Male%20infertility Management

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

Optimizing metastatic hormone-sensitive prostate cancer treatment in advanced prostate cancer

Assoc Prof. Darren Poon, Assoc Prof. Edmund Chiong, 14 Jan 2021

Metastatic hormone-sensitive prostate cancer (mHSPC) refers to the condition whereby patients have metastatic prostate cancer and no prior hormonal therapy or androgen deprivation therapy (ADT). Typically, patients with mHSPC have been treated with ADT alone, following which, the overwhelming majority develop castration resistance over time and head towards eventual mortality. In recent years, the publication of various landmark trials has prompted dramatic changes in the mHSPC treatment landscape, and had favourably impacted overall survival (OS) in these patients. At a recent webinar, A/Prof Darren Poon, Honorary Consultant in Clinical Oncology, Hong Kong Sanatorium & Hospital, and Honorary Clinical Associate Professor, Department of Clinical Oncology, The Chinese University of Hong Kong, reviewed treatment options in mHSPC, while A/Prof Edmund Chiong, Head and Senior Consultant, Department of Urology, National University Hospital, Singapore, presented a case which was discussed by an esteemed panel of experts. This webinar was jointly organized by the Singapore Society of Oncology and the Singapore Urological Association, and supported by Astellas.