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.

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
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30 Jul 2016
Long-term testosterone replacement therapy (TRT) is beneficial in men with late-onset hypogonadism (LOH) in a study and is even associated with improvement in sexual function and vitality, physical pain, general health, and overall health-related quality of life (HRQoL).