New developments in the evaluation and management of male infertility

摘要

A male factor exists in 30% of infertile unions New options, particularly ICSI, have revolutionized its management but should not create an environment wherein the evaluation of the male focuses only on ART outcomes All men require a thorough assessment for reversible causes of infertility, comorbidities and sexual/relationship difficulties consequent upon this diagnosis. Endocrine, genetic and histological evaluations play key roles in diagnosis and must be viewed critically Increasingly, genetic defects are being described in otherwise healthy men with 'idiopathic' spermatogenic failure, including karyotypic anomalies, Y chromosomal deletions and potentially in X-linked and autosomal genes This new knowledge has major implications for clinical practice and the health of offspring The background rate of natural fertility in subfertile men means that treatments should be assessed in placebo-controlled RCTs: such evidence is lacking for many common treatments In obstructive azoospeimia, the decision to use surgical correction as opposed to sperm retrieval and ICSI is affected by the surgical access and skill, female cofactors and site-specific cost-effectiveness considerations The use of testicular sperm in nonobstructive azoospermia requires discussion of the realistic prospects for live births, and its safety for the man and his offspring.