Although male reproductive functions are impaired in about half of the infertile couples seeking offspring, even today the examination and treatment of the male partner continues to be neglected.
Despite the lack of evidence for a "sperm crisis", so highly touted in the press, the public remains worried, while the fact that male fertility declines beyond the age of 40 years and is accompanied by increasing genetic risks for the offspring goes largely unnoticed. In addition to a thorough physical examination supplemented by imaging techniques such as ultrasonography of the scrotal organs, semen analysis according to WHO guidelines, hormone determinations, and cyto- and molecular genetic analyses form part of the routine investigation of the infertile male. Few disorders have become subjects of rational treatment, such as hypogonadotropic hypogonadism with gonadotropins or GnRH, treatment of sexually transmitted diseases by antibiotics, and microsurgical reconstruction of blocked seminal ducts. Early treatment of maldescended testes in boys or changing lifestyle (e.g., discontinuation of smoking) are important preventive measures. In the age of evidence-based medicine, most empirical treatments have been demonstrated to be ineffective. Thus, pregnancy rates from patients with varicocele who underwent long-practiced surgical or radiologic interventional therapy were not different from those of patients receiving counseling. At present, in cases of non-obstructive azoospermia or severe oligoasthenoteratozoospermia, intracytoplasmic sperm injection (ICSI) using single sperm derived from semen or extracted from testicular biopsy tissue (TESE) represents the most successful treatment modality, although it remains symptomatic and not curative.
Written by:
Nieschlag E. Are you the author?
Centrum für Reproduktionsmedizin und Andrologie, Universitätsklinikum Münster, Domagkstr. 11, 48129, Münster, Deutschland.
Reference: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013 Dec;56(12):1619-27.
doi: 10.1007/s00103-013-1859-2
PubMed Abstract
PMID: 24337123
Article in German.
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