for 20-30% of the problem and the remaining 20-30% is due to a blend of both male and female factors. 2
The factors affecting male infertility: A systematic review
International Journal of Reproductive BioMedicine (IJRM)
Background: In recent years, the incidence of male infertility has increased worldwide. It is necessary to study the factors that influence male infertility in each area/region for better management. Objective: To determine the factors affecting male infertility in the Iranian male population. Materials and Methods: An online search was conducted in electronic databases including PubMed, Google Scholar, SID, and Scopus to identify articles on the factors associated with male infertility, published in English and Persian. The keywords used to perform the search included “factor”, “epidemiology”, “causes of infertility”, and “male infertility”. The search was conducted without a time restriction, up to April 2020. Results: The search resulted in a total number of 691 studies. After an assessment of the articles, finally 14 studies were included in this study with a total number of 26,324 infertile males. The factors associated with male infertility included semen abnormalities, varico...
2020
Infertility is a devastating experience for both partners as they try to conceive. Historically, when a couple could not conceive, the woman has carried the stigma of infertility; however, men and women are just as likely to contribute to the couple\u27s infertility. With the development of assisted reproductive technology (ART), the treatment burden for male and unexplained infertility has fallen mainly on women. Equalizing this burden requires reviving research on male infertility to both improve treatment options and enable natural conception. Despite many scientific efforts, infertility in men due to sperm dysfunction is mainly diagnosed by a semen analysis. The semen analysis is limited as it only examines general sperm properties such as concentration, motility, and morphology. A diagnosis of male infertility rarely includes an assessment of internal sperm components such as DNA, which is well documented to have an impact on infertility, or other components such as RNA and cen...