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.
Congenital Adrenal Hyperplasia Male Infertility Hypogonadotropic Hypogonadism Testicular Biopsy Male Factor Infertility
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Mosher WD, Pratt WF. Fecundity and infertility in the United States: incidence and trends. Fertil Steril. 1991;56:192–3.PubMedGoogle Scholar
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
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
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
Segal S, Yaffe H, Laufer N, et al. Male hyperprolactinemia:effects on fertility. Fertil Steril. 1979;32:556–61.PubMedGoogle Scholar
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
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
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
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
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
Kamischke A, Nieschlag E. Treatment of retrograde ejaculation and anejaculation. Hum Reprod Update. 1999;5:448–74.PubMedCrossRefGoogle Scholar
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
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
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
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
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
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
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
Jarow JP. Transrectal ultrasonography in the diagnosis and management of ejaculatory duct obstruction. J Androl. 1996;17:467–72.PubMedGoogle Scholar
Potts JM, Pasqualotto FF, Nelson D, et al. Patient characteristics associated with vasectomy reversal. J Urol. 1999;161:1835–9.PubMedCrossRefGoogle Scholar
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
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
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
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
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.
Steckel J, Dicker AP, Goldstein M. Relationship between varicocele size and response to varicocelectomy. J Urol. 1993;149:769–71.PubMedGoogle Scholar
Jarow JP, Ogle SR, Eskew LA. Seminal improvement following repair of ultrasound detected subclinical varicoceles. J Urol. 1996;155:1287–90.PubMedCrossRefGoogle Scholar
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
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
Lee R, Li PS, Goldstein M, et al. A decision analysis of treatments for obstructive azoospermia. Hum Reprod. 2008;23:2043–9.PubMedCrossRefGoogle Scholar
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
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
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
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