Introduction to male infertility
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(Dr Yorgos Nikas/Science Photo Library)
After many decades of the term infertility being used with the constant assumption of the word female in front of it, male infertility has joined the mainstream medical discourse. In many cases of male infertility, however, a specific cause has yet to be identified. Yet advances are being made, and the successful treatment of most cases of male infertility makes studying this subject a particularly rewarding exercise.
Reports of declining sperm counts and increasing incidence of urogenital abnormalities and testicular cancer from many different countries have stimulated public interest and concern about male infertility. While modern lifestyles and environmental pollution have been incriminated in infertility, whether there is a true deterioration of human semen quality is still a matter of some controversy.
Recently the World Health Organization (WHO) revised the reference values for human semen characteristics that valuates the male fecundity at 95th and the lower reference at 2.5 and 5th centile from men who had fathered a child within one year of trying for a pregnancy. These values seem to lean towards lower sperm counts, low motility and lower morphology (compared with the previous WHO reference values in 1987, 1992 and 1999). This poses the question – is the male fecundity on the decline or is the fecundity maintained at these lower reference values?
A quagmire of epidemiology, lifestyle, environmental pollution, systemic illnesses, medications and partner's fertility can all affect male fecundity. There are advances in male fertility tests at the molecular level, which WHO hasn’t addressed, in assessing the effect of ROS (reactive oxygen species), oxidative stress and its effect on sperm DNA (DNA fragmentation) and aneuploidy assessment of the spermatozoa.
This tutorial discusses the causes, evaluation and treatment of male infertility.
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Learning objectives When you have completed this tutorial you will be able to:
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Last updated: 12/08/10 (tutorial reviewed and updated by Mr Rashmi Patel)
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