madman
Super Moderator
Cutting-Edge Evaluation of Male Infertility
Ujval Ishu Pathak, MPH, Joseph Scott Gabrielsen, MD, Ph.D., Larry I. Lipshultz, MD
KEY POINTS
*A male factor contributes to 50% of cases of infertility, yet only 7.5% of men are referred for urologic evaluation.
*The male infertility evaluation is critical to identify the cause of infertility but may also reveal other information relevant to the health of the patient and his offspring.
*The history, physical, and semen analysis remain the mainstay of the male infertility evaluation. Additional hormonal and genetic testing may be indicated.
BASIC EVALUATION
A thorough medical history, physical examination, and at least 2 semen analyses are the cornerstone of any evaluation of the infertile man.4 These provide information that can guide treatment and further evaluation.
History and Physical Examination
*Semen Analysis
*Testosterone and Follicle-Stimulating Hormone
EXTENDED EVALUATION
*Radiological Examination
*Laboratory Assessment
*Karyotype testing
*Y chromosome microdeletion testing *
*Cystic fibrosis gene mutations
*Seminal oxidants
*DNA fragmentation
*Fluorescence in situ hybridization
Advanced Testing/Future Directions
Epigenetics DNA
Metabolomics, Proteomics, Lipidomics, and Other “-omics”
Extracellular Vesicles
SUMMARY
The proper evaluation of the male is a critical component of the evaluation of the infertile couple. Despite advances in ART that permit paternity with a limited number of sperm, the purpose of the examination of the infertile man goes beyond identifying the cause of infertility and may identify factors that could affect the health of the patient and/or his offspring. Although the fundamental components of the evaluation have remained constant, advances in our understanding of the pathophysiology, combined with advances in technology, have enhanced our ability to diagnose and treat male infertility.
Ujval Ishu Pathak, MPH, Joseph Scott Gabrielsen, MD, Ph.D., Larry I. Lipshultz, MD
KEY POINTS
*A male factor contributes to 50% of cases of infertility, yet only 7.5% of men are referred for urologic evaluation.
*The male infertility evaluation is critical to identify the cause of infertility but may also reveal other information relevant to the health of the patient and his offspring.
*The history, physical, and semen analysis remain the mainstay of the male infertility evaluation. Additional hormonal and genetic testing may be indicated.
BASIC EVALUATION
A thorough medical history, physical examination, and at least 2 semen analyses are the cornerstone of any evaluation of the infertile man.4 These provide information that can guide treatment and further evaluation.
History and Physical Examination
*Semen Analysis
*Testosterone and Follicle-Stimulating Hormone
EXTENDED EVALUATION
*Radiological Examination
*Laboratory Assessment
*Karyotype testing
*Y chromosome microdeletion testing *
*Cystic fibrosis gene mutations
*Seminal oxidants
*DNA fragmentation
*Fluorescence in situ hybridization
Advanced Testing/Future Directions
Epigenetics DNA
Metabolomics, Proteomics, Lipidomics, and Other “-omics”
Extracellular Vesicles
SUMMARY
The proper evaluation of the male is a critical component of the evaluation of the infertile couple. Despite advances in ART that permit paternity with a limited number of sperm, the purpose of the examination of the infertile man goes beyond identifying the cause of infertility and may identify factors that could affect the health of the patient and/or his offspring. Although the fundamental components of the evaluation have remained constant, advances in our understanding of the pathophysiology, combined with advances in technology, have enhanced our ability to diagnose and treat male infertility.
