When I was taking my urology boards 30 years ago, a question on the exam was how to treat an azoospermic man with an FSH level of 2 to 3 times normal, and the answer was to counsel to adopt. So much ...has changed in those intervening years: the most common patient that I treat today is exactly that man, and a live birth is achieved in approximately 70%. Between then and now, what made reproductive success possible in this previously hopeless clinical scenario was the introduction of intracytoplasmic sperm injection and the ability to use it with testicular sperm derived from a microsurgical systematic survey of seminiferous tubule size and quality.
However, treatment of the male lags behind that of the female for a variety of reasons, with the principle one being male gametogenesis is longer and less easily observed than the female. The quick weeks of ovulation may be followed by ultrasound, but with months long spermatogenesis and its tiny sperms, should they only exist in the testis and not in the ejaculate, the only way of knowing what’s happening in the testis is to do surgery. Fortunately, the binary outcome of sperm or not is providing us with means to test endocrine stimulatory protocols in the male similar to those in the female that have made in-vitro fertilization so successful. Cryopreservation of testicular tissue is another advance making these procedures more convenient for patients and physicians, and importantly, knowing whether biological gametes from the male are available for IVF.
Follicle-stimulating hormone (FSH) treatment has been proven effective in stimulating spermatogenesis and improving the reproductive ability of men with hypogonadotropic hypogonadism, while the ...usefulness of such a treatment in infertile patients with normal pituitary function is restricted to a subgroup of responders that, however, cannot be identified by the current diagnostic tools before treatment. In this review we summarize the role played by FSH in the modulation of spermatogenesis, the effect of FSH treatment at a standard replacement dose and at higher dose on sperm parameters, spontaneous and in vitro fertilization pregnancy rates, and the efforts made to identify possible responders to FSH treatment.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objective To examine outcomes of intracytoplasmic sperm injection (ICSI) using testicular versus ejaculated sperm among men with cryptozoospermia. Design Meta-analysis. Setting Not applicable. ...Patient(s) Men with cryptozoospermia undergoing consecutive ICSI cycles using ejaculated or testicular sperm. Intervention(s) A systematic search was performed using PubMed (inception to August 2015). Inclusion criteria were studies comparing ICSI outcomes among men with cryptozoospermia using ejaculated and testicular sperm. Main Outcome Measure(s) Primary outcomes included ICSI fertilization or pregnancy rates (PRs). Secondary analysis included number of retrieved oocytes, maternal and paternal ages. Meta-analysis of weighted data using a random effects model was performed. Results are reported as relative risk or weighted mean differences (WMD) with 95% confidence intervals (CI). Result(s) Five cohort studies were included, encompassing 272 ICSI cycles and 4,596 injected oocytes. There were no differences in ICSI PRs (relative risk RR 0.53, 95% CI 0.19–1.42, I2 = 67%) or fertilization rates (RR 0.91, 95% CI 0.78–1.06, I2 = 73%) between testicular and ejaculated sperm groups. There was a significant trend toward increasing maternal age (WMD 1.69 years, 95% CI −2.71 to −0.66) and paternal age (WMD 2.61 years, 95% CI −4.73 to −0.48) with testicular sperm. There was no difference between numbers of oocytes retrieved (WMD 0.95, 95% CI −0.15 to 2.05). Post-hoc power analysis revealed pβ <20% for PR analysis and pβ <10% for fertilization rate analysis. Conclusion(s) The existing literature does not support a recommendation for men with cryptozoospermia to use testicular sperm in preference over ejaculated sperm for ICSI.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The summary presented herein represents Part I of the two-part series dedicated to the Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. Part I outlines the appropriate evaluation of ...the male in an infertile couple. Recommendations proceed from obtaining an appropriate history and physical exam (Appendix I), as well as diagnostic testing, where indicated.
The Emergency Care Research Institute Evidence-based Practice Center team searched PubMed®, Embase®, and Medline from January, 2000 through May, 2019. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. (Table 1) This summary is being simultaneously published in Fertility and Sterility and The Journal of Urology.
This Guideline provides updated, evidence-based recommendations regarding evaluation of male infertility as well as the association of male infertility with other important health conditions. The detection of male infertility increases the risk of subsequent development of health problems for men. In addition, specific medical conditions are associated with some causes for male infertility. Evaluation and treatment recommendations are summarized in the associated algorithm. (Figure 1)
The presence of male infertility is crucial to the health of patients and its effects must be considered for the welfare of society. This document will undergo updating as the knowledge regarding current treatments and future treatment options continues to expand.
Diagnóstico y tratamiento de la infertilidad masculina: guía de la AUA/ ASRM parte 1.
El resumen representa la Parte I de una serie de dos partes dedicada al diagnóstico y tratamiento de la infertilidad masculina: Guía de la AUA/ASRM. La primera parte describe la evaluación apropiada del hombre en una pareja infértil. Las recomendaciones pasan por la realización de una historia y un examen físico apropiados (Apéndice I), así como pruebas de diagnóstico, cuando esté resulte indicado.
El equipo del Centro de Práctica Basada en la Evidencia del Instituto de Investigación de Cuidados de Emergencia buscó en PubMed, Embase y Medline desde enero de 2000 hasta mayo de 2019. Cuando existían pruebas suficientes, se asignaba al conjunto de pruebas una calificación de A (alta), B (moderada) o C (baja) para el apoyo de las recomendaciones fuertes, moderadas o condicionales. En ausencia de pruebas suficientes, se proporciona información adicional en forma de Principios Clínicos y Opiniones de Expertos. (Cuadro 1). Este resumen se publica simultáneamente en Fertility and Sterility y The Journal of Urology.
Esta guía proporciona recomendaciones actualizadas y basadas en la evidencia sobre la evaluación de la infertilidad masculina, así como la asociación de la infertilidad masculina con otras condiciones de salud importantes. La detección de la infertilidad masculina aumenta el riesgo de posterior desarrollo de los problemas de salud de los hombres. Además, determinadas afecciones médicas se asocian con algunas causas de la infertilidad masculina. La evaluación y las recomendaciones de tratamiento se resumen en el algoritmo asociado. (Figura 1)
La presencia de la infertilidad masculina es crucial para la salud de los pacientes y sus efectos deben ser considerados para el bienestar de sociedad. Este documento se actualizará a medida que continúe el conocimiento sobre los tratamientos actuales y las opciones de tratamiento futuras para expandirse.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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