Engaging Practicing Gynecologists in the Management of Infertile Men

Abstract

In the modern era, contemporary management of male infertility has undergone groundbreaking changes with the introduction of new concepts, advanced testing, and therapeutic interventions. As practicing gynecologists are often the first physicians who encounter an infertile couple, it is essential that these clinicians are continuously updated about the new pearls and pitfalls of male infertility management. Semen analysis is commonly ordered by gynecologists. In 2010, the WHO released new cutoff reference values for the semen parameters adopting novel methodology, which has incited much debate. Reference values have been lowered in comparison with previous standards, with a direct clinical implication in decision-making strategies. Specialized sperm-function tests, such as sperm oxidative stress and sperm chromatin integrity assessments, became clinically available, thus offering an opportunity to better understand sperm dysfunctions concealed during routine semen analysis. Furthermore, the initial counseling of azoospermic men by an andrologically well educated gynecologist may alleviate the misconception and distress surrounding the false belief of sterility, and will clarify the 123 available options of percutaneous and microsurgical spermretrieval techniques and assisted conception outcome. Regarding varicocele, which is commonly seen in infertile males, it is now clear that the best treatment option for infertile men with clinical varicocele is the microsurgical vein ligation. Natural conception is significantly improved after varicocelectomy, and recent data suggest that such treatment optimizes reproductive outcome of couples undergoing ICSI or micro-TESE sperm retrieval. Lastly, new therapeutic interventions, including oral antioxidant therapy and lifestyle modifications, have gained increasing attention, as they aid in alleviating male infertility.

Decreased Expression of KIFC1 in Human Testes with Globozoospermic Defects

“…Immunohistochemical detection of the KIFC1 protein was carried out as previously described [23]. Testicular tissue was fixed in 4% paraformaldehyde overnight, washed three times for 15 min with phosphate-buffered saline (PBS), and incubated overnight in 0.5 M sucrose in PBS.…”

Assessment and Detection of male Reproductive Outcome (ANDRO) model as a concept for improving the contribution of general practitioners in Indonesia for male infertility management

“…Couples with infertility problems usually visit a specialist, especially a gynecologist, to solve their problem. 2 This also happens in Indonesia with the unequal distribution of specialist doctors between urban and rural areas. 3 In Indonesia, there is an andrologist as a specialist doctor who has competencies for male infertility problems but is still limited.…”

A missing vas deferens: practical implications for urologists performing vasectomies and managing infertile men

“…An objection is that although up to 80% of men with a congenital unilateral absence of vas deferens (CUAVD) have ipsilateral renal agenesis, the kidney may be present and other renal malformations such as ectopia, malrotation, fusion or polycystic disease may occur ( 7 ). Despite not warranting further intervention, informing the affected men that they have only one kidney or a renal anomaly is good medical practice as it may prompt such men to take a better life-style, thus preventing the occurrence of type 2 diabetes and hypertension that may impact their renal function later in life ( 8 ). On the other hand, 1–2% of males investigated for infertility have congenital absence of vas agenesis ( 1 , 6 , 9 ).…”