male%20infertility
MALE INFERTILITY

Infertility is the inability to conceive despite regular unprotected sexual intercourse for one year.

Male infertility as the sole cause accounts for 20% & 30-40% as a contributory factor to infertility in couples.

Causes include: hypothalamic pituitary disease, primary testicular disease, disorders of sperm transport, genetic disorders, idiopathic infertility, infections, immune system disorders, iatrogenic causes, and chronic illness.

Male%20infertility Management

Follow Up

  • Prognostic factors include duration & etiology of infertility, semen analysis findings, & assessment of female partner
  • Annual follow-up is recommended in patients w/ Klinefelter syndrome
After Surgery
  • Annual ultrasound is mandatory for patients who underwent orchiectomy
  • Semen analysis is required every 3 months after surgery or until pregnancy occurs
  • Patient should be examined for possible persistent obstruction, sperm autoimmunity, post-operative atrophy, or other spermatogenic defects after genital tract obstruction removal
Failed Fertilization
  • Refer the couple to a specialist after fertilization of oocyte fails
  • Examination of sperm binding & penetration should be reassessed, including other defects in the sperm-oocyte interaction
  • ICSI may be considered after failed IVF
Semen Cryopreservation
  • A process that stores semen at subzero temperatures (-196°C) to interrupt cell metabolism
  • Should be offered to patients undergoing biopsy or sperm retrieval, patients undergoing cancer treatment or procedures that may affect fertility, men w/ decreasing sperm quality due to a chronic illness, & after induction of spermatogenesis in men w/ hypogonadotropic hypogonadism

Counselling

Couple Counselling
  • Should address the psychological & emotional effects of infertility on couples & individually
  • Both partners should be seen during consultations
  • Advise couples about the pros & cons of available treatments
  • Counselling prior to, during, & after fertility treatments are advised
    • The couple may experience cycles of optimism & despair that should be addressed
  • Inform the couple that stress on both the male & female partner may contribute to fertility problems (decreased libido, reduced frequency of intercourse)
  • Timing of sexual intercourse may help couples conceive
    • Vaginal sexual intercourse every 2-3 days may increase the chances of conception, depending on the cause of infertility
Genetic Counselling
  • Recommended for couples w/ genetic abnormalities & those w/ hereditary diseases prior to treatments & reproductive techniques
    • Y-deletions are inherited by male offsprings
  • Brief couples on the risks their future child might incur prior to proceeding w/ treatments
    • If both parents are carriers, there is 50% chance of the offspring developing a clinical defect
Editor's Recommendations
Most Read Articles
3 days ago
Routinely used for treating cardiovascular diseases, statins have been shown to benefit other conditions, and new evidence suggests that using the drug at high intensity reduces the risk of hip or knee replacement, an effect that may be specific to rheumatoid arthritis.
Jairia Dela Cruz, 3 days ago
Following vegan and vegetarian diets, which offer plenty of what is good for health, has been reported to have a downside: an increased risk of depression and anxiety, especially for younger adults.
Pearl Toh, 29 Jun 2020
Having migraine during midlife appears to be associated with a higher risk of developing dementia in later life, according to a large population-based longitudinal Danish study presented at the AHS* 2020 Virtual Meeting, indicating that migraine may be a risk factor for dementia.
Roshini Claire Anthony, Yesterday

Upadacitinib may be a suitable treatment for patients with active psoriatic arthritis (PsA) who have insufficient response to non-biologic disease-modifying anti-rheumatic drugs (non-bDMARDs), according to results of the phase III SELECT-PsA-1* trial presented at EULAR 2020.