Practical Clinical and Diagnostic Pathway for the Investigation of the Infertile Couple

Abstract

CapsuleThis expert opinion summarizes current knowledge on risk factors for infertility and identifies a practical clinical and diagnostic approach for the male and female partners of an infertile couple aimed to improve the investigation and management of fertility problems.BackgroundInfertility represents an important and growing health problem affecting up to 16% of couples worldwide. In most cases, male, female, or combined factor can be identified, and different causes or risk factors have been related to this condition. However, there are no standardized guidelines on the clinical-diagnostic approach of infertile couples and the recommendations concerning infertility are sometimes lacking, incomplete, or problematic to apply.ObjectiveThe aim of this work is to provide an appropriate clinical and diagnostic pathway for infertile couples designed by a multidisciplinary-team of experts. The rationale is based on the history and physical examination and then oriented on the basis of initial investigations. This approach could be applied in order to reduce variation in practice and to improve the investigation and management of fertility problems.MethodsProminent Italian experts of the main specialties committed in the ART procedures, including gynecologists, andrologists, embryologists, biologists, geneticists, oncologists, and microbiologists, called “InfertilItaly group”, used available evidence to develop this expert position.OutcomesStarting from the individuation of the principal risk factors that may influence the fertility of females and males and both genders, the work group identified most appropriate procedures using a gradual approach to both partners aimed to obtain a precise diagnosis and the most effective therapeutic option, reducing invasive and occasionally redundant procedures.ConclusionsThis expert position provides current knowledge on risk factors and suggests a diagnostic workflow of infertile couples. By using this step-by-step approach, health care workers involved in ART, may individuate a practical clinical management of infertile couples shared by experts.

Detection of Sperm DNA Integrity and Some Immunological Aspects in Infertile Males

“…As related to the sperm parameters of subjects with primary infertility and those with secondary infertility, many studies reported large and overlapping differences, whereas this study showed no significant difference in sperm parameters in exception to the non-progressive sperm motility, which had a significant difference between the two types of infertility that agreed by other studies. The studied cases with primary type of infertility showed an increasing level of DNA fragmentation compared to other cases with a secondary type of infertility which are in agreement with similar studies and reported that the incidence of sperm DNA damage is higher in primary infertile patients who may harm fertility potential (Garolla, et al, 2021). All outcomes of involved cases and those with primary type infertility indicated a significant difference between the IgG and IgA detected by a direct method according to sperm tail bound.…”

Insulino-resistenza e fertilità nella donna con attenzione a sindrome dell’ovaio policistico (PCOS) e malattia epatica non alcoolica (NAFLD)

“…Conseguentemente, qualsiasi alterazione che interferisca con questi meccanismi può comportare dei problemi di fertilità. Un importante fattore da indagare nello studio della fertilità femminile è la riduzione di cicli ovulatori, dunque potenzialmente fertili, che caratterizza la PCOS [5]. La PCOS ha una prevalenza dell'8-13% nella popolazione femminile in età fertile e rappresenta la causa principale d'infertilità anovulatoria nelle donne [6].…”

Zinc Oxide Particles Can Cause Ovarian Toxicity by Oxidative Stress in Female Mice Model

“…As an important part of toxicology, toxicity to the female reproductive system is under intense scrutiny. Infertility affects approximately 16% of couples worldwide, 9 with female factors accounting for half of these cases. 10 The ovary is one of the most critical organs in the female reproductive system.…”