Contemporary concepts in the evaluation and management of male infertility

Abstract

Infertility in men is a common condition. At the core of the medical evaluation of the male partner in a couple who are unable to conceive is the history and physical examination. Special attention should be directed to the patient’s developmental history and any use of testosterone products. The physical examination focuses on the genitals, and includes assessments of the size and consistency of the testicles, epididymis, vas deferens, and presence of varicoceles. Although many sophisticated tests are available, semen analysis is still the most important diagnostic tool used to assess fertility, and includes parameters such as sperm count, motility and viability. Treatment of male factor infertility can involve targeted agents, in the case of specific conditions such as hypogonadotropic hypogonadism, or it can be empirical—using medical therapy or assisted conception techniques—for patients in whom no underlying cause has been identified. Although an all-encompassing treatment for male factor infertility has not yet been developed, the field offers many promising avenues of research.

Drug Ligand-Induced Activation of Translocator Protein (TSPO) Stimulates Steroid Production by Aged Brown Norway Rat Leydig Cells

“…Primary hypogonadism also occurs in many infertile men. Approximately 15% of couples seek infertility-related medical appointments, with male factor effects contributing to 40%-50% of these cases (46,53,54). For 30% of infertile men, no identifiable cause is found, and in greater than 50% of these men, there is both primary hypogonadism and reduced sperm production (53,55).…”

The impact of environmental exposures and lifestyle on male reproductive performance

“…Еще одним элементом современного биокомплекса АндроДоз является L-карнитин. В некоторых исследованиях [86][87][88][89][90][91][92] отмечается увеличение подвижности и числа спер-матозоидов после назначения карнитина пациентам с астено-и олигозооспермией. Другой активной со-ставляющей комплекса АндроДоз является коэнзим Q 10 .…”

Genetic aspects of male infertility

“…Following the detection of abnormalities in karyotype, clinics should always offer patients genetic counselling, explaining that paternity is associated with the risk of transmitting the abnormalities to offspring, and that it may be recommended to consider a sperm donor or adoption [5]. An indication for the performance of genetic tests is azoospermia and oligozoospermia < 10-15 mln sperm in the ejaculate.…”

“…Approximately 8% of males at reproductive age show infertility or reduced fertility [1]. Standard management in the diagnostics of male infertility covers medical history taking, physical examination, endocrine and viral laboratory, and quantitative and qualitative analysis of sperm, which is crucial for the determination of fertility [5]. In the expanded diagnostics, the presence of the reactive oxygen species (ROS) in sperm is evaluated, biochemical analysis of seminal plasma performed, and the degree of sperm chromatin damage or the presence of antisperm antibodies assessed [6].…”

“…5% of cases of reduced fertility). Klinefelter syndrome (47 XXY) is a numerical chromosome aberration most often diagnosed in this test -up to 10% of cases of azoospermia [5]. The presence of an extra X chromosome causes damage to the seminal epithelium and in consequence, a lack of sperm cells in the semen [9,10].…”