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MALE FACTOR INFERTILITY: EVALUATION AND MANAGEMENT


Authors: Larry I. Lipshultz;  Md
Authors place of work: Division of Male Reproductive Medicine and Surgery, Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
Published in the journal: Urol List 2006; 4(1): 6-14

Summary

There is a male factor involved in up to half of all infertile couples. Potential etiologies in male factor infertility are many and require thorough evaluation for their accurate identification. A complete medical history in conjunction with a focused examination can allow for an appropriate choice of laboratory and imaging studies. The semen analysis is a crucial first step, but by no means is it sufficient to determine a specific etiology or dictate therapy. A systematic approach is necessary to help guide the work-up and rule out less likely causes. The etiologies discussed within this article are tremendously broad, and the prognosis for any given couple depends, in large part, on the etiology. Without a firm understanding of the genetics, anatomy, physiology, and complex interplay of the male reproductive system, the evaluation becomes an inefficient exercise that often fails to define the precise etiology. Couples with male factor infertility need a systematic approach with the efficiency of ultimate treatment determined largely by the physician's ability to identity the specific cause of the man's reproductive failure.

KEY WORDS:
male infertility, diagnostics, treatment


Zdroje

1. Poland ML, Moghissi KS, Giblin PT, Ager JW, Olson JM. Variation of semen measures within normal men. Fertil Steril 1985; 44: 396-400.

2. Kolettis PN, Sabanegh ES. Significant medical pathology discovered during a male infertility evaluation. J Urol 2001; 166: 178-180.

3. Sigman M, Lipschultz LI. Evaluation of the subfertile male. In: Lipsehultz LI, Howard SS (eds). Infertility in the male. 3rd ed. St. Louis: Mosby 1997: 173-193.

4. Chipkevitch E, Nishimura RT, Tu DG. Galea-Rojas M. Clinical measurement of testicular volume in adolescents: comparison of the reliability of 5 methods. J Urol 1996; 156: 2050-2053.

5. Naughton CK, Nangiu AK, Agarwal A. Patho­phy­sio­lo­gy of varicoceles in male infertility. Hum Reprod Update 2001; 7: 473-481.

6. Sigman M. Jarow JP. Endocrine evaluation of infertile men. Urology 1997; 50: 659-664.

7. Jaffe TM, Kim ED, Hoekstra TH, Lipshultz LI. Sperm pellet analysis: a technique to detect the presence of sperm in men considered to have azoospermia by routine semen analysis. J Urol 1998: 159: 1548-1550.

8. Seminara SB, Oliveria LM, Beranova M, Hayes FJ, Crowley WF Jr. Genetics of hypogonadotropic hypogonadism. J Endocrinol Invest 2000; 23: 560-565.

9. Bick D, Franco B, Sherins RJ, Heye D, Pike L, Crawford J et al. Brief report intragenic deletion of the KALIG-1 gene in Kallmann's syndrome. N Engl J Med 1992; 326: 1752-1755.

10. Franco B, Guioli S, Pragliola A et al. A gene detec­ted in Kallmann's syndrome shares homology with neural cell adhesion and axonal path-finding molecules. Nature 1991; 353: 529-536.

11. Weiss J, Axelrod L, Whitcomb RW, Harris PE, Crowley jr WF, Jameson JL. Hypogonadism caused by a single amino acid substitution in the beta subunit of luteinizing hormone. N Engl J Med 1992; 326: 179-183.

12. Wu SM; Leschek EW; Rennert OM; Chan WY. Luteinizing hormone receptor mutations in disorders of sexual development and cancer. Front Biosci 2000; 5: D343-352.

13. Simoni M, Gromoll J, Hoppner W, Kamischke A, Krafft T, Stahle D et al. Mutational analysis of the follicle-stimulating hormone (FSH) receptor in normal and infertile men: identification and characterization of two discrete FSH receptor isoforms. J Clin Endocrinol Metab 1999: 84: 751-755.

14. Grillin JG. Androgen resistance: the clinical and molecular spectrum. N Engl J Med 1992; 326: 611-618.

15. Quigley CA, De Bellis A, Marschke KB, el Awady MK, Wilson EM, French FS. Androgen receptor defects: historical, clinical, and molecular perspectives. Endocr Rev 1995; 16: 271-321.

16. Brinkmann AO. Molecular basis of androgen insensitivity. Mol Cell Endocrinol 2001; 179: 105-109.

17. Casella R, Maduro MR, Lipshultz LI, Lamb DJ. Significance of the polyglutamine tract polymorphism in the androgen receptor. Urology 2001; 58: 651-656.

18. Pavlovich CP, King P, Goldstein M, Schlegel PN. Evidence of a treatable endocrinopathy in infertile men. J Urol 2001; 165: 837-841.

19. Belloli G, D'Agostino S, Pesce C, Fantuz E. Varicocele in childhood and adolescence and other testicular anomalies: a epidemiological study. Pediatr Med Chir 1993; 15: 159-162.

20. Pryor JL, Howards SS. Varicocele. Urol Clin North Am 1987; 14: 499-513.

21. Jarow JP, Coburn M, Sisman M. Incidence of vari­coceles in men with primary and secondary infertility. Urology 1996; 47: 73-76.

22. Dubin L, Amelar RD. Varicocelectomy 986 cases in a twelve-year study. Urology 1977, 10: 446-449.

23. Saypol DC, Howards SS, Turner TT, Miller ED Jr. Influence of surgically induced varicocele on testicular blood flow, temperature, and histology in adult rats and dogs. J Clin Invest 1981; 68: 39-45.

24. MacCleod JHR. The effect of hyperpcrexia on sper­ma­tozoa counts in men. Endocrinology 1941; 28: 780.

25. Peng BC, Tomashefsky P, Nagler HM. The cofactor effect: varicocele and infertility. Fertil Steril 1990; 54: 143-148.

26. Cayan S, Kadioglu A, Orhan I, Kandirali E, Tefekli A, Tellaloglu S. The effect of microsurgical varico­celectomy on serum follicle stimulating hormone, testosterone and free testosterone levels in infertile men with varicocele. BJU Int 1999; 84: 1046-1049.

27. Su LM, Goldstein M, Schlegel PN. The effect of variocelectomy on serum testosterone levels in infertile men with varicoceles. J Urol 1995; 154: 1752-1755.

28. Madgar I, Weissenberg R, Lunenfeld B et al. Con­trolled trial of high spermatic vein ligation for varicocele in infertile men. Fertil Steril 1995; 63: 120-124.

29. Kibar Y, Seçkin B, Erduran D: The effects of subinguinal varicocelectomy on Kruger morphology and semen parameters. J Urol 2002; 168: l071-1074.

30. Schatte EC, Hirshberg SJ, Fallick ML, Lipschultz LI, Kim ED. Varicocelectomy Improves Sperm Strict Morpho­logy and Motility. J Urol 1998; 160: 1338-1340.

31. Vazquez-Levin MH, Friedmann P, Goldberg SI, et al. Response of routine semen analysis and critical assessment of sperm morphology by Kruger classification to therapeutic varicocelectomy. J Urol 1997; 158: 1804-1807.

32. Ohl DA. The effect of varicocele repair on optimi­zed sperm penetration assay. Orlando. FL: ASRM 2001.

33. Mostafa T, Anis TH, El-Nashar A et al. Varico­celec­to­my reduces reactive oxygen species levels and increa­ses antioxidant activity of seminal plasma from infertile men with varicocele. Int J Androl 2001; 24: 261-265.

34. Matthews GJ, Matthews ED, Goldstein M. Induc­tion of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia. Fertil Steril 1998; 70: 71-75.

35. Kim ED, Leibman BB, Grinblat DM, Lipshultz LI. Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol 1999; 162: 732-140.

36. Kadioglu A, Tefekli A, Cayan S, Kandirali E, Erdemir F, Tellaloglu S. Microsurgical inguinal varicocele repair in azoospermic men. Urology 2001; 57: 328-333.

37. Cayan S, Erdemir F, Ozbey I, Turek PJ, Kadioglu A, Tellaloglu S. Can varicocelectomy significantly change the way couples use assisted reproductive technologies? J Urol 2002; 167: 1749-1752.

38. Schlegel PN. Is assisted reproduction the optimal treatment for varicocele-associated male infertility? A cost-effectiveness analysis. Urology 1997; 49: 83-90.

39. Johnson MD. Genetic risks of intracytoplasmic sperm injection in the treatment of male infertility: recommendations for genetic counseling and scree­ning. Fertil Steril 1998; 70: 397-411.

40. De Braekeleer M, Dao TN. Cytogenetic studies in male infertility: a review. Hum Reprod 1991; 6: 245-250.

41. Palermo GD, Schlegel PN, Sills ES, Veeck LL, Zaninovic N, Menendez S, Rosenwaks Z. Births after intracytoplasmic injection of sperm obtained by testicular extraction from men with nonmosaic Kline­felter's syndrome. N Engl J Med 1998; 338: 588-590.

42. Therman ESM. Human Chromosomes: structure, behavior and effects. 3rd ed. New York: Springer Verlag 1993.

43. Gordon DL, Krmpotic E, Thomas W, Gandy HM, Paulsen CA. Pathologic testicular findings in Klinefelter's syndrome. 47,XXY vs 46,XY-47,XXY. Arch Intern Med 1972; 130: 726-729.

44. Poulakis V, Witzsch U, Diehl W, de Vries R, Becht E, Trotnow S. Birth of two infants with normal karyo­type after intracytoplasmic injection of sperm obtained by testicular extraction from two men with nonmosaic Klinefelter's syndrome. Fertil Steril 2001; 76: 1060-1062.

45. Koopman P, Gubbay J, Vivian N, Goodfellow P, Lovell-Badge R. Male development in chromosomally female mice transgenic for Sry. Nature 1991; 135: 117-121.

46. Tiepolo L, Zuffardi O. Localization of factors controlling spermatogenesis in the nonfluorescent portion of the human Y chromosome long arm. Hum Genet 1976; 34: 119-124.

47. Foresta C, Moro E, Ferlin A. Y chromosome microdeletions and alterations of spertnatogencsis. Endocr Rev 2001; 22: 226-239.

48. Belin V, Farhat M, Monset-Couchard M. Intracytoplasmic sperm injection pregnancy with trisomy 20p and monosomy 22q in a newborn resulting from a balanced paternal translocation. Biol Neonate 1999; 75: 398-401.

49. Page PC, Silber S, Brown LG. Men with infertility caused by AZFc deletion can produce sons by intracytoplasmic sperm injection, but are likely to transmit the deletion and infertility. Hum Reprod 1999; 14: 1722-1726.

50. Villumsen AL, Zachau-Christiansen B. Sponta­neous alterations in position of the testes. Arch Dis Child 1966; 41: 198-200.

51. Cooper B. The histology of the retained testis in the human subject at different ages and its comparison with the testis. J Anat 1929; 64: 5-10.

52. Rogers E, Teahan S, Gallagher H, Butler MR, Grainger R, McDermott TE et al. The role of orchiectomy in the management of postpubertal cryptorchidism. J Urol 1998; 159: 851-854.

53. Job JC, Toublanc JE, Chaussain JL, Gendrel D, Roger M, Canlorbe P. The pituitary-gonadal axis in cryptorchid infants and children. Eur J Pediatr 1987; 146 (Suppl 2): S2-S5.

54. Leissner J, Filipas D, Wolf HK, Fisch M. The undescended testis: considerations and impact on fertility. BJU Int 1999; 83: 885-892.

55. Lipshultz LI. Cryptorchidism in the subfertile male. Fertil Steril 1976; 27: 609-620.

56. Chan PT, Palermo GD, Veeck LL, Rosenwaks Z, Schlegel PN. Testicular sperm extraction combined with intracytoplasmic sperm injection in the treatment of men with persistent azoospermia postchemotherapy. Cancer 2001; 92: 1632-1637.

57. Schlegel P. Management of ejaculatory duct obstruction. In: Lipschultz L, Howards S (eds). Infertility in the Male. 3rd ed. St Louis: Mosby 1997: 385-394.

58. Quinzii C, Castellani C. The cystic fibrosis transmembrane regulator gene and male infertility. J endocrinol Invest 2000; 23: 684-689.

59. Daudin M, Bieth E, Bujan L, Massat G, Pontonnier F, Mieusset R. Congenital bilateral absence of the vas deferens: clinical characteristics, biological parameters, cystic fibrosis transmembrane conductance re­gulator gene mutations, and implications for genetic counseling. Fertil Steril 2000; 74: 1164-1174.

60. Menge AC, Beitner O. Interrelationships among semen characteristics, antisperm antibodies, and cervical mucus penetration assays in infertile couples. Fertil Steril 1989; 51: 486-492.

61. Menge AC, Medley NE, Mangione CM, Dietrich JW. The incidence and influence of antisperm antibodies in infertile human couples on sperm-cervical mucus interactions and subsequent fertility. Fcrtil Steril 1982; 38: 434-446.

62. Collins JA, Burrows EA, Yeo J, YoungLai EV. Frequency and predictive value of antisperm antibodies among infertile couples. Hum Reprod 1993; 8: 592-598.

63. Jarow JP, Sanzone JJ. Risk factors for male partner antisperm antibodies. J Urol 1992; 148: 1803-1807.

64. Heidenreich A, Bonfig R, Wilbert DM, Strohmaier WL, Engelmann UH. Risk factors for antisperm antibodies in infertile men. Am J Reprod Immunol 1994; 31: 69-76.

65. Tung KS, Unanue ER, Dixon FJ. Pathogenesis of experimental allergic orchitis II. The role of antibody. J Immunol 1971; 106(6): 1463-1472.

66. Clarke GN, Elliott PJ, Smaila C. Detection of sperm antibodies in semen using the immunobead test: A survey of 813 consecutive patients. Am J Reprot Immunol Microbiol 1985; 7: 118-123.

67. Barratt CL, Dunphy BC, McLeod I, Cooke ID. The poor prognostic value of low to moderate levels of sperm surface-bound antibodies Hum Reprod 1992; 7: 95-98.

68. Bandoh R, Daitoh T, Yamano S, Aono T, Kamada M. Effect of sperm-immobilizing antibodies on the acrosome reaction of human spermatozoa. Fertil Steril 1992; 57: 387-392.

69. Liu DY, Clarke GN, Baker HW. Inhibition of human sperm-zona pellucida and sperm-oolemma building by antisperm antibodies. Fertil Steril 1991; 55: 440-442.

70. Agarwal A. Treatment of immunological infertility by sperm washing and intrauterine insemination. Arch Androl 1992; 29: 207-213.

71. Shulman S, Harlin B, Davis P, Reynick JV. Immune infertility and new approaches to treatment. Fertil Steril 1978; 29: 309-313.

72. Bollendorf A, Check JH, Katsoff D, Fedele A. The use of chymotrypsin/galactose to treat spermatozoa bound with anti-sperm antibodies prior to intra-ute­rine insemination. Hum Report 1994; 9: 484-488.

73. Shaban SF et al. Treatment of abnormalities of ejaculation. In: Lipshultz LI, Howards SS. Infertility in the male. 3rd edition. St Louis: Mosby 1997: 423-438.

74. Brindley GS. Reflex ejaculation under vibratory stimulation in paraplegic men. Paraplegia 1981; 19: 299-302.

75. Bird VG, Brackett NL, Lynne CM, Aballa TC, Ferrell SM. Reflexes and somatic responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury. Spinal Cord 2001; 39: 514-519.

76. de Roux N, Young J, Misrahi M, Schaison G, Milgrom E. Loss of function mutations of the GnRH receptor: a new cause of hypogonadotropic hypogonadism. J Pediatr Endocrinol Metab 1999; 12 (Suppl 1): 627-275.

77. Jackson RS, Creemers JW, Ohagi S, Raffin-Sanson ML, Sanders L, Montague CT et al. Obesity and impaired prohormone processing associated with mutations in the human prohormone convertase 1 gene. Nat Genet 1997; 16: 303-306.

78. Smeets DF, Hamel BC, Nelen MR, Smeets HJ, Bollen JH, Smits AP et al. Prader-Willi syndrome and Angelman syndrome in cousins from a family with a translocation between chromosomes 6 and 15. N Engl J Med 1992; 326: 807-811.

Štítky
Paediatric urologist Urology
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