What is New in the Clinical Assessment and Treatment of the InfertileMale

Abstract

Male infertility is a fast-evolving area. Recently published evidence has challenged several established concepts and added to the knowledge in the field. Traditionally, the clinical assessment of the subfertile male includes a history and physical examination, hormonal evaluation and semen analyses. Regarding the latter, the World Health Organization has established new reference values that in general include lower limits than those of previous editions. Specialized sperm function assays, such as sperm DNA integrity and measurements of oxidative stress, are now clinically available and may be integrated to the conventional semen analysis to provide a more comprehensive evaluation of a man’s fertility status. Also, molecular biology genetic testing involving the Y-chromosome can correctly identify oligozoospermic and azoospermic men misdiagnosed as having idiopathic infertility and be of prognostic value for sperm retrieval in non-obstructive azoospermia. In the field of treatment, emerging evidence suggests that antioxidant therapy along with life-style modifications improve the male reproductive health. Microsurgery has increased the success rates for both varicocele treatment and sperm retrieval for assisted conception. Microsurgical treatment of clinical varicoceles may optimize reproductive outcome of couples undergoing intracytoplasmic sperm injection or microsurgical testicular sperm extraction. Men with non-obstructive azoospermia, elevated follicle-stimulating hormone levels and small testes may no longer be considered sterile. Modern retrieval techniques are used to collect testicular sperm that can be used to produce a healthy biological offspring via assisted conception. This article reviews what is new in the clinical assessment and treatment of the infertile male, including the implications of this increased knowledge in the management of the infertile couple and assisted reproduction technology outcomes.