Infertility: Practical Clinical Issues for Routine Investigation of the Male Partner.

Alberto Ferlin,Carlo Foresta

doi:10.3390/jcm9061644

Abstract

About one-fifth of couples has fertility problems in Western countries. Male factors are present in about half of them, either alone or in combination with female causes. Therefore, both partners should be evaluated simultaneously. The fertility status and/or specific conditions of each partner influence the clinical and treatment approach. This article summarizes in a practical way when, how, and why the male partner of an infertile couple should be investigated. The available evidence and international guidelines were used, interpreting, discussing, and expanding them from personal decades-long experience in this field. The aim is to delineate the most appropriate clinical approach for the male partner of infertile couples, considering traditional and emerging technologies and laboratory analyses in the context of their clinical significance. Components of the initial evaluation in men without known risk factors for infertility should include at minimum medical history, physical examination, and semen analysis. Semen microbiological examination, endocrine assessment, scrotal ultrasound, and transrectal ultrasound are suggested in most men and are mandatory when specific risk factors for male infertility are known to be present or when the initial screening demonstrated abnormalities. Full examination, including genetic tests, testicular histology, or additional tests on sperm, is clinically oriented and/or suggested after the results of initial investigations.

Highlights

In Western countries, approximately 15–20% of couples are infertile as defined by the inability to conceive after one year of unprotected intercourse
Technology and assisted reproduction erroneously prompted the concept that full medical investigation for infertile men is not necessary and, on the other hand, male infertility is often defined only based on semen analysis
Guidelines for the optimal diagnostic evaluation of male infertility exist [1,2,3,4,5,6,7], there is no general consensus on the best clinical workup for the male partner of an infertile couple based on evaluation of the fertility potential and risk factors of both partners and taking into account diagnostic tests developed more recently for analyzing sperm function and causes of spermatogenic impairment

Summary

Introduction

In Western countries, approximately 15–20% of couples are infertile as defined by the inability to conceive after one year of unprotected intercourse. Technology and assisted reproduction erroneously prompted the concept that full medical investigation for infertile men is not necessary and, on the other hand, male infertility is often defined only based on semen analysis. The focus is to delineate the most appropriate clinical and diagnostic approach for the male partner of infertile couples, considering traditional and emerging technologies and laboratory analyses in the context of their clinical significance. To this aim, we referred to available evidence and international guidelines, and interpreted, discussed, and expanded them from our personal decades-long experience in this field

Objectives

Methods

Findings

Conclusion