Clinical Male Infertility and Assisted Reproduction

Abstract

The current issue of Journal of Andrology is designated as a Special Issue on Clinical Male Infertility and Assisted Reproduction. The opportunity to create a Special Issue developed because of a high number of quality papers that were recently accepted for publication. Highlighting these papers with a Special Issue is an opportunity to capitalize on the purposeful goal of the Journal to solicit high quality papers in basic and clinical Andrology, emphasizing genetic aspects of Andrology and assisted reproduction. Encompassed in the focus on clinical genetics, we have included manuscripts in this issue that examine the relationship between varicocele and DNA integrity (Enciso et al) as well as varicoceles and sperm aneuploidy (Baccetti et al). Although DNA integrity and sperm aneuploidy appear more common in men with varicoceles, it is not clear whether it is the physical condition of varicocele, or merely poor sperm production that result in these sperm DNA abnormalities. Different approaches to evaluation of sperm DNA integrity were compared in a paper from the Utah group (Chohan et al). This is an important topic because of increasing attention being drawn to DNA integrity and its ability to detect male factor contributions to infertility. Other studies on clinical genetics included a report on the frequency of androgen receptor mutations in Indian men (Singh et al) and further investigation of the genetic anomalies that are present in men with globozoospermia (Christensen et al). This article is complemented by the paper from Emilia et al, also investigating chromosome abnormalities in men with large heads or multiple tails. Too often, treatment of patients with globozoospermia and other phenotypically-identifiable conditions is undertaken using assisted reproduction without any consideration of the potential underlying genetic anomalies. A study from Chen et al reported on the inverse relationship between sperm apoptosis and sperm motility in infertile men. Kovacic reported on the value of pentoxifylline stimulation prior to use of sperm for assisted reproduction, a useful clinical tool to help identify viable sperm among a population of immotile spermatozoa. Several articles examined technical issues relating to sperm retrieval and assisted reproduction. Given the increasing role of andrologists in assisted reproduction, these articles are worthy of note. Hauser et al compared sperm extraction (TESE) with testicular aspiration, and Wald et al reported on outcomes using frozen or fresh testicular sperm from men with nonobstructive azoospermia used for ICSI. The discussions from Androlog outline a current area of controversy regarding the relative value of assisted reproduction versus specific treatment of male infertility (vasectomy reversal). Nistal et al described five patients with Wolffian-derived intratesticular abnormalities; given the increased potential for detection of small and benign lesions within the testis, a greater understanding of rare intratesticular lesions is worthwhile. More information on alpha-glucosidase activity in human semen was presented by Schill et al. Whereas clinical evaluation of glucosidase activity is not a standard in the United States, its application in Europe is far more common. Other insight into clinical topics is provided in the articles by Shafik et al and Corona et al describing specific aspects of ejaculatory and sexual function. Haugen et al described the characteristics of semen parameters in a group of fertile men from Norway. Amory et al provide further information on the use of oral androgen supplementation (testosterone in oil) in combination with 5-alpha reductase inhibitors. Such a combination provides promise as treatment of men with androgen deficiency, enhancing circulating testosterone levels while limiting their effects on the prostate. A breakthrough article is included in this Special Issue, outlining the important antifertility effects of DDT on men. Although DDT is not used in the United States any longer, effects on fertility may still be seen in other countries, particularly in Africa where it is still in use, and concern about its metabolic products may exist long after popular use is stopped (De Jager et al). Taken together, these articles reflect an increase in the high quality articles that we have been receiving at the Journal—we hope our readers agree with our reviewers and the editors in their appraisal of these articles.