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Review Special Issue Series: Old and New Challenges in the Management of Male Factor Infertility

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Reproductive Medicine & Andrology".

Deadline for manuscript submissions: closed (20 July 2024) | Viewed by 7509

Special Issue Editor


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Guest Editor
Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
Interests: azoospermia (non-obstructive and obstructive); surgical sperm retrieval for ICSI; epididymis pathology in male infertility; seminal tract surgery; severe male infertility (all kinds); sperm DNA fragmentation in clinical practice; varicocele
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Special Issue Information

Dear Colleagues,

This Review Special Issue Series, entitled “Review Special Issue Series: Old and New Challenges in the Management of Male Factor Infertility”, is committed to presenting an exclusive collection of comprehensive reviews.

Although the infertility of couples is caused by a male factor in 30–50% of cases, an adequate (or even any) andrological assessment of the male partner is seldom obtained, the assumption being that only the male gamete, and not the human subject, matters in the achievement of oocyte fertilization and pregnancy, regardless of the man’s health condition. This represents a clear case of gender discrimination. The reproductive ability of couples with severe male factor infertility may be significantly impaired without the appropriate medical or surgical management of the severe spermatogenic dysfunction; on the other hand, couples are referred to donor sperm IUI or IVF when the male partner is azoospermic, without attempting to individuate the cause and the possible medical or surgical treatment applicable to such a condition. Managing infertile couples in such a way may expose couples to an increased risk of treatment failure; in addition, since male infertility has been proposed as an independent risk factor for poor health status and early mortality, if infertile men are evaluated early in life, there is an opportunity for health assessment, counseling, and disease prevention. Clinical training in male infertility is most commonly an aspect of andrology training; however, some urologists or endocrinologists may have little experience in the counseling and management of infertile men. The purpose of the present Special Issue is, therefore, thanks to the contribution of internationally renowned experts in the field, to provide the readers with a comprehensive and evidence-based update on the challenges faced in the management of male factor infertility.

Prof. Dr. Giovanni M. Colpi
Guest Editor

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Keywords

  • male infertility
  • male gamete
  • reproductive ability
  • surgical management
  • spermatogenic dysfunction

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Published Papers (5 papers)

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Review

14 pages, 298 KiB  
Review
Male Fertility as a Proxy for Health
by Calvin C. Zhao, Michael Scott and Michael L. Eisenberg
J. Clin. Med. 2024, 13(18), 5559; https://doi.org/10.3390/jcm13185559 - 19 Sep 2024
Viewed by 884
Abstract
Male fertility is affected by a wide range of medical conditions that directly and indirectly affect spermatogenesis. As such, it can be useful as both an indicator of current health and a predictive factor for future health outcomes. Herein, we discuss the current [...] Read more.
Male fertility is affected by a wide range of medical conditions that directly and indirectly affect spermatogenesis. As such, it can be useful as both an indicator of current health and a predictive factor for future health outcomes. Herein, we discuss the current literature regarding the association between male fertility and systemic health conditions and exposures. We review the connection between male fertility and genetics, medications, diet, and environmental pollutants, as well as its effects on future oncologic, cardiovascular, and autoimmune conditions. Understanding this interplay will allow more health care providers to engage in health counseling that will not only improve men’s reproductive outcomes but also their overall health. Full article
16 pages, 1596 KiB  
Review
Sperm DNA Fragmentation in Male Infertility: Tests, Mechanisms, Meaning and Sperm Population to Be Tested
by Donata Conti, Costanza Calamai and Monica Muratori
J. Clin. Med. 2024, 13(17), 5309; https://doi.org/10.3390/jcm13175309 - 7 Sep 2024
Viewed by 1350
Abstract
Sperm DNA fragmentation (sDF) is a DNA damage able to predict natural conception. Thus, many laboratories added tests for the detection of sDF as an adjunct to routine semen analysis with specific indications. However, some points related to sDF are still open. The [...] Read more.
Sperm DNA fragmentation (sDF) is a DNA damage able to predict natural conception. Thus, many laboratories added tests for the detection of sDF as an adjunct to routine semen analysis with specific indications. However, some points related to sDF are still open. The available tests are very different each from other, and a direct comparison, in terms of the prediction of reproductive outcomes, is mandatory. The proposed mechanisms responsible for sDF generation have not yielded treatments for men with high levels of sDF that have gained the general consent in clinical practice, thus requiring further research. Another relevant point is the biological meaning to attribute to sDF and, thus, what we can expect from tests detecting sDF for the diagnosis of male infertility. SDF can represent the “tip of iceberg” of a more extended and undetected sperm abnormality somehow impacting upon reproduction. Investigating the nature of such a sperm abnormality might provide novel insights into the link between sDF and reproduction. Finally, several studies reported an impact of native sDF on assisted reproduction technique outcomes. However, to fertilise the oocyte, selected spermatozoa are used where sDF, if present, associates with highly motile spermatozoa, which is the opposite situation to native semen, where most sDF associates with non-viable spermatozoa. Studies comparing the impact of sDF, as assessed in both native and selected spermatozoa, are needed. Full article
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49 pages, 2032 KiB  
Review
Non-Obstructive Azoospermia and Intracytoplasmic Sperm Injection: Unveiling the Chances of Success and Possible Consequences for Offspring
by Ahmad Majzoub, Marina C. Viana, Arnold P. P. Achermann, Isadora T. Ferreira, Rita J. Laursen, Peter Humaidan and Sandro C. Esteves
J. Clin. Med. 2024, 13(16), 4939; https://doi.org/10.3390/jcm13164939 - 21 Aug 2024
Viewed by 1104
Abstract
Non-obstructive azoospermia (NOA) is found in up to 15% of infertile men. While several causes for NOA have been identified, the exact etiology remains unknown in many patients. Advances in assisted reproductive technology, including intracytoplasmic sperm injection (ICSI) and testicular sperm retrieval, have [...] Read more.
Non-obstructive azoospermia (NOA) is found in up to 15% of infertile men. While several causes for NOA have been identified, the exact etiology remains unknown in many patients. Advances in assisted reproductive technology, including intracytoplasmic sperm injection (ICSI) and testicular sperm retrieval, have provided hope for these patients. This review summarizes the chances of success with ICSI for NOA patients and examines preoperative factors and laboratory techniques associated with positive outcomes. Furthermore, we reviewed possible consequences for offspring by the use of ICSI with testicular sperm retrieved from NOA patients and the interventions that could potentially mitigate risks. Testicular sperm retrieved from NOA patients may exhibit increased chromosomal abnormalities, and although lower fertilization and pregnancy rates are reported in NOA patients compared to other forms of infertility, the available evidence does not suggest a significant increase in miscarriage rate, congenital malformation, or developmental delay in their offspring compared to the offspring of patients with less severe forms of infertility or the offspring of fertile men. However, due to limited data, NOA patients should receive specialized reproductive care and personalized management. Counseling of NOA patients is essential before initiating any fertility enhancement treatment not only to mitigate health risks associated with NOA but also to enhance the chances of successful outcomes and minimize possible risks to the offspring. Full article
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29 pages, 1697 KiB  
Review
Leukocytospermia and/or Bacteriospermia: Impact on Male Infertility
by Ralf Henkel
J. Clin. Med. 2024, 13(10), 2841; https://doi.org/10.3390/jcm13102841 - 11 May 2024
Cited by 3 | Viewed by 1926
Abstract
Infertility is a globally underestimated public health concern affecting almost 190 million people, i.e., about 17.5% of people during their lifetime, while the prevalence of male factor infertility is about 7%. Among numerous other causes, the prevalence of male genital tract infections reportedly [...] Read more.
Infertility is a globally underestimated public health concern affecting almost 190 million people, i.e., about 17.5% of people during their lifetime, while the prevalence of male factor infertility is about 7%. Among numerous other causes, the prevalence of male genital tract infections reportedly ranges between 10% and 35%. Leukocytospermia is found in 30% of infertile men and up to 20% in fertile men. Bacterial infections cause an inflammatory response attracting leukocytes, which produce reactive oxygen species (ROS) and release cytokines, both of which can cause damage to sperm, rendering them dysfunctional. Although leukocytospermia and bacteriospermia are both clinical conditions that can negatively affect male fertility, there is still debate about their impact on assisted reproduction outcomes and management. According to World Health Organization (WHO) guidelines, leukocytes should be determined by means of the Endtz test or with monoclonal antibodies against CD15, CD68 or CD22. The cut-off value proposed by the WHO is 1 × 106 peroxidase-positive cells/mL. For bacteria, Gram staining and semen culture are regarded as the “gold standard”, while modern techniques such as PCR and next-generation sequencing (NGS) are allowing clinicians to detect a wider range of pathogens. Whereas the WHO manual does not specify a specific value as a cut-off for bacterial contamination, several studies consider semen samples with more than 103 colony-forming units (cfu)/mL as bacteriospermic. The pathogenic mechanisms leading to sperm dysfunction include direct interaction of bacteria with the male germ cells, bacterial release of spermatotoxic substances, induction of pro-inflammatory cytokines and ROS, all of which lead to oxidative stress. Clinically, bacterial infections, including “silent” infections, are treatable, with antibiotics being the treatment of choice. Yet, non-steroidal antiphlogistics or antioxidants should also be considered to alleviate inflammatory lesions and improve semen quality. In an assisted reproduction set up, sperm separation techniques significantly reduce the bacterial load in the semen. Nonetheless, contamination of the semen sample with skin commensals should be prevented by applying relevant hygiene techniques. In patients where leukocytospermia is detected, the causes (e.g. infection, inflammation, varicocele, smoking, etc.) of the leukocyte infiltration have to be identified and addressed with antibiotics, anti-inflammatories or antioxidants in cases where high oxidative stress levels are detected. However, no specific strategy is available for the management of leukocytospermia. Therefore, the relationship between bacteriospermia and leukocytospermia as well as their specific impact on functional sperm parameters and reproductive outcome variables such as fertilization or clinical pregnancy must be further investigated. The aim of this narrative review is to provide an update on the current knowledge on leukocytospermia and bacteriospermia and their impact on male fertility. Full article
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10 pages, 552 KiB  
Review
Partial Epididymal Obstruction as a Cause of Idiopathic Oligozoospermia: A Reproductive Urologist’s Perspective Following 35 Years of Surgical and Clinical Experience
by Giovanni M. Colpi and Ettore Caroppo
J. Clin. Med. 2024, 13(2), 382; https://doi.org/10.3390/jcm13020382 - 10 Jan 2024
Viewed by 1668
Abstract
The role of partial epididymal obstruction as contributing to the development of oligozoospermia has been neglected for decades. In the early 1970s, however, Robert Schoysman, a gynecological surgeon devoted to the surgical and medical management of male factor infertility, dedicated many efforts to [...] Read more.
The role of partial epididymal obstruction as contributing to the development of oligozoospermia has been neglected for decades. In the early 1970s, however, Robert Schoysman, a gynecological surgeon devoted to the surgical and medical management of male factor infertility, dedicated many efforts to study such a pathology and its possible effects on male fertility. Following the studies of this pioneer in the field, we concentrated our attention to the patterns of partial and complete epididymal obstruction during surgical scrotal exploration, once made possible even in oligozoospermic men by diagnostic and therapeutic interventions, such as vasovesciculography or seminal tract washout test, at present considered obsolete and no longer feasible in light of the current guidelines. Interestingly, we found signs of partial epididymal obstruction in about 30% of oligozoospermic men with normal testicular volume and serum FSH level as well as normal spermatogenesis at testis biopsy. We, then, compared the findings of scrotal ultrasound with those of scrotal exploration and found that the ultrasound abnormalities of the epididymis were highly predictive of anatomic alteration of the gland. In the present study, we report our experience, together with a historical review of the literature, on this topic. Full article
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