The Andrological Landscape in the Twenty-First Century: Making Sense of the Advances in Male Infertility Management for the Busy Clinicians
Abstract
:1. Introduction
2. Advances in Male Infertility Diagnostics
2.1. The Clinical Relevance and Implications of Changes in the sixth edition of the WHO Manual of Semen Analysis
2.2. Sperm DNA Fragmentation—Rationale, Testing Techniques, and Clinical Applications
2.3. The Use of AI in Semen Analyses: Diagnostic Implication in Defining Treatment Direction
2.4. Home Semen Analysis: Overview, Comparison, and Limitations
2.5. Prospect of “Omics” in Male Infertility
2.6. Genetic Tests in Men with Infertility—The Role and Status of Genome and Exome Sequencing
2.7. Advances in Varicocele Diagnosis
3. Advances in Male Infertility Treatment
3.1. The Role of Oxidative Stress and Antioxidants
3.2. The Evolution of the Indications of Varicocele Repair in Subfertile Men
3.2.1. Sperm DNA Fragmentation
3.2.2. Hypogonadism
3.2.3. Non-Obstructive Azoospermia
3.2.4. Orchalgia
3.3. The Stepwise Approach to Surgical Sperm Retrieval
3.4. Current Scientific Evidence Regarding The Optimization of a Patient before Surgical Sperm Retrieval and Its Impact on Sperm Yield
3.4.1. Hormonal Therapy in NOA Prior to mTESE
3.4.2. Antioxidants Prior to mTESE
3.4.3. Varicocele Repair Prior to mTESE
3.4.4. Gonadotropin Replacement Therapy for Male Hypogonadotropic Hypogonadism
4. Key Points
- The latest WHO Manual has made it possible to overcome many limitations of the previous edition.
- Although the WHO Manual has now included SDF as an extended test and the literature supports the diagnostic usefulness of SDF assessment, further efforts are needed to standardize the testing methods and establish clear reference values.
- Artificial intelligence will play an essential role in the future to improve the evaluation and diagnosis of male infertility.
- At-home semen analysis tests can be helpful in the early identification of patients with altered sperm parameters who need further investigation and wish to avoid the embarrassment some patients feel about undergoing sperm examination in a laboratory.
- “Omics” studies represent a significant area of interest in fertility assessment and, in the future, may make it possible to reduce the proportion of patients diagnosed with idiopathic infertility significantly.
- Varicocele still represents a topic of considerable clinical interest, and identifying new diagnostic indices will enable an increasingly better selection of patients for treatment.
- A growing body of evidence suggests that varicocele can affect the pan testicular function.
- Even though most men with varicocele have normal conventional semen parameters, varicocele could still affect men’s fertility, probably through increasing sperm DNA damage and decreasing intratesticular testosterone production, which indirectly affects spermatogenesis.
- Regardless of fertility, hypogonadism is an emerging indication for VR. Several studies reported the improvement of testosterone levels in hypogonadal men but not in euogonadal men.
- mTESE remains the gold standard of management for NOA. Adopting a stepwise technique and quality control measures during surgery increases the chances of sperm retrieval while minimizing trauma.
- Considerable research has been carried out to optimize the patients before TESE and to increase the chances for sperm retrieval using an adjuvant therapy or VR. However, no definite recommendations could be made from an evidence-based point of view.
5. Experts Comment
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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The Sixth Edition of the WHO Manual of Semen Analysis | |
---|---|
Advantages | Limitations |
Analyzes a larger and more geographically diverse population. Specifies that the 5th centile values are only one way to interpret the results of SA, and the use of the 5th centile alone is not sufficient to diagnose male infertility. | |
Second-level investigations were included in specific categories of patients:
| Reintroduction of the distinction between slowly progressive and rapidly progressive motility without any recent studies and which is difficult to quantify accurately by the manual method |
The absence of clear reference limits for clinicians not experienced in the field. |
Type of Kit | Type of Outcome Assessed | Advantages | Limitations |
---|---|---|---|
SpermCheck Fertility | Sperm concentration above or below 20 mil | Rapid (10 min) Simple to interpret | No information about the exact value of sperm concentration. No information about other parameters. |
Micra Sperm Test | Sperm count, sperm motility, and sperm volume | Rapid (30 min) It allows the quantification of three different parameters | Risk of interpretation error by the observer. No evaluation of morphology |
Trak | Sperm count | Rapid (6 min) Simple to interpret | No information about the exact sperm concentration. No information about other parameters. |
Fertell Male Fertility Home Test | Sperm motile count | Rapid Simple to interpret | No information about the exact value of sperm motile count. No information about other parameters. |
SwimCount Sperm Quality Test | Progressive sperm motile count | Rapid (1 h) Simple to interpret | No information about the exact value of progressive sperm motile count. No information about other parameters. |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Motawi, A.; Crafa, A.; Hamoda, T.; Shah, R.; Agarwal, A. The Andrological Landscape in the Twenty-First Century: Making Sense of the Advances in Male Infertility Management for the Busy Clinicians. Int. J. Environ. Res. Public Health 2024, 21, 1222. https://doi.org/10.3390/ijerph21091222
Motawi A, Crafa A, Hamoda T, Shah R, Agarwal A. The Andrological Landscape in the Twenty-First Century: Making Sense of the Advances in Male Infertility Management for the Busy Clinicians. International Journal of Environmental Research and Public Health. 2024; 21(9):1222. https://doi.org/10.3390/ijerph21091222
Chicago/Turabian StyleMotawi, Ahmad, Andrea Crafa, Taha Hamoda, Rupin Shah, and Ashok Agarwal. 2024. "The Andrological Landscape in the Twenty-First Century: Making Sense of the Advances in Male Infertility Management for the Busy Clinicians" International Journal of Environmental Research and Public Health 21, no. 9: 1222. https://doi.org/10.3390/ijerph21091222