Management Of Male Factor Infertility Research Articles

Overview of Current Approaches to the Evaluation and Management of Male Infertility

Infertility, the inability to conceive after one year of regular, unprotected intercourse, is secondary to male-only factors in 20% and a combination of male and female factors in 30% to 40% of cases. Advances in the identification and management of male factor infertility have provided new and often successful options for paternity.

UK Urology Trainees' Exposure to Dedicated Infertility Training: How Good is That Training?

Objective: The management of male-factor infertility (MFI) is one component of the UK urological training curriculum. Sub-specialising gynaecologists, training in reproductive medicine, are also expected to achieve similar competencies. This study aimed to determine UK urology trainees' views on the quality of Their training in managing the infertile male. Methods: All UK urological trainees, identified through the British Association of Urological Surgeons (BAUS) or Joint Committee on Surgical Training (JCST) databases were e-mailed and invited to partake in an online survey, accessed through SurveyMonkey™. Results: 176 (51.6%) urological trainees responded. Only 3.6% were assured of exposure to training in MFI investigation and management and <35% had any exposure to vasectomy reversal. 61.3% wanted infertility to make up some part of their work as a consultant but only 27% rated their training as adequate. 79.9% felt threatened by the potential loss of skills and patients to gynaecologists with sub-specialist interests in reproductive medicine. Conclusions: UK urological trainees reported that exposure to dedicated training in MFI is suboptimal and ultimately, insufficient to equip them for the consultant practice they desire. Urology training needs re-structuring to ensure retention of this skill set and to support the aspirations of interested urological trainees.

The value of fallopian tube sperm perfusion in the management of male factor infertility: a randomized controlled trial

To investigate whether fallopian tube sperm perfusion (FSP) improves pregnancy rates over standard intrauterine insemination (IUI) in male factor infertility. Randomized controlled trial. The study population consisted of 120 couples allocated into two equal groups: group I (n = 60): FSP with 4 ml of inseminate; and group II (n = 60): IUI with 0.5 ml of inseminate. The study was done at Cairo University. All women underwent the same mild controlled ovarian stimulation protocol. Clomiphene citrate (Clomid; Aventis pharma S.AE, Global Napi Pharmaceuticals, Cairo, Egypt) 100 mg / day were administered orally from day 3 to 7 of the cycle. HMG (Merional; IBSA, Lugano, Switzerland) 75 IU / day was administered intramuscularly from day 6 to 8. Follicullometry was performed on day 9 of the cycle & HMG dose was adjusted, if necessary. When 2 to 3 follicles ≥18 mm in diameter were present, HCG (Choriomon; IBSA, Lugano, Switzerland) 10,000 IU was administered intramuscularly. A single insemination was performed 36 hours after HCG administration. On the insemination day, women were allocated into two groups with a ratio of 1:1 using computer-generated random numbers: group I (FSP using pediatric Foley catheter) and group II (standard IUI). Data analysis was performed using the Statistical Package for the Social Sciences, v16.0 (SPSS, Chicago, IL, USA). There was no statistically significant difference regarding patient or cycle characteristics. The pregnancy rate was significantly higher (P = 0.0369) in group I (16/60; 26.7%) compared with group II (7/60; 11.7%). One case of twin pregnancy occurred in each group. Two abortions occurred in group I and one in group II, while one case of ectopic pregnancy occurred in group I. The FSP is a simple and effective technique in the management of mild or moderate male infertility.

1603: Efficacy and Safety of Percutaneous Testicular Sperm Extraction (Ptese)-Icsi in the Management of Male-Factor Infertility

You have accessJournal of UrologyDiscussed Poster, Tuesday, May 11, 2004, 1:00 - 5:00 pm1 Apr 20041603: Efficacy and Safety of Percutaneous Testicular Sperm Extraction (Ptese)-Icsi in the Management of Male-Factor Infertility Maroun Abi Moussa, Jean François Griveau, Andrea Manunta, Jean-Jacques Patard, Dominique Le Lannou, François Guillé, and Bernard Lobel Maroun Abi MoussaMaroun Abi Moussa More articles by this author , Jean François GriveauJean François Griveau More articles by this author , Andrea ManuntaAndrea Manunta More articles by this author , Jean-Jacques PatardJean-Jacques Patard More articles by this author , Dominique Le LannouDominique Le Lannou More articles by this author , François GuilléFrançois Guillé More articles by this author , and Bernard LobelBernard Lobel More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)38811-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1603: Efficacy and Safety of Percutaneous Testicular Sperm Extraction (Ptese)-Icsi in the Management of Male-Factor Infertility." The Journal of Urology, 171(4S), p. 423 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 423 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Maroun Abi Moussa More articles by this author Jean François Griveau More articles by this author Andrea Manunta More articles by this author Jean-Jacques Patard More articles by this author Dominique Le Lannou More articles by this author François Guillé More articles by this author Bernard Lobel More articles by this author Expand All Advertisement Loading ...

R-042. New perspectives for therapeutic management of male factor infertility: treatment with HU-FSH of dyspermic patients undergoing ICSI

R-042. New perspectives for therapeutic management of male factor infertility: treatment with HU-FSH of dyspermic patients undergoing ICSI

Hormonal and genetic control of germ cell apoptosis in the testis.

Programmed cell death is an evolutionarily conserved cell death process that plays a major role during normal development and homeostasis. In many cases, the ordered execution of this internal death programme leads to typical morphological and biochemical changes that have been termed apoptosis. The crucial role of this mode of cell death in the pathogenesis of diverse human diseases including cancer, acquired immunodeficiency syndrome, neurodegeneratives disorders, atherosclerosis and cardiomyopathy is now supported by a wealth of data. In adult mammals, including humans, germ cell death is conspicuous during normal spermatogenesis and plays a pivotal role in sperm output. Withdrawal of gonadotrophins and testosterone further enhances the degeneration of germ cells in the testis. The availability of a quantitative method for analysing the testicular DNA fragmentation and in situ methods to localize specific germ cells undergoing apoptosis, either spontaneously or in response to a variety of death triggering signals, opens new avenues in the understanding of the significance of germ cell apoptosis during normal and abnormal states of spermatogenesis. A growing body of evidence demonstrates that both spontaneous (during normal spermatogenesis) and accelerated germ cell death triggered by deprivation of the gonadotrophic support or moderately increased scrotal temperature in adult rats occur almost exclusively via apoptosis. Although there has been spectacular progress in the understanding of the molecular mechanisms of apoptosis in various systems other than spermatogenesis, elucidation of the biochemical and molecular mechanisms by which germ cell apoptosis is regulated has only just begun. It is likely that germ cell apoptosis is controlled in a cell-type specific fashion, but the basic elements of the death machinery may be universal. In addition, there is increasing evidence that homozygous disruption of a number of genes in mice results in infertility through accelerated germ cell apoptosis. Manipulation of spermatogenesis by survival factor(s) deprivation or increases in extrinsic death signals in loss-of-function or gain-of-function mouse models provides a basis for further attempts to define the intrinsic regulation of various death-related genes by external death signals. Such information is crucial for effective management of male factor infertility as well as more targeted approaches to male contraception.

Hormonal and genetic control of germ cell apoptosis in the testis

Programmed cell death is an evolutionarily conserved cell death process that plays a major role during normal development and homeostasis. In many cases, the ordered execution of this internal death programme leads to typical morphological and biochemical changes that have been termed apoptosis. The crucial role of this mode of cell death in the pathogenesis of diverse human diseases including cancer, acquired immunodeficiency syndrome, neurodegeneratives disorders, atherosclerosis and cardiomyopathy is now supported by a wealth of data. In adult mammals, including humans, germ cell death is conspicuous during normal spermatogenesis and plays a pivotal role in sperm output. Withdrawal of gonadotrophins and testosterone further enhances the degeneration of germ cells in the testis. The availability of a quantitative method for analysing the testicular DNA fragmentation and in situ methods to localize specific germ cells undergoing apoptosis, either spontaneously or in response to a variety of death triggering signals, opens new avenues in the understanding of the significance of germ cell apoptosis during normal and abnormal states of spermatogenesis. A growing body of evidence demonstrates that both spontaneous (during normal spermatogenesis) and accelerated germ cell death triggered by deprivation of the gonadotrophic support or moderately increased scrotal temperature in adult rats occur almost exclusively via apoptosis. Although there has been spectacular progress in the understanding of the molecular mechanisms of apoptosis in various systems other than spermatogenesis, elucidation of the biochemical and molecular mechanisms by which germ cell apoptosis is regulated has only just begun. It is likely that germ cell apoptosis is controlled in a cell-type specific fashion, but the basic elements of the death machinery may be universal. In addition, there is increasing evidence that homozygous disruption of a number of genes in mice results in infertility through accelerated germ cell apoptosis. Manipulation of spermatogenesis by survival factor(s) deprivation or increases in extrinsic death signals in loss-of-function or gain-of-function mouse models provides a basis for further attempts to define the intrinsic regulation of various death-related genes by external death signals. Such information is crucial for effective management of male factor infertility as well as more targeted approaches to male contraception.

Superovulation and intrauterine insemination in the treatment of male factor infertility.

Recent studies report that superovulation combined with intrauterine insemination (IUI) is more successful than superovulation alone, IUI alone or superovulation with intracervical insemination in couples with male subfertility. Our study evaluated two superovulation protocols in the management of male factor infertility using IUI: (A) clomiphene citrate and human chorionic gonadotropin (HCG) and (B) human menopausal gonadotropin and HCG. Fifteen couples with severe oligoasthenozoospermia (OAS) were treated with protocol A in 54 cycles, and no pregnancies were achieved. Eight of the 15 couples with severe OAS subsequently received protocol B for 24 cycles and elicited no pregnancies. Thirty-seven couples with moderate OAS received protocol A for 169 cycles, and 2 pregnancies ensued (5.4% per couple and 1.12% per cycle). Twelve of the 35 nonpregnant couples with moderate OAS then received protocol B for 31 cycles, and 4 pregnancies were recorded (33.3% per couple and 12.9% per cycle).

Successful twin pregnancy and delivery after microinseminated oocyte fallopian transfer for male factor infertility

The case described indicate that microinseminated oocyte fallopian transfer may be a potentially useful option of management of male factor infertility. The question of the effect of a breach in the oocyte/embryo zona during micromanipulation procedure on the outcome of their in vitro culture remains to be addressed.

Assisted reproductive technologies for male factor infertility

Experience in the diagnosis and treatment of infertility has led to an increased understanding of the prominent role male factors play in many couples' inability to conceive. While many forms of male factor infertility are amenable to treatment, for some patients there is no corrective therapy available. For this reason, a great deal of attention has been focused on developing technologies for semen processing and sperm utilization in cases of decreased semen quality. One area of research is the development of more sophisticated methods of assessing sperm function, as well as methods of sperm preparation. Progress is also being made in the application of technologies such as intrauterine insemination and in vitro fertilization in the treatment of male factor infertility. Such developments have improved prospects for fertility among patients suffering from decreased semen quality, as well as those suffering from such disorders as ejaculatory failure and congenital vasal agenesis. Current research also offers promise for future applications such as gamete micromanipulation. This technology holds potential for improving fertility even among patients suffering from profound male factor disorders. The following is a summary of recent publications pertaining to the application of these assisted reproductive technologies in the management of male factor infertility.