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Spermatogenesis and Assisted Fertility Treatment

  • Andrew A. DwyerEmail author
  • Elizabeth Williamson
  • Margaret G. Au
  • Channa Jayasena
Chapter

Abstract

Approximately 15% of couples are affected by infertility and it is estimated that male factors contribute to roughly half of cases. Careful history and clinical assessment is warranted in men presenting with infertility. Genetic defects such as Klinefelter syndrome and iatrogenic causes such as exogenous testosterone treatment are not uncommonly identified causes of infertility in men presenting for endocrine consultation. Importantly, neuroendocrine aetiologies of male infertility such as congenital hypogonadotrophic hypogonadism (CHH) are more amenable to treatment compared to gonadal defects causing hypergonadotrophic hypogonadism. Assessing predictors of outcomes is an important aspect of setting appropriate patient expectations prior to beginning fertility-inducing treatment. Tailored hormonal therapies can effectively develop sperm in approximately 75% of men with CHH. Additionally, assisted reproductive technologies can be a helpful complement in challenging cases. This chapter is intended to give the endocrine nurse context for the approach to male infertility and provides an overview of hormonal treatments and relevant assisted reproductive technologies. Emphasis is given to setting realistic patient expectations, delivering coordinated care including appropriate referral to fertility specialists and elements related to therapeutic education and psychosocial support relevant for this patient population.

Keywords

Ethics Fertility agents, male Follicle stimulating hormone GnRH Gonadotrophins Infertility, male Spermatogenesis 

Abbreviations

ART

Assisted reproductive technologies

ASRM

American Society of Reproductive Medicine

BMI

Body mass index

CAH

Congenital adrenal hyperplasia

CBAVD

Congenital bilateral absence of the vas deferens

CFTR

Cystic fibrosis transmembrane regulator

CGH

Comparative genomic hybridization

CHH

Congenital hypogonadotrophic hypogonadism

CPHD

Combined pituitary hormone deficiency

ESHRE

European Society of Human Reproduction and Embryology

FSH

Follicle stimulating hormone

GnRH

Gonadotrophin-releasing hormone

hCG

Human chorionic gonadotrophin

HIV

Human immunodeficiency virus

HPG

Hypothalamic-pituitary-gonadal

IB

Inhibin B

ICSI

Intracytoplasmic sperm injection

IUI

Intra-uterine insemination

IVF

In vitro fertilization

LH

Luteinizing hormone

MESA

Microsurgical epididymal sperm aspiration

micro-TESE

Microsurgical testicular sperm extraction

PCAs

Permeable cryoprotective agents

PESA

Percutaneous epididymal sperm aspiration

PGD/PGS

Pre-implantation genetic diagnosis/screening

SHBG

Sex hormone binding globulin

T

Testosterone

TARTs

Testicular adrenal rest tumours

TV

Testicular volume

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Andrew A. Dwyer
    • 1
    • 2
    Email author
  • Elizabeth Williamson
    • 3
  • Margaret G. Au
    • 4
  • Channa Jayasena
    • 5
  1. 1.William F. Connell School of Nursing, Boston CollegeChestnut HillUSA
  2. 2.Boston CollegeChestnut HillUSA
  3. 3.Reproductive Medicine UnitUniversity College London HospitalsLondonUK
  4. 4.Department of PediatricsCedars-Sinai Medical CenterLos AngelesUSA
  5. 5.Reproductive Endocrinology and AndrologyImperial College and Hammersmith HospitalLondonUK

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