An update on the clinical assessment of the infertile male

Male infertility is directly or indirectly responsible for 60% of cases involving reproductive-age couples with fertility-related issues. Nevertheless, the evaluation of male infertility is often underestimated or postponed. A coordinated evaluation of the infertile male using standardized procedures improves both diagnostic precision and the results of subsequent management in terms of effectiveness, risk and costs. Recent advances in assisted reproductive techniques (ART) have made it possible to identify and overcome previously untreatable causes of male infertility. To properly utilize the available techniques and improve clinical results, it is of the utmost importance that patients are adequately diagnosed and evaluated. Ideally, this initial assessment should also be affordable and accessible. We describe the main aspects of male infertility evaluation in a practical manner to provide information on the judicious use of available diagnostic tools and to better determine the etiology of the most adequate treatment for the existing condition.

[1]  Organización Mundial de la Salud.  WHO laboratory manual for the examination and processing of human semen , 2010 .

[2]  W. Cates,et al.  WORLDWIDE PATTERNS OF INFERTILITY: IS AFRICA DIFFERENT? , 1985, The Lancet.

[3]  P. Turek,et al.  Definition and current evaluation of subfertile men. , 2006, International braz j urol : official journal of the Brazilian Society of Urology.

[4]  K. Barnhart,et al.  Do sperm DNA integrity tests predict pregnancy with in vitro fertilization? , 2008, Fertility and sterility.

[5]  K. Fujita,et al.  Prediction of successful outcome of microdissection testicular sperm extraction in men with idiopathic nonobstructive azoospermia. , 2004, The Journal of urology.

[6]  L. Brown,et al.  Clinical characterization of 42 oligospermic or azoospermic men with microdeletion of the AZFc region of the Y chromosome, and of 18 children conceived via ICSI. , 2002, Human reproduction.

[7]  P. Stahl,et al.  A decade of experience emphasizes that testing for Y microdeletions is essential in American men with azoospermia and severe oligozoospermia. , 2010, Fertility and sterility.

[8]  S. Esteves,et al.  Influence of antisperm antibodies in the semen on intracytoplasmic sperm injection outcome. , 2007, International braz j urol : official journal of the Brazilian Society of Urology.

[9]  R. Ofir,et al.  The incidence and possible relevance of Y-linked microdeletions in babies born after intracytoplasmic sperm injection and their infertile fathers , 1996 .

[10]  M. Goldstein,et al.  Urogenital anomalies in men with congenital absence of the vas deferens. , 1996, The Journal of urology.

[11]  C. Barratt,et al.  Diagnostic tools in male infertility-the question of sperm dysfunction. , 2011, Asian journal of andrology.

[12]  R. Oates.  Evaluation of the azoospermic male. , 2012, Asian journal of andrology.

[13]  C. Foresta,et al.  Y chromosome microdeletions and alterations of spermatogenesis. , 2001, Endocrine reviews.

[14]  C. Lombard,et al.  A study of semen parameters with emphasis on sperm morphology in a fertile population: an attempt to develop clinical thresholds. , 2001, Human reproduction.

[15]  L. Lipshultz,et al.  Significant medical pathology uncovered by a comprehensive male infertility evaluation. , 1994, Fertility and sterility.

[16]  J. Jarow,et al.  Endocrine evaluation of infertile men. , 1997, Urology.

[17]  H. Fisch,et al.  Infection and pyospermia in male infertility , 2004, World Journal of Urology.

[18]  J. Pryor,et al.  The Doppler assessment of varicoceles and internal spermatic vein reflux in infertile men. , 1980, British journal of urology.

[19]  A. Matamoros,et al.  Color Doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical examination. , 1997, Urology.

[20]  Z. Rosenwaks,et al.  Detection of sperm in men with Y chromosome microdeletions of the AZFa, AZFb and AZFc regions. , 2003, Human reproduction.

[21]  S. Esteves,et al.  Transurethral resection of partially obstructed ejaculatory ducts: seminal parameters and pregnancy outcomes according to the etiology of obstruction. , 1998, The Journal of urology.

[22]  J. Kurhanewicz,et al.  A novel application of 1H magnetic resonance spectroscopy: non-invasive identification of spermatogenesis in men with non-obstructive azoospermia. , 2010, Human reproduction.

[23]  P. Schlegel,et al.  Aromatase inhibitors for male infertility. , 2002, The Journal of urology.

[24]  Remah M Kamel,et al.  Management of the infertile couple: an evidence-based protocol , 2010, Reproductive biology and endocrinology : RB&E.

[25]  L. Dubin,et al.  Varicocelectomy: twenty-five years of experience. , 1988, International journal of fertility.

[26]  A. Wetzels,et al.  Semen parameters, including WHO and strict criteria morphology, in a fertile and subfertile population: an effort towards standardization of in-vivo thresholds. , 2001, Human reproduction.

[27]  E. Belgrano,et al.  Color Doppler ultrasound investigation of varicocele , 2004, World Journal of Urology.

[28]  Jing Du,et al.  Differential diagnosis of azoospermia and etiologic classification of obstructive azoospermia: role of scrotal and transrectal US. , 2010, Radiology.

[29]  S. Masoodi,et al.  Epidemiologic and etiologic aspects of primary infertility in the Kashmir region of India. , 1997, Fertility and sterility.

[30]  C. Lombard,et al.  Predictive value of normal sperm morphology in intrauterine insemination (IUI): a structured literature review. , 2001, Human reproduction update.

[31]  A. Agarwal,et al.  Detection of testicular cancer in men presenting with infertility. , 2003, Revista do Hospital das Clinicas.

[32]  J. Jarow.  Seminal vesicle aspiration in the management of patients with ejaculatory duct obstruction. , 1994, The Journal of urology.

[33]  J W Overstreet,et al.  Sperm morphology, motility, and concentration in fertile and infertile men. , 2001, The New England journal of medicine.

[34]  L. Veeck,et al.  AZF microdeletions of the Y chromosome and in vitro fertilization outcome. , 2004, Fertility and sterility.

[35]  L. Levine,et al.  The value of pituitary magnetic resonance imaging in men with hypogonadism. , 2003, The Journal of urology.

[36]  S. Oehninger,et al.  Predictive value of abnormal sperm morphology in in vitro fertilization. , 1988, Fertility and sterility.

[37]  A. W. Endtz.  A rapid staining method for differentiating granulocytes from "germinal cells" in Papanicolaou-stained semen. , 1974, Acta cytologica.

[38]  D. Rausch,et al.  Imaging of male infertility: pictorial review. , 2009, AJR. American journal of roentgenology.

[39]  C. Lombard,et al.  Predictive value of normal sperm morphology: a structured literature review. , 1998, Human reproduction update.

[40]  F. van der Veen,et al.  The value of palpation, varicoscreen contact thermography and colour Doppler ultrasound in the diagnosis of varicocele. , 1996, Human reproduction.

[41]  E. Lamb,et al.  Do the results of semen analysis predict future fertility? A survival analysis study. , 1988, Fertility and sterility.

[42]  A. Agarwal,et al.  Evaluation of acrosomal status and sperm viability in fresh and cryopreserved specimens by the use of fluorescent peanut agglutinin lectin in conjunction with hypo-osmotic swelling test. , 2007, International braz j urol : official journal of the Brazilian Society of Urology.

[43]  C. Lombard,et al.  The Use of Semen Parameters to Identify the Subfertile Male in the General Population , 2005, Gynecologic and Obstetric Investigation.

[44]  R John Aitken,et al.  Sperm cell biology: current perspectives and future prospects. , 2011, Asian journal of andrology.

[45]  L. Dubin,et al.  Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. , 1970, Fertility and sterility.

[46]  M. Hellerstein,et al.  A stable isotope-mass spectrometric method for measuring human spermatogenesis kinetics in vivo. , 2006, The Journal of urology.