Male partners infertile couples
They got married five years later, and three years afterwards had saved enough to buy a family home in a quiet cul-de-sac in London. Then, when Davina was 29 and James 33, they started trying for a baby. But after a year of trying, nothing had happened. Davina went to their GP, who referred her for the kind of invasive tests that have become the norm for women who experience problems conceiving: she had an internal, transvaginal scan to check her womb for fibroids, and an HSG test, where dye was pushed into her fallopian tubes to see if they were blocked.SEE VIDEO BY TOPIC: Understanding Male Infertility
SEE VIDEO BY TOPIC: Male Factor Infertility Video – Brigham and Women’s HospitalContent:
- Optimal Evaluation of the Infertile Male
- Male Infertility
- Semen Quality of Male Partners of Infertile Couples in Ile-Ife, Nigeria
- ‘It tears every part of your life away’: the truth about male infertility
- Association of body mass index with some fertility markers among male partners of infertile couples
Optimal Evaluation of the Infertile Male
Unabridged version of this best practice statement [pdf]. Kolettis, MD; Larry R. Lipshultz, MD; R. Prins, PhD; Jay I. Sandlow, MD; Peter N. Schlegel, MD. This review offers recommendations for the optimal diagnostic evaluation of the male partner of an infertile couple. Male infertility can be due to a variety of conditions. Some of these conditions are identifiable and reversible, such as ductal obstruction and hypogonadotropic hypogonadism.
Other conditions are identifiable but not reversible, such as bilateral testicular atrophy secondary to viral orchitis. When identification of the etiology of an abnormal semen analysis is not possible, as is the case in many patients, the condition is termed idiopathic. When the reason for infertility is not clear, with a normal semen analysis and partner evaluation, the infertility is termed unexplained. Rarely patients with normal semen analyses have sperm that do not function in a manner necessary for fertility.
The purpose of the male evaluation is to identify these conditions when present. Identification and treatment of reversible conditions may improve the male's fertility and allow for conception through intercourse.
Even azoospermic patients may have active sperm production or could have sperm production induced with treatment. Detection of conditions for which there is no treatment will spare couples the distress of attempting ineffective therapies. Detection of certain genetic causes of male infertility allows couples to be informed about the potential to transmit genetic abnormalities that may affect the health of offspring.
Thus, an appropriate male evaluation may allow the couple to better understand the basis of their infertility and to obtain genetic counseling when appropriate. If specific corrective treatment is not available, it still may be possible to employ assisted reproductive techniques such as testicular or epididymal sperm retrieval with intracytoplasmic sperm injection ICSI. Alternatively, such couples may consider therapeutic donor insemination or adoption. Finally, male infertility may occasionally be the presenting manifestation of an underlying life-threatening condition.
The goals of the optimal evaluation of the infertile male are to identify:. The two organizations had agreed to collaborate to prepare documents of importance in the field of male infertility.
In October , an updated assessment of the literature on male infertility by the AUA Practice Guidelines Committee PGC found insufficient outcomes data to support a formal meta-analysis and an evidence-based guideline. The evidence was generally of a low level, being derived overwhelmingly from nonrandomized studies. The Panel was charged with developing a best practice statement, based on the previous report, by employing published data in concert with expert opinion.
The Panel co-chairmen and members were selected by the PGC. The mission of the Panel was to develop recommendations, based on expert opinion, for optimal clinical practices in the diagnosis and treatment of male infertility. It was not the intention of the Panel to produce a comprehensive treatise on male infertility. The Medline search spanning through October was supplemented by review of bibliographies and additional focused searches. In all, articles were deemed by the Panel members to be suitable for scrutiny.
Three of the four original reports were updated with new findings and are presented in the documents in colored font. This updated document was submitted for peer review, and comments from 21 physicians and researchers were considered by the Panel in making revisions. Funding of the Panel was provided by the AUA; members received no remuneration for their work. Each Panel member provided a conflict of interest disclosure to the AUA.
A couple attempting to conceive should have an evaluation for infertility if pregnancy fails to occur within one year of regular unprotected intercourse. An evaluation should be done before one year if 1 male infertility risk factors such as a history of bilateral cryptorchidism are known to be present; 2 female infertility risk factors, including advanced female age over 35 years , are suspected; or 3 the couple questions the male partner's fertility potential.
In addition, men who question their fertility status despite the absence of a current partner should have an evaluation of their fertility potential. The initial screening evaluation of the male partner of an infertile couple should include, at a minimum, a reproductive history and two semen analyses. If possible, the two semen analyses should be separated by a time period of at least one month.
The reproductive history should include 1 coital frequency and timing; 2 duration of infertility and prior fertility; 3 childhood illnesses and developmental history; 4 systemic medical illnesses e. The semen analyses should be conducted as described in the section, 'Components of a full evaluation of male infertility. Men with secondary infertility should be evaluated in the same way as men who have never initiated a pregnancy primary infertility. Recommendations: An initial screening evaluation of the male partner of an infertile couple should be done if pregnancy has not occurred within one year of unprotected intercourse.
An earlier evaluation may be warranted if a known male or female infertility risk factor exists or if a man questions his fertility potential. The initial evaluation for male factor infertility should include a reproductive history and two properly performed semen analyses. A full evaluation by a urologist or other specialist in male reproduction should be done if the initial screening evaluation demonstrates an abnormal male reproductive history or an abnormal semen analysis.
Further evaluation of the male partner should also be considered in couples with unexplained infertility and in couples in whom there is a treated female factor and persistent infertility. The full evaluation for male infertility should include a complete medical and reproductive history, a physical examination by a urologist or other specialist in male reproduction and at least two semen analyses.
Based on the results of the full evaluation, the physician may recommend other procedures and tests to elucidate the etiology of a patient's infertility. These tests may include additional semen analyses, endocrine evaluation, post-ejaculatory urinalysis, ultrasonography, specialized tests on semen and sperm, and genetic screening. The patient's medical history is used to identify risk factors and behavior patterns that could have a significant impact on male infertility.
The history should include all factors listed above for a reproductive history plus 1 a complete medical and surgical history; 2 a review of medications prescription and non- prescription and allergies; 3 a review of lifestyle exposures and a review of systems; 4 family reproductive history; and 5 a survey of past infections such as sexually transmitted diseases and respiratory infections. A general physical examination is an integral part of the evaluation of male infertility.
In addition to the general physical examination, particular focus should be given to the genitalia including 1 examination of the penis; including the location of the urethral meatus; 2 palpation of the testes and measurement of their size; 3 presence and consistency of both the vasa and epididymides; 4 presence of a varicocele; 5 secondary sex characteristics including body habitus, hair distribution and breast development; and 6 digital rectal exam.
The diagnosis of congenital bilateral absence of the vasa deferentia CBAVD is established by physical examination. Scrotal exploration is not needed to make this diagnosis. Semen analysis is the cornerstone of the laboratory evaluation of the infertile male and helps to define the severity of the male factor. Methods of semen analysis are discussed in many textbooks, and detailed laboratory protocols have been published by the World Health Organization WHO.
These instructions should include a defined period of abstinence of two to three days. Semen can be collected by masturbation or by intercourse using special semen collection condoms that do not contain substances detrimental to sperm.
The specimen may be collected at home or at the laboratory. The specimen should be kept at room or body temperature during transport and examined within one hour of collection. To ensure accurate results, the laboratory should have a quality control program for semen analysis, which conforms to the standards outlined in the Clinical Laboratory Improvement Amendments CLIA.
Information on these standards, which include proficiency testing, can be found at the CLIA web site. The semen analysis provides information on semen volume as well as sperm concentration, motility and morphology. Azoospermia should not be diagnosed until the specimen is centrifuged at maximum speed preferably x g for 15 minutes, and the pellet is examined.
Although the methods for routine measurement of sperm concentration and motility have changed little during the past two decades, sperm morphology assessment has evolved considerably.
The WHO criteria for scoring sperm morphology 3 are similar to the Kruger Tygerberg strict criteria. Sperm morphology assessment by strict criteria will be discussed later in depth and has been used to identify couples who have a poor chance of fertilization with standard in vitro fertilization IVF 5 or a better chance of fertilization with ICSI.
True reference ranges have not been established for semen parameters. The reference values in Table 1 are based on the clinical literature. It must be emphasized that the reference values for semen parameters are not the same as the minimum values needed for conception, and that men with semen variables outside the reference ranges may be fertile.
Conversely, patients with values within the reference range may still be infertile. Recommendations: The minimum full evaluation for male infertility for every patient should include a complete medical history, physical examination by a urologist or other specialist in male reproduction and at least two semen analyses.
Additional procedures and tests, used to elucidate problems discovered by the full evaluation, may be suggested later as well. Hormonal abnormalities of the hypothalamic-pituitary testicular axis are well-recognized, though not common causes of male infertility. An endocrine evaluation should be performed if there is:.
Some experts believe that all infertile males should have an endocrine evaluation, but there is no consensus of opinion on this controversy. The minimum initial hormonal evaluation should consist of measurements of serum follicle-stimulating-hormone FSH and serum testosterone levels. If the testosterone level is low, a repeat measurement of total and free testosterone or bioavailable testosterone , as well as determination of serum luteinizing hormone LH and prolactin levels should be obtained.
Although serum gonadotropin levels are variable because they are secreted in a pulsatile manner, a single measurement is usually sufficient to determine a patient's clinical endocrine status.
A normal serum FSH level does not guarantee the presence of intact spermatogenesis, however, an elevated FSH level even in the upper range of "normal" is indicative of an abnormality in spermatogenesis. Recommendation: An initial endocrine evaluation should include at least a serum testosterone and FSH.
Low-volume or absent ejaculate suggests retrograde ejaculation, lack of emission, ejaculatory duct obstruction, hypogonadism or CBAVD. In order to diagnose possible retrograde ejaculation, the physician should perform a post-ejaculatory urinalysis for any man whose ejaculate volume is less than 1. It is also important to assure that either incomplete collection or very short abstinence periods less than 1 day are not the causes of the low-volume ejaculate. The post-ejaculatory urinalysis is performed by centrifuging the specimen for 10 minutes at a minimum of x g, and microscopically inspecting the pellet at x magnification.
The presence of any sperm in a post-ejaculatory urinalysis of a patient with azoospermia or aspermia is suggestive of the diagnosis of retrograde ejaculation. Significant numbers of sperm must be found in the urine of patients with low ejaculate volume oligospermia in order to suggest the diagnosis of retrograde ejaculation. Expert consensus on the definition of significant numbers of sperm in the urine does not exist. Recommendation: A post-ejaculatory urinalysis should be performed in patients with ejaculate volumes of less than 1 ml, except in patients with bilateral vasal agenesis or clinical signs of hypogonadism.
Normal seminal vesicles are less than 2. Patients with CBAVD may also have these findings because they often have absent or atrophic seminal vesicles. Patients with partial ejaculatory duct obstruction often, but not always, present with semen having low volume, oligoasthenospermia and poor forward progression. Some experts routinely recommend TRUS in oligospermic patients with low volume ejaculates, palpable vasa and normal testicular size. Recommendation: Transrectal ultrasonography is indicated in azoospermic patients with palpable vasa and low ejaculate volumes to determine if ejaculatory duct obstruction exists.
Some experts recommend transrectal ultrasonography for oligospermic patients with low volume ejaculates, palpable vasa and normal testicular size to determine if partial ejaculatory duct obstruction is present.
Infertility is the result of a disease an interruption, cessation, or disorder of body functions, systems, or organs of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery. The duration of unprotected intercourse with failure to conceive should be about 12 months before an infertility evaluation is undertaken, unless medical history, age, or physical findings dictate earlier evaluation and treatment. Home Topics Index Infertility. Infertility Infertility is the result of a disease an interruption, cessation, or disorder of body functions, systems, or organs of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery.
Background: Infertility is the most important reproductive health and social issue confronting married couples in our environment. The contribution of male factor is assuming a tremendous proportion. Seminal fluid analysis SFA remains an indispensable tool in the evaluation of the fertility potential of these male partners. Aim and Objectives: This study aimed to determine the pattern of seminal fluid parameters and its impact on infertility among male partners of infertile couple at a public health facility in Ilorin. Results: All male partners of infertile couple who had infertility consultation at the ART unit consented to SFA during the study period.
Semen Quality of Male Partners of Infertile Couples in Ile-Ife, Nigeria
Unabridged version of this best practice statement [pdf]. Kolettis, MD; Larry R. Lipshultz, MD; R. Prins, PhD; Jay I. Sandlow, MD; Peter N. Schlegel, MD. This review offers recommendations for the optimal diagnostic evaluation of the male partner of an infertile couple. Male infertility can be due to a variety of conditions. Some of these conditions are identifiable and reversible, such as ductal obstruction and hypogonadotropic hypogonadism. Other conditions are identifiable but not reversible, such as bilateral testicular atrophy secondary to viral orchitis.
The present study summarizes the results of a questionnaire sent to men involved in a fertility investigation. The answers illustrate the psychological problems linked to the infertile state, indicate that men are generally well orientated about the extent of the problem and imply an increasing negative attitude to donor insemination. In the majority of cases, the infertile couples first contacted a gynecologist rather than a general practitioner or other specialist. In over one third of the cases, this contact occurred within the first 12 months of attempting to procure a pregnancy.
Visit coronavirus. About 85 percent of male-female couples will be able to get pregnant within 12 months of trying. For those that do not, infertility of either the male or female partner could be the reason.
‘It tears every part of your life away’: the truth about male infertility
Objectives: The objective was to evaluate seminal fluid indices of male partners of infertile couples so as to identify the current status of the contributions of male factor to infertility in our environment. Materials and methods: This is a prospective study of the seminal fluid indices of consecutively consenting male partners of infertile couples seen at the Fertility and Endocrinology Research unit of the Department of Obstetrics Gynaecology and Perinatology, Obafemi Awolowo University Teaching Hospital Ile-Ife between May and June Results: The results of the semen analysis of male partners of the infertile couples were retrieved and analyzed. The patterns of semen parameters noted in infertile males were oligozoospermia, teratozoospermia, asthenozoospermia, azoospermia, oligoteratozoospermia, oligoasthenozoospermia, and oligoasthenoteratozoospermia, asthenoteratozoospermia found inSEE VIDEO BY TOPIC: Male infertility: The secret shame of having no sperm - BBC News
Several studies have addressed the impact of viral infections on male infertility. However, it is still unknown whether human papillomavirus HPV can alter seminal parameters. The aim of this study was to determine the prevalence of HPV in the semen of male partners of couples seeking fertility evaluation. Additionally, we assessed the possibility that HPV infections affect seminal parameters. Basic seminal parameters were analyzed, and HPV was detected and genotyped by polymerase chain reaction. Of these,
Association of body mass index with some fertility markers among male partners of infertile couples
Background : Infertility is defined as failure to conceive within one or more years of regular unprotected coitus. The infertility state is dependent on the female factor as well as masculine factor; an altered masculine factor is designated when any cause or causes of infertility reside in the male. Objectives : The present study aims to assess the seminal patterns of male partners of infertile couples for various parameters and their possible contribution to infertility. Material and Methods : The present study was conducted on male partners of infertile couples who were referred by Gynecology and Obstetric department to Pathology Department, Government Medical College, Patiala for semen examination. The semen was collected by masturbation in all cases in a clean dry detergent free container. After liquefaction and mixing, basic analysis was done which includes volume, viscosity, pH, spermatozoal concentration, motility and morphology. Data was evaluated by means of chi-square test. Conclusion : Male factors were mostly responsible as a cause of infertility.