Infertility in the Male | PDF Download

Description:

This gold standard text has kept its readers abreast of rapid advancements in reproductive medicine and surgery since 1983. Continuing this tradition, this fifth edition has been fully updated and revised to provide clear, didactic advice on best practice for a variety of clinical situations faced by practitioners across many specialties – including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice who see men with suboptimal fertility and reproductive problems. Completely restructured to include pedagogical features such as easily accessible key concepts that cement understanding and real-world use. Covering everything from foundations of anatomy and embryology, through clinical evaluation, diagnostic approaches, treatment and fertility care in context within the healthcare system and society, thrilling advances and future directions are also included. This new edition is an essential reference for all who are working in this young and rapidly evolving field.

Introduction

The last and fourth edition of Infertility in the Male was published in 2009, and significant advances were realized in reproductive medicine and surgery in the intervening decade. In this edition, we have covered the more recent advances in the field while maintaining the core foundation of information needed for practitioners in diagnosing and treating the man seeking care for fertility. We have also endeavored to make the book more structured, and hopefully easier to use, for the student and specialist alike.

For the first time, we have organized the book into sections: “Scientific Foundations of Male Infertility,” the basic biological science undergirding reproductive medicine; “Clinical Evaluation of the Infertile Male,” which covers clinical diagnosis; “Laboratory Diagnosis of Male Infertility,” detailing laboratory diagnosis of testicular dysfunction and the basics of sperm cryopreservation; “Treatment of Male Infertility,” describing the means and strategies for therapy for these diagnoses; and finally “Health Care System and Culture,” which contextualizes male fertility care in society and the world. Many of these chapters have substantial overlap, as they consider topics from more than one perspective – while the chapter “Cryopreservation of Sperm – History and Current Practice” in the “Laboratory Diagnosis of Male Infertility” section attends to the history and laboratory processes of storing sperm for future use, “Male Oncofertility – Considerations for Fertility Preservation and Restoration” in the “Treatment of Male Infertility” section describes the conditions the clinician will encounter to utilize banking; “Sperm Retrieval Surgery” details how to surgically obtain sperm, and “The Use of Sperm in Medically Assisted Reproduction” explains how to use cryopreserved sperm in medically assisted reproduction techniques such as in vitro fertilization/intracytoplasmic sperm injection.

While chapters in the fourth edition included sentences in bold to draw the attention of the reader to their most pertinent parts, to facilitate the use of the book in practice, chapters now also include Key Points in boxes to facilitate and cement understanding and real-world use. Multiple related chapters in the fourth edition were combined – thus, although there are fewer chapters in this book, compared to its predecessor, they are deeper, more interrelated, and more understandable.

The section “Scientific Foundations of Male Infertility” begins, as did the previous edition, with a chapter detailing the anatomy and embryology of the male reproductive tract and gonadal development, the epididymis, and accessory sex organs, thus forming the basis of accurate anatomic diagnosis and surgery. The following chapter describes the complex interplay of cells and their communicating molecules that coordinate the production of sperm in the testis; its immediate succeeding chapter details how and what happens to sperm in the epididymis that makes them capable of fertilizing the ovum. As the male reproductive system is largely controlled by the endocrine system, a chapter follows describing the production and control of sex steroids in the male, laying the essentials for accurate endocrine therapy detailed later in the book. Once sperm is made, it must make its exit, and the chapter on erection, emission, and ejaculation then addresses these processes. Science never sleeps, and the final chapter in this section describes the enormous leaps in genomic modification and epigenetics during the last decade that are sure to be the foundation for diagnostic and therapeutic advances in the years to come.

The next section “Clinical Evaluation of the Infertile Male” brings our current knowledge of male reproductive pathology and its diagnosis to the armamentarium of the male fertility specialist. It begins with one of the most rapidly evolving areas in the field, our understanding of how other diseases are related to reproductive dysfunction, a chapter on “Infertility as a Metric of Men’s Health.” This presents one of the most important reasons why we care for male infertility – it may reveal significant underlying health conditions. Following is the chapter “Office Evaluation of the Subfertile Male” that gives the practitioner concrete strategies to be used in the office encounter, including questions to ask, what to look for, and clinical interpretation of the semen analysis. As the field is unusual, in that two people are required for an outcome, “Evaluation of the Infertile Male’s Partner” provides a high-level review of the diagnosis of the female. By reading it, the practitioner will have a clear understanding of the steps taken in parallel by the female fertility specialist in order to best integrate reproductive care. “Imaging the Male Reproductive System” provides the reader with when and how to use radiographic and ultrasonographic tools in the diagnosis of the infertile male and, importantly, when they are not necessary. Another area of explosive growth in the field in the past decade has been in our understanding of environmental toxicants and their effect on male reproduction, reviewed in “Effects of Environmental Chemicals on Male Reproduction.” With “Endocrine Causes of Male Infertility – Diagnosis and Treatment,” the foundation presented in the chapter detailing the male endocrine system in the prior section is carried forward into pathological endocrine states and how to diagnose them. The chapter “Spermatogenesis – Diagnosis of Normal and Abnormal States” provides an overview of spermatogenic pathology and its diagnosis, integrating the basic knowledge describing spermatogenesis in the prior section with related systems in this section, as well as providing context for treatment to be detailed more completely in a subsequent section on therapy. The chapter “Inheritance and Male Fertility” delineates genomic conditions manifesting as male reproductive dysfunction and carries forward the epigenetic background laid in the prior section into what practitioners need to consider in the clinic. Still bedeviling clinicians and patients alike, the commonly encountered varicocele is elucidated in the chapter bearing its name, including its history, pathophysiology, diagnosis, indications for treatment, and, as this chapter is targeted to a specific condition, the treatment itself. The section concludes with a chapter detailing infectious and immunological considerations in the diagnosis of male infertility, an often confounding area for those diagnosing and treating the infertile male. With a clear understanding of the material presented thus far, the practitioner is ready to diagnose any man presenting with infertility using the tools currently available in reproductive clinical science.

In the time-tested process of clinical evaluation of male reproductive dysfunction, the practitioner next obtains laboratory testing. The next section begins with an overview of the two pillars of reproductive laboratory assessment – endocrine and sperm – in “The Laboratory Evaluation of the Infertile Male” and provides a highlevel overview of other topics such as sperm DNA fragmentation. These cutting-edge forms of assessment of male infertility are substantially expanded in the subsequent chapter “Advanced Diagnostic Approaches to Male Infertility” that details the myriad forms of sperm DNA integrity assays and which and when they are best used, and an encyclopedic list of currently known genomic defects affecting male fertility that are currently used for clinical diagnosis in some parts of the world. Sperm are dynamic cells, and the following chapter “Evaluating Defects in Sperm Function” describes the assays used in determining how well sperm swim and do their job in fertilizing an ovum. As the laboratory is critical in freezing sperm for future use, the final chapter in the section “Cryopreservation of Sperm – History and Current Practice” describes methods of preserving sperm, while contextualizing these techniques in their use both specifically as a therapy and broadly in a health care system.

With an understanding of the biological science of male reproduction and how to diagnose its dysfunction in the clinic and laboratory, the reader is now prepared to treat specific conditions of male infertility in the next section. The first chapter “Medical Treatment of Male Infertility” reviews endocrine therapy, nonendocrine medicines, and nutraceuticals. Should sperm be produced in the testis but encounter barriers to traversing and exiting the male reproductive tract, “Surgery to Improve Sperm Delivery” details the procedural methods to address the various causative problems. Should the making of sperm in the testis be at fault or it not be possible to alter the reproductive tract to deliver sperm, going to the source of sperm in the male gonad is necessary and the subsequent chapter “Sperm Retrieval Surgery” describes when and how to do so. If sperm is obtained from the testis or present in low quantities in the ejaculate, medically assisted reproduction is required and the chapter “The Use of Sperm in Medically Assisted Reproduction” details those methods, providing the practitioner with an understanding of what happens to sperm in the laboratory and beyond. During the past decade, a field coined “oncofertility” has expanded into a systematic approach to fertility preservation for cancer survivors, and the chapter bearing its name describes all aspects of this in great detail. The other side of fertility is when it no longer is desired, and the chapter “Male Contraception” enumerates the many exciting advances that may soon lead to options beyond female oral contraceptives, barrier methods, and vasectomy. The section concludes with the thrilling advances coming in male fertility therapy in “Future Directions in Male Infertility.”

The final section puts fertility care in its context in the health care system and in society. Mental health is an indispensable component of care, as patients are often devastated to learn that they have problems in the most basic of human desires, and the chapter “Mental Health and Male Reproduction” attends to this critical facet of care. Reproduction is a social construct with often legal implications and needs, and the chapter “Legal Issues and Male Reproduction” offers a review of those most pertinent. Gender affirmation procedures have become more common during the last decade, and those individuals needing these procedures should be offered the opportunity for children, with considerations prior to and after treatment; the chapter “Male Reproduction in the Transgender Patient” concretely reviews this rapidly evolving field. Finally, male reproductive care is not limited to one corner of the world, and the chapter “Global and Cultural Aspects of Male Reproductive Care” reviews various customs and practices to which practitioners must be sensitive in order to effectively and respectfully provide care.

A few notes before we release you into the world of male reproductive health care. The first is one of nomenclature. In the early days of treating male infertility, there were no options for spermatogenic dysfunction such as testis sperm extraction with intracytoplasmic sperm injection. Hence, in diagnosing azoospermia, there were only two forms – one involving obstruction that may be addressed with surgical correction, and the other due to spermatogenic dysfunction where nothing was available. One was, and still is, termed “obstructive azoospermia,” an apt and accurate name for the condition. The other was called “nonobstructive azoospermia,” as nothing could be done for it. Today, that second form is very commonly treated with medicine and surgery, and to continue to call it “nonobstructive azoospermia” does little to explain what it actually is. We have begun more commonly using the descriptive term “azoospermia due to spermatogenic dysfunction,” and you will find that terminology in this book. However, in this edition, as the older term “nonobstructive azoospermia” remains in the literature, we have left it to individual chapter authors which nomenclature they prefer for azoospermia when the pathology is spermatogenic dysfunction.

You will also find disagreements and multiple viewpoints when authors cover similar topics. We heartily encouraged these, as medicine is as much art as science, and the interpretation of the medical literature is not an exercise in revealing absolute truths. We chose leading practitioners and scientists to write chapters, but every human has orientations and biases. We want you to see those for what they are and to choose your own interpretations and clinical strategies.

Finally, as we conclude the compilation of this book, we are missing something extremely important – the effect of the COVID-19 pandemic on male reproduction. Early studies suggest that men convalesced from the disease do not harbor virus in semen, but these results are highly preliminary [1]. With the tragic, staggering numbers of those infected, we will ultimately have more information; however, at this time, we do not have sufficient study data to clearly discuss the effects, since much of this disease still remains a mystery. In future years, we will know more.

With those notate bene, it is time for you to begin the book. Happy reading, and we wish you all the best in your care for men struggling with infertility