Male Infertility

Management of Infertile Men in Reproductive Medicine

1st Edition - November 29, 2023
Editors: Ashok Agarwal, Florence Boitrelle, Panagiotis Drakopoulos, Hassan Nooman Sallam, Ramadan Saleh
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 9 3 0 4 7 - 5
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 9 3 0 4 8 - 2
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 9 3 0 4 9 - 9

Despite the fact that about half of infertility problems stem from male factors, gynecologists are often the first health care providers to perform the initial assessment of the… Read more

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Despite the fact that about half of infertility problems stem from male factors, gynecologists are often the first health care providers to perform the initial assessment of the infertile couple. For this reason, it is critical that gynecologists and reproductive medicine specialists remain up to date on the primary conditions that cause male infertility, as well as current diagnostic tools and treatment options of both natural and assisted conception. From diagnosis through treatment, Male Infertility: Management of Infertile Men in Reproductive Medicine offers expert, straightforward guidance on the pathophysiology and management of male infertility for clinicians who assist couples early in the process of trying to conceive.

Cover image
Title page
Table of Contents
Copyright
Dedication
Contributors
Foreword
Preface
About the Author
List of Illustrations
List of Tables
SECTION 1. Definition, Epidemiology, and Implications of Male Infertility
1. Definition, epidemiology, and implications of male infertility
Introduction
Epidemiology of male infertility
Health implications of male infertility
Summary
References
SECTION 2. Causes of Male Infertility
2. Pretesticular causes of male infertility
Introduction
Physiopathology of the hypothalamic-pituitary-gonadal axis
Clinical picture and diagnosis
Etiologies of hypogonadotropic hypogonadism
Medical treatment of hypogonadotropic hypogonadism
Clinical case scenarios
Summary
References
3. Testicular causes of male infertility
Introduction
Congenital causes of male infertility
Genetic causes
Infective causes
Disorders of spermatogenesis
Testicular tumors
Trauma to the testis
Torsion of the testis
Testicular microcalcifications
Cell phone radiation
Heat exposure
Secondary testicular causes of male infertility
Management of testicular causes of male infertility
Treatment
Clinical case scenarios
Summary
References
4. Posttesticular causes of male infertility
Introduction
Posttesticular causes of male infertility
Clinical scenarios
Summary
References
5. Environmental/lifestyle factors and male infertility
Introduction
Environmental/occupational factors and male infertility
Summary
References
6. Idiopathic male infertility
Introduction
Etiology and prevailing theories
Diagnosis of idiopathic male infertility
Treatment of idiopathic male infertility
Summary
References
SECTION 3. Diagnosis of Male Infertility
7. Medical history and physical examination of infertile males
Introduction
History
Physical examination
Telehealth and male infertility assessment
Summary
References
8. Basic semen analysis
Introduction
Basic semen examination—changes in the world health organization manual, 6th edition
Reference values
Conclusion
Summary
References
9. Sperm DNA fragmentation tests
Introduction
Sperm DNA structure
Types of sperm DNA fragmentation
DNA repair
Causes of sperm DNA fragmentation
Impact of SDF on reproductive outcomes
Terminal deoxynucleotidyl transferase dUTP nick-end labeling assay
Sperm chromatin structure assay
Sperm chromatin dispersion test
Comet assay (single-cell gel electrophoresis)
Current recommendations of sperm DNA fragmentation testing by professional societies
Challenges of sperm DNA fragmentation testing in clinical practice
Clinical scenarios
Summary
References
10. Genetic and genomic tests of infertile males
Introduction
Genetic tests
Genomic tests
Clinical/laboratory scenarios
Summary
Funding
References
11. Computer-assisted semen analysis
Introduction
Description of different types of computed-assisted semen analysis systems
Semen examinations using computer-assisted semen analysis
Recommendations, advantages, and disadvantages of computer-assisted semen analysis systems
Perspectives and emerging technologies
Summary
References
12. Seminal oxidative stress and reactive oxygen species testing
Introduction
Sources of reactive oxygen species in the male reproductive tract
Antioxidant regulation of reactive oxygen species in the male reproductive tract
Physiological role of reactive oxygen species in male reproduction and fertility
Pathological effects of oxidative stress in male reproduction
Seminal biomarkers of reactive oxygen species and oxidative stress
Summary
References
13. Assessment of reproductive hormones in infertile males
Introduction
Gonadotropins
Testosterone and testicular androgens
The human spermatogenesis
Pretesticular causes: The hypothalamus-pituitary-gonadal axis
Testicular causes: Primary testicular failure
Laboratory assessment
Clinical case scenarios
Summary
References
14. Imaging in male factor infertility
Introduction
Male reproductive gross anatomy
Basic principles of ultrasonography
Basic principles of computed tomography
Basic principles of magnetic resonance imaging
Testis imaging
Epididymis imaging
Vas deferens imaging
Seminal vesicle and ejaculatory duct imaging
Summary
References
SECTION 4. Medical Treatment of Male Infertility
15. Hormonal therapy of male infertility
Introduction
Hormonal therapy of infertile males
Clinical case scenarios
Summary
References
16. Antioxidants therapy of male infertility
Introduction
Protective action of antioxidants
Impact of antioxidant therapy of infertile males on semen parameters
Impact of antioxidant therapy of infertile males on pregnancy outcomes
Practice patterns of the use of antioxidant therapy in male infertility
Professional societies’ guidelines of antioxidant therapy in male infertility
Limitations of antioxidant therapy in male infertility
Summary
References
17. Antibiotic therapy of male infertility
Introduction
Semen and testicular microbiomes
Seminal microbiome and assisted reproductive technique outcome
Diagnosis of genital tract infection
Impact of leukocytospermia on male fertility
Antibiotics therapy of male infertility
Overview of the current guidelines
Antibiotics as adjuvants in assisted reproductive technique
Clinical case scenarios
Antibiotic alternatives
Summary
References
18. Alternative therapy of male infertility
Introduction
Nutrition and male fertility
Malnutrition/nutrient deficiencies and male infertility
Herbal treatment for male infertility
Herbs with positive effects on sperm quality
Herbs with negative effects on sperm quality
Physical exercise and male fertility
The positive impact of exercise on male fertility
The negative impact of exercise on male fertility
Psychological and behavioral therapy
Effects of psychological stress on reproductive function
Treatment of psychological stress–related disease
Clinical/laboratory case scenario
Summary
References
SECTION 5. Surgical Treatment of Male Infertility
19. Varicocele repair in infertile males
Introduction
Pathogenesis of varicocele
Diagnosis and grading of varicocele
Impact of varicocele on male fertility
Society guidelines
Types of intervention
Outcomes of intervention
Complications of varicocelectomy
Summary
Clinical case scenarios
References
20. Management of ejaculatory duct obstruction
Introduction
Epidemiology of obstruction of male reproductive tract
Anatomical considerations
Functional considerations
Etiology and pathophysiology of ejaculatory duct obstruction
Evaluation of ejaculatory duct obstruction
Differential diagnosis of ejaculatory duct obstruction
Treatment of ejaculatory duct obstruction
Clinical case scenario
Summary
References
21. Surgical sperm retrieval and processing for assisted reproductive technology
Introduction
Narrative review
Summary
References
SECTION 6. Assisted Reproduction
22. Intrauterine insemination with homologous semen
Introduction
Diagnostic work-up before intrauterine insemination and when to start with intrauterine insemination
Indications for intrauterine insemination with partner semen
Factors influencing intrauterine insemination outcome
Perinatal outcome after intrauterine insemination/prevention of multiple pregnancies
Cost effectiveness of intrauterine insemination
Summary
References
23. In vitro fertilization/intracytoplasmic sperm injection
Introduction
Indications for in vitro fertilization
Current technique of in vitro fertilization
Improvements in in vitro fertilization techniques over the past 30 years
Advances of intracytoplasmic sperm injection—improvements over the last 30 years
Clinical case scenarios
Summary
References
24. Techniques for selection of surgically retrieved sp erm for intracytoplasmic sperm injection
Introduction
Surgically retrieved sperm selection
Sperm selection methods
Intracytoplasmic morphologically selected sperm injection
Microfluidics-based sperm selection techniques
Clinical case scenarios
Summary
References
25. Sperm banking
Introduction
Indications of sperm cryopreservation
Sperm cryopreservation
Assisted reproductive technique outcomes with frozen donor sperm
Emergence of field of oncofertility and its importance in assisted reproductive technique
Management of cryobanking services and facilities
General requirements for sperm banking
Conclusions
Summary
References
SECTION 7. Clinical Practice Guidelines for Male Infertility
26. Guidelines of the American society for reproductive medicine, American urological association, and European association of urology
Introduction
Causes and risk factors of male infertility
Diagnosis of male infertility
Management of male infertility before the assisted reproductive technology stage
Male infertility management with assisted reproductive techniques
Clinical/laboratory case scenario
Summary
References
27. Expert opinion: Management of male infertility in the postintracytoplasmic sperm injection era
Introduction
The importance of evaluating and treating male infertility
Controversies in evaluation of an infertile male
Conclusion
Summary
References
SECTION 8. Insights Into the Future of Male Infertility
28. Clinical perspective in the postintracyoplasmic sperm injection era
Introduction
Role of epigenetics in the management of male infertility
Role of proteomics in the management of male infertility
Optimizing sperm selection techniques for intracytoplasmic sperm injection
Molecular markers for predicting sperm retrieval in nonobstructive azoospermia
The future of stem cell therapy in male infertility
Fertility preservation in cancer patients
Role of artificial intelligence in the practice of male infertility
Summary
References
29. Research perspectives in the postintracytoplasmic sperm injection era
Introduction
New developments in androurological diagnostics
Utility of artificial intelligence in reproductive medicine
Applications of stem cell research in male fertility preservation
Summary
References
Index

Ashok Agarwal

Ashok Agarwal, PhD, HCLD (ABB), ELD (ACE) is the Head of Andrology Center and Director of Research at the American Center for Reproductive Medicine since 1993. He holds these positions at The Cleveland Clinic Foundation, where he is Professor of Surgery (Urology) at the Lerner College of Medicine of Case Western Reserve University. Ashok was trained in Male Infertility and Andrology at the Brigham and Women’s Hospital and Harvard Medical School and later worked as Assistant Professor of Urology at Harvard from 1988 to 1992. Ashok has over 28 years of experience in directing busy male infertility diagnostic facilities and fertility preservation services. He is very well published with over 735 scientific papers and reviews in peer-reviewed scientific journals and is ranked in Scopus as the #1 author in the world in the fields of Male Infertility/Andrology and Human Assisted Reproduction, based on the number of peer-reviewed publications, citation scores (Scopus: 32,432; Google Scholar: 69,225), and h-index (Scopus: 97; Google Scholar: 128). He is currently an editor of more than 40 medical text books/manuals related to male infertility, ART, fertility preservation, DNA damage, and antioxidants and active in basic and clinical research. His laboratory has trained over 1,000 scientists, clinicians, graduate, and undergraduate students from the United States and more than 55 countries. Ashok is the recipient of over 100 grants totaling over 15 million dollars. His current research interests include proteomics of male infertility and the molecular markers of oxidative stress and DNA integrity in the pathophysiology of male reproduction.

Affiliations and expertise

Head, Andrology Center, Director of Research, American Center for Reproductive Medicine, Cleveland, Ohio

Florence Boitrelle

Affiliations and expertise

ART and Andrology-Hospital of Poissy St. Germain, University Paris-Saclay, Paris, France

Panagiotis Drakopoulos

Prof. Dr. Panagiotis Drakopoulos is Visiting Professor at the Centre for Reproductive Medicine (Universitair Ziekenhuis Brussel) in Belgium and Clinical & Scientific of the infertility clinic "I.R.I.S MED" in Herakion, Crete, Greece. He is recognized as a subspecialist in reproductive medicine and surgery by ESHRE (European Society of Human Reproduction and Embryology) and EBCOG (European Board & College of Obstetrics and Gynaecology). He has authored numerous articles in high indexed journals of the field, such as Fertility and Sterility and Human Reproduction. His research focuses on reproductive endocrinology as well as on poor ovarian responders and strategies to improve their outcome.

Affiliations and expertise

Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel,

Life Sciences

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Social Sciences & Humanities

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Male Infertility

Management of Infertile Men in Reproductive Medicine

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Ashok Agarwal

Florence Boitrelle

Panagiotis Drakopoulos