Abstract
Extraordinary advances have been achieved in the field of male infertility in the last decades. There are new concepts in sperm physiology and several modern tools for the assessment of spermatogenesis kinetics in vivo. New tests using molecular biology and DNA damage assays allow the clinician to correctly diagnose men so far classified as having idiopathic male infertility. In the field of treatment, microsurgery has increased success rates either for reconstruction of the reproductive tract or the retrieval of spermatozoa for assisted conception. Emerging evidence suggests that life-style and environmental conditions are of utmost importance in male fertility and subfertility. This review discusses several concepts that have changed over the last years, such as the duration of the spermatogenic cycle in humans, Y-chromosome infertility, the reproductive potential of non-mosaic Klinefelter syndrome men, the impact of paternal age and sperm DNA in male infertility, the role of antioxidants in the treatment of infertile men, the predictive factors and techniques for sperm retrieval in non-obstructive azoospermia, and the microsurgical treatment of clinical varicoceles. Whenever possible, levels of evidence are provided as suggested by the Oxford Center of Evidence-based Medicine.
Highlights
8% of men in reproductive age seek medical assistance for fertility-related problems
In ~50% of non-mosaic Klinefelter syndrome (KS) azoospermic men testicular sperm are found by micro-TESE
Children born after intracytoplasmic sperm injection (ICSI) using testicular sperm from KS men have normal karyotype because the minor foci of germ cells into the seminiferous tubuli are euploid
Summary
8% of men in reproductive age seek medical assistance for fertility-related problems. Bungum et al (2004) demonstrated that higher clinical pregnancy rates (52.9 % vs 22.2 %) and delivery rates (47.1 % vs 22.2 %) were obtained after ICSI as compared to IVF when semen samples with high levels of sperm DNA damage were used, as previously suggested [27] (Level B evidence). Sperm DNA damage testing may be indicated in unexplained or idiopathic infertility, when a traditional semen analysis is normal and no evident female reproductive system pathologies can be revealed, and in selected cases of recurrent miscarriage. A case series study suggested that an increased intake of antioxidant-rich food or antioxidant supplements (see appendix) by men with high levels of sperm DNA fragmentation or lipid per-
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