Male factor infertility trends throughout the last 10 years: Report from a tertiary‐referral academic andrology centre

Abstract

Background Trends of male factor causes of couples' infertility over time have been poorly investigated. Objective We investigated trends in the causes of pure male factor infertility (MFI) throughout the last 10 years in a tertiary‐referral academic andrology center. Material and Methods Baseline characteristics at first presentation from a cohort of 1647 consecutive male factor infertility patients belonging to primary infertile couples between 2008 and 2018 have been comprehensively collected over time. Seven major causes of male factor infertility were identified: varicocoele; history of cryptorchidism; hypogonadism (primary and secondary); obstructive azoospermia; genetic abnormalities; other causes (large group including the remnant conditions of known causes); and idiopathic infertility. Rates of different male factor infertility causes over the study period were analyzed. Multivariable logistic regression models tested the likelihood of male factor infertility causes over time. Estimated trends were explored graphically. Results Of all, varicocoele was found in 615 (37.3%), cryptorchidism in 124 (7.5%), genetic abnormalities in 61 (3.7%), hypogonadism in 165 (10%), obstructive conditions in 55 (3.3%), other causes in 129 (7.8%) patients, and idiopathic infertility in 498 (30.3%) patients, respectively. Over time, a reduction in the proportions of cryptorchidism and varicocoele (all P < 0.001) cases was observed, along with an increase in the proportions of hypogonadism, other causes of MFI and idiopathic cases (all P ≤ 0.01). Rates of genetic and obstructive cases remained stable. The observed trends were confirmed at logistic regression models. Discussion and Conclusions A decreasing trend in the proportions of varicocoele and cryptorchidism at first presentation was observed over the last 10 years; conversely, the proportions of idiopathic cases, hypogonadal patients, and infertile men presenting with other male factor infertility causes significantly increased over the same time frame at a single tertiary‐referral academic andrology center.

Infertile couples still undergo assisted reproductive treatments without initial andrological evaluation in the real‐life setting: A failure to adhere to guidelines?

“…34 This may also explain why semen analysis alone is insufficient in predicting success when the couple is planning to undergo ART. Second, it is also known that the spectrum of potential causes of MFI has changed over time, 37 with an ever more growing number of men with more severe cases and many more unexplained or idiopathic cases for which at least a basic andrological consultation should be considered. Third, the incorrect timing of assessment, i.e., after ART, cannot only delay the couple's fertility management but may also not be cost effective.…”

The Impact of Endocrine-Disrupting Chemicals in Male Fertility: Focus on the Action of Obesogens

“…Studies have allowed us to understand the relationship between obesogens and weight gain better. One of the first studies demonstrated that tributyltin (TBT), a human-made chemical introduced into the environment mainly due to its widespread use as an antifouling agent in ships and other submerged structures, acts as a nanomolar-affinity ligand for PPARγ and its heterodimeric partner, 9-cis retinoic acid receptor (RXR) [7,20,55,56]. TBT is considered the obesogen model and belongs to the organotins which comprises of several families sharing structural similarities [57,58] (including e.g., butyltins, phenyltins and octyltins), being used in diverse applications including the aforementioned biocidal activities, in the production of polyurethane foams and silicones, and in the stabilization of plastics [59].…”

“…In the last decades, male fertility has decreased significantly. Today, 15% of the population is infertile, and one in seven couples is infertile at reproductive age [20]. About 50% of the cases are due to the male factor, and in many of them, it occurs due to idiopathic infertility [20].…”

“…Today, 15% of the population is infertile, and one in seven couples is infertile at reproductive age [20]. About 50% of the cases are due to the male factor, and in many of them, it occurs due to idiopathic infertility [20]. The etiology of this adverse trend remains a subject of intense debate, but there has been a consensual awareness regarding the role of external factors, such as lifestyle habits and its associated factors, especially the permanent exposure to EDCs.…”

Effects of recreational cannabis on testicular function in primary infertile men

“…A male factor contributes to up to 50% of cases of couples experiencing infertility 2 . Some modifiable factors have been associated with male factor infertility (MFI), such as diet, obesity, smoking habits, alcohol abuse, and physical exercise 3,4 . Recreational drug use has also been associated with a reduced fertility in up to 4.1% of overall infertile male cases 5 .…”