Advertisement

Medical and Surgical Interventions in Male Fertility

  • Kevin Chandler
  • Edmund SabaneghJr.Email author
Chapter
Part of the Current Clinical Urology book series (CCU)

Abstract

Infertility, defined as the failure to conceive after 1 year of unprotected intercourse, affects about 15% of reproductive age couples. Over the years, treatment of infertility has become increasingly more successful, and this has largely been dependent on interdisciplinary interactions among a number of specialties. With joint efforts between primary care physicians, obstetricians, urologists, geneticists, endocrinologists, and andrologists, couples are now able to undergo comprehensive stepwise evaluations that allow their physicians to determine the cause of infertility, provide evidence-based advice regarding prognoses, and determine the best approach toward achieving pregnancy or family planning.

In this chapter, we focus on the male infertility evaluation, and the medical and surgical treatment options available, both alone and in combination with assisted reproductive techniques (ART). It is our goal to discuss the thought process behind the evaluation and when to proceed with each type of intervention. Ultimately, this chapter will assist in the identification of tests to initiate the infertility evaluation, recognize criteria for subspecialty referral, and assist with patient counseling. In addition, it can serve as a general framework to help urologists and infertility specialists formulate plans for evaluation and treatment of their infertility patients.

Keywords

Congenital Adrenal Hyperplasia Male Infertility Hypogonadotropic Hypogonadism Testicular Biopsy Male Factor Infertility 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Mosher WD, Pratt WF. Fecundity and infertility in the United States: incidence and trends. Fertil Steril. 1991;56:192–3.PubMedGoogle Scholar
  2. 2.
    Thonneau P, Marchand S, Tallec A, et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988-1989). Hum Reprod. 1991;6:811–6.PubMedGoogle Scholar
  3. 3.
    The Optimal Evaluation of the Infertile Male: Best Practice Statement, Revised 2010. http://www.auanet.org/content/media/optimalevaluation2010.pdf. Accessed 13 May 2011.
  4. 4.
    Carlsen E, Andersson AM, Petersen JH, et al. History of febrile illness and variation in semen quality. Hum Reprod. 2003;18:2089–92.PubMedCrossRefGoogle Scholar
  5. 5.
    Sigman M, Jarow JP. Endocrine evaluation of infertile men. Urology. 1997;50:659–64.PubMedCrossRefGoogle Scholar
  6. 6.
    Sigman M, Jarow JP. Male Infertility. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007. p. 609–53.Google Scholar
  7. 7.
    Augarten A, Weissenberg R, Pariente C, et al. Reversible male infertility in late onset congenital adrenal hyperplasia. J Endocrinol Invest. 1991;14:237–40.PubMedGoogle Scholar
  8. 8.
    Segal S, Yaffe H, Laufer N, et al. Male hyperprolactinemia:effects on fertility. Fertil Steril. 1979;32:556–61.PubMedGoogle Scholar
  9. 9.
    De Rosa M, Colao A, Di Sarno A, et al. Cabergoline treatment rapidly improves gonadal function in hyperprolactinemic males: a comparison with bromocriptine. Eur J Endocrinol. 1998;138:286–93.PubMedCrossRefGoogle Scholar
  10. 10.
    van’t Verlaat JW, Croughs RJ. Withdrawal of bromocriptine after long-term therapy for macroprolactinomas; effect on plasma prolactin and tumour size. Clin Endocrinol (Oxf). 1991;34:175–8.Google Scholar
  11. 11.
    Mathur S, Williamson HO, Baker ME, et al. Sperm motility on postcoital testing correlates with male autoimmunity to sperm. Fertil Steril. 1984;41:81–7.PubMedGoogle Scholar
  12. 12.
    Robinson JN, Forman RG, Nicholson SC, et al. A comparison of intrauterine insemination in superovulated cycles to intercourse in couples where the male is receiving steroids for the treatment of autoimmune infertility. Fertil Steril. 1995;63:1260–6.PubMedGoogle Scholar
  13. 13.
    Lähteenmäki A, Räsänen M, Hovatta O. Low-dose prednisolone does not improve the outcome of in-vitro fertilization in male immunological infertility. Hum Reprod. 1995;10:3124–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Kamischke A, Nieschlag E. Treatment of retrograde ejaculation and anejaculation. Hum Reprod Update. 1999;5:448–74.PubMedCrossRefGoogle Scholar
  15. 15.
    Ghanem H, Shamloul R. An evidence-based perspective to the medical treatment of male infertility: a short review. Urol Int. 2009;82:125–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Skakkebaek NE, Hammen R, Philip J, et al. Quantification of human seminiferous epithelium. 3. Histologicalstudies in 44 infertile men with normal chromosome complements. Acta Pathol Microbiol Scand A. 1973;81:97–111.Google Scholar
  17. 17.
    Kahraman S, Ozgur S, Aksoy S, et al. High implantation and pregnancy rates with testicular sperm extraction and intracytoplasmic sperm injection in obstructive and non-obstructive azoospermia. Hum Reprod. 1996;11:673–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Yoshida A, Miura K, Shirai M. Evaluation of seminiferous tubule scores obtained through testicular biopsy examinations of nonobstructive azoospermic men. Fertil Steril. 1997;68:514–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Kessaris DN, Wasserman P, Mellinger BC. Histopathological and cytopathological correlations of percutaneous testis biopsy and open testis biopsy in infertile men. J Urol. 1995;153:1151–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Carpi A, Agarwal A, Sabanegh E, et al. Percutaneous biopsy of the testicle: a mini review with a proposal flow chart for non-obstructive azoospermia. Ann Med. 2011;43:83–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Sheynkin YR, Ye Z, Menendez S, et al. Controlled comparison of percutaneous and microsurgical sperm retrieval in men with obstructive azoospermia. Hum Reprod. 1998;13:3086–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Jarow JP. Transrectal ultrasonography in the diagnosis and management of ejaculatory duct obstruction. J Androl. 1996;17:467–72.PubMedGoogle Scholar
  23. 23.
    Potts JM, Pasqualotto FF, Nelson D, et al. Patient characteristics associated with vasectomy reversal. J Urol. 1999;161:1835–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Belker AM, Thomas Jr AJ, Fuchs EF, et al. Results of 1,469 microsurgical vasectomy reversals by the vasovasostomy study group. J Urol. 1991;145:505–11.PubMedGoogle Scholar
  25. 25.
    Kolettis PN, Sabanegh ES, Nalesnik JG, et al. Pregnancy outcomes after vasectomy reversal for female partners 35 years old or older. J Urol. 2003;169:2250–2.PubMedCrossRefGoogle Scholar
  26. 26.
    Pasqualotto FF, Pasqualotto EB, Ågarwal A, et al. Results of microsurgical anastomosis in men with seminal tract obstruction due to inguinal herniorrhaphy. Rev Hosp Clin Fac Med Sao Paulo. 2003;58:305–9.PubMedGoogle Scholar
  27. 27.
    Johnson CW, Bingham JB, Goluboff ET, et al. Transurethral resection of the ejaculatory ducts for treating ejaculatory symptoms. BJU Int. 2005;95:117–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Witt MA, Lipshultz LI. Varicocele: a progressive or static lesion? Urology. 1993;42:541–3.PubMedCrossRefGoogle Scholar
  29. 29.
    Report on Varicocele and Infertility: An AUA Best Practice Policy and ASRM Practice Committee Report, Reviewed and Validity Confirmed 2010. www.auanet.org/resources.cfm?ID=466. Accessed 12 June 2011.
  30. 30.
    Steckel J, Dicker AP, Goldstein M. Relationship between varicocele size and response to varicocelectomy. J Urol. 1993;149:769–71.PubMedGoogle Scholar
  31. 31.
    Jarow JP, Ogle SR, Eskew LA. Seminal improvement following repair of ultrasound detected subclinical varicoceles. J Urol. 1996;155:1287–90.PubMedCrossRefGoogle Scholar
  32. 32.
    Agarwal A, Deepinder F, Cocuzza M, et al. Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach. Urology. 2007;70:532–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Kolettis PN, Thomas Jr AJ. Vasoepididymostomy for vasectomy reversal: a critical assessment in the era of intracytoplasmic sperm injection. J Urol. 1997;158:467–70.PubMedCrossRefGoogle Scholar
  34. 34.
    Lee R, Li PS, Goldstein M, et al. A decision analysis of treatments for obstructive azoospermia. Hum Reprod. 2008;23:2043–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Meng MV, Greene KL, Turek PJ. Surgery or assisted reproduction? A decision analysis of treatment costs in male infertility. J Urol. 2005;174:1926–31.PubMedCrossRefGoogle Scholar
  36. 36.
    de Mouzon J, Goossens V, Bhattacharya S, et al. Assisted reproductive technology in Europe, 2006: results generated from European registers by ESHRE. Hum Reprod. 2010;25:1851–62.PubMedCrossRefGoogle Scholar
  37. 37.
    Bagis T, Haydardedeoglu B, Kilicdag EB, et al. Single versus double intrauterine insemination in multi-follicular ovarian hyperstimulation cycles: a randomized trial. Hum Reprod. 2010;25:1684–90.PubMedCrossRefGoogle Scholar
  38. 38.
    Gunby J, Daya S. IVF Directors Group of the Canadian Fertility and Andrology Society. Assisted reproductive technologies (ART) in Canada: 2003 results from the Canadian ART Register. Fertil Steril. 2007;88:550–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Department of UrologyCleveland ClinicClevelandUSA

Personalised recommendations