Clinical management of male infertility
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Giovanni Beretta
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Transcript of Clinical management of male infertility
Giovanni Beretta
Giovanni Beretta
Introduction Paolo Turchi MD Giovanni Beretta Giorgio Cavallini Look Inside Get Access
Prevalence Definition and Classification of Infertility Paolo Turchi Look Inside Get Access
Interpretation of Sperm Analysis Giovanni Beretta Look Inside Get Access
Diagnosis of Infertility Edoardo S Pescatori MD Look Inside Get Access
General Therapeutic Approach to Male Infertility Giorgio Cavallini Look Inside Get Access
Giovanni Beretta
Azoospermia Giorgio Franco Leonardo Misuraca Gabriele Tuderti Look Inside Get Access
Varicocele and Infertility Giovanni Beretta Look Inside Get Access
Chromosomic Causes of Infertility Gianni Paulis Look Inside Get Access
Male Idiopathic (Oligo) plusmn (Astheno) plusmn (Terato)-Spermia Giorgio Cavallini Look Inside Get Access
Obesity and Male Infertility Carlo Maretti Look Inside Get Access
O
Giovanni Beretta
Unexplained Couple Infertility (Male Role) Giorgio Cavallini Look Inside Get Access
Inflammatory Infertility Giorgio Cavallini Gianni Paulis Look Inside Get Access
Testicular Pathology Fulvio Colombo Giorgio Gentile Alessandro Franceschelli Look Inside Get Access
Endocrine Infertility Giorgio D Piubello Look Inside Get Access
O
Giovanni Beretta
Iatrogenic Infertility Giovanni Beretta Look Inside Get Access
Dietary Complements and Phytotherapy Bruno Giammusso Look Inside Get Access
Environmental Pollution and Infertility Giorgio Cavallini Look Inside Get Access
The Role of the Andrologist in Assisted Reproduction Giorgio Cavallini Giovanni Beretta Look Inside Get
Access
Sexual Problems and Infertility Giovanni Beretta Look Inside Get Access
Giovanni Beretta
O IntroductionO Paolo Turchi MD Giovanni Beretta
Giorgio Cavallini
O Get Access
O Abstract
O The clinical management of infertility suffers from a way of thinking still widely propagated today by thoseworking in the field who often consider the understanding of the male factor of infertility too vagueand its remedies not yet supported by solid scientificevidence With respect to such uncertainty assistedreproduction techniques (ART) are recommended to couples these offer the possibility of having a child in a reasonably short time and at little cost even in the presence of a male factor [1 2] Unilateral handling of reproductive care according to this common way of thinking might provide the couple with the best chances of procreation In fact there are four strong reasons to favor bilateral management of the infertile couple including an assessment of the male
Interpretation of Sperm AnalysisGiovanni Beretta
AbstractSemen analysis is used to measure the amount and quality of a manrsquos semen and sperm and can provide information about sperm production Sperm analysis should follow the Laboratory Manual for the Examination and Processing of Human Semen by the World Health Organization (World Health Organisation (2010) WHO laboratory manual for the examination and processing of human semen 5th edn WHO Geneva) A decrease in the number of spermatozoa to fewer than 15 millionmL is called oligospermia a decrease in motility is termed asthenozoospermia and a percentage of abnormal forms exceeding 96 is known as teratozoospermia These abnormalities if found together are described as the oligoasthenoteratozoospermia (OAT) syndrome Seminal volume and pH can indicate several pathologic conditions such as agenesis of seminal vesicles and vasa deferentiaSemen analysis is not a predictor of pregnancy but a routine semen analysis is still the first step in male fertility investigation Over the years a large number of sperm function tests have been used to determine whether the spermatozoa have the biological capacity to reach and fertilize ovocytes resulting in live births A variety of tests are available to evaluate different aspects of these functions This chapter describes sperm function tests that are relatively simple to carry out and are of clinical help in infertile men (Ombelet et al Hum Reprod 12987ndash993 1997)
O Diagnosis of Infertility
O Edoardo S Pescatori MD
O Get Access
O Abstract
O Male factors of infertility accounts as sole or contributoryfactors in approximately 50 of causes of couple infertility A minimum andrologic evaluation of the male partner of the couple having difficulty conceiving is mandatory and it shouldcomprise medical history physical examination and interpretation of sperm analysis To only conduct a spermanalysis is not acceptable The benefits of a sound male workup are to identify treatable causes of infertility and the possibility to detect underlying pathologic factors posing a riskto male health in general in addition to male fertility itself The extent of male diagnostic investigations must always be appraised in light of the possible presence of female factorinfertility
Prevalence Definition and Classification of Infertility
Paolo Turchi
Abstract
Infertility defined by the World Health Organization as ldquoa disease of the
reproductive system defined by the failure to achieve a clinical pregnancy after
12 months or more of regular unprotected sexual intercourserdquo is considered by
experts in the field to be a problem that affects 15ndash20 of couples Another
fact on which there is substantial convergence of views is that a male cause is
present in about 50 of cases These data however are questionable and not
measurable in a direct way although several indirect methods have been used
In fact in most cases of couple infertility the presence of a male factor is
established on the basis of the seminal data that is on laboratory data
characterized by a high coefficient of variability In addition time to pregnancy a
parameter that can identify cases of a couplersquos subfecundity has been shown
to correlate with sperm quality and quantity sexual activity and a number of
other conditions The current trend to refer the infertile couple to in vitro
fertilization programs without a comprehensive male evaluation reduces the
possibility of understanding the real impact of male infertility namely his
biological incapacity to reproduce on the function of a couple-based concept
such as fertility
OGeneral Therapeutic Approach to Male Infertility
O Giorgio Cavallini
O Abstract
O Severe oligoasthenospermia seems to be a more crucial aspect than moderate dyspermiain the restoration of couple fertility Femaleage is a further critical aspect in the correctionof male factor infertility Many lifestyle factorssuch as vigorous exercise psychologicalstress cigarette smoking illicit drug use and alcohol negatively influence fertility whereasothers such as Mediterranean diet and moderate exercise may be beneficial
O Azoospermia
O Giorgio Franco Leonardo Misuraca Gabriele Tuderti
O Get Access
O Abstract
O Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation With a prevalence of 1 among the general male population and 10ndash15 among infertile men it can be classified in two large groups obstructive and non-obstructive azoospermia (OA and NOA) The first is caused by an obstruction in the seminal tract (epididymis vas ejaculatory ducts) and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic hormonal and acquired conditions Diagnostic workup of azoospermia includes personal and familiar history clinical evaluation hormonal and semen biochemical assessment scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration open biopsy and in selected cases vasography OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART NOA treatment is represented by sperm retrieval for ART Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA and we describe a novel stepwise approach of this technique to reduce invasivity
O Varicocele and Infertility
O Giovanni Beretta
O Abstract
O Many authors have argued over the relationship betweeninfertility and varicocele over the last 100 years In the first century ad Celsus first documented this pathology stating thatldquothe testicle of varicocele is smaller than the unaffected siderdquo Most investigators have suggested that the presence of a varicocele could result in lower fertility rates The incidence of varicocele is greater in subfertile males than in the general population A review of incidental varicoceles found in the general population approximately 60 were associated with semen abnormalities (Johnson et al South Med J 6334ndash36 1970) However the facts that not all men with varicocele are infertile and that surgical management does not improve fertilityin 100 of cases has prompted some doubt as to role of surgery laparoscopy or subinguinal microscopicvaricocelectomy in this abnormality (Al-Kandari et al Urology 69417ndash420 2007) These points are reviewed and discussed in this chapter
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
Giovanni Beretta
Introduction Paolo Turchi MD Giovanni Beretta Giorgio Cavallini Look Inside Get Access
Prevalence Definition and Classification of Infertility Paolo Turchi Look Inside Get Access
Interpretation of Sperm Analysis Giovanni Beretta Look Inside Get Access
Diagnosis of Infertility Edoardo S Pescatori MD Look Inside Get Access
General Therapeutic Approach to Male Infertility Giorgio Cavallini Look Inside Get Access
Giovanni Beretta
Azoospermia Giorgio Franco Leonardo Misuraca Gabriele Tuderti Look Inside Get Access
Varicocele and Infertility Giovanni Beretta Look Inside Get Access
Chromosomic Causes of Infertility Gianni Paulis Look Inside Get Access
Male Idiopathic (Oligo) plusmn (Astheno) plusmn (Terato)-Spermia Giorgio Cavallini Look Inside Get Access
Obesity and Male Infertility Carlo Maretti Look Inside Get Access
O
Giovanni Beretta
Unexplained Couple Infertility (Male Role) Giorgio Cavallini Look Inside Get Access
Inflammatory Infertility Giorgio Cavallini Gianni Paulis Look Inside Get Access
Testicular Pathology Fulvio Colombo Giorgio Gentile Alessandro Franceschelli Look Inside Get Access
Endocrine Infertility Giorgio D Piubello Look Inside Get Access
O
Giovanni Beretta
Iatrogenic Infertility Giovanni Beretta Look Inside Get Access
Dietary Complements and Phytotherapy Bruno Giammusso Look Inside Get Access
Environmental Pollution and Infertility Giorgio Cavallini Look Inside Get Access
The Role of the Andrologist in Assisted Reproduction Giorgio Cavallini Giovanni Beretta Look Inside Get
Access
Sexual Problems and Infertility Giovanni Beretta Look Inside Get Access
Giovanni Beretta
O IntroductionO Paolo Turchi MD Giovanni Beretta
Giorgio Cavallini
O Get Access
O Abstract
O The clinical management of infertility suffers from a way of thinking still widely propagated today by thoseworking in the field who often consider the understanding of the male factor of infertility too vagueand its remedies not yet supported by solid scientificevidence With respect to such uncertainty assistedreproduction techniques (ART) are recommended to couples these offer the possibility of having a child in a reasonably short time and at little cost even in the presence of a male factor [1 2] Unilateral handling of reproductive care according to this common way of thinking might provide the couple with the best chances of procreation In fact there are four strong reasons to favor bilateral management of the infertile couple including an assessment of the male
Interpretation of Sperm AnalysisGiovanni Beretta
AbstractSemen analysis is used to measure the amount and quality of a manrsquos semen and sperm and can provide information about sperm production Sperm analysis should follow the Laboratory Manual for the Examination and Processing of Human Semen by the World Health Organization (World Health Organisation (2010) WHO laboratory manual for the examination and processing of human semen 5th edn WHO Geneva) A decrease in the number of spermatozoa to fewer than 15 millionmL is called oligospermia a decrease in motility is termed asthenozoospermia and a percentage of abnormal forms exceeding 96 is known as teratozoospermia These abnormalities if found together are described as the oligoasthenoteratozoospermia (OAT) syndrome Seminal volume and pH can indicate several pathologic conditions such as agenesis of seminal vesicles and vasa deferentiaSemen analysis is not a predictor of pregnancy but a routine semen analysis is still the first step in male fertility investigation Over the years a large number of sperm function tests have been used to determine whether the spermatozoa have the biological capacity to reach and fertilize ovocytes resulting in live births A variety of tests are available to evaluate different aspects of these functions This chapter describes sperm function tests that are relatively simple to carry out and are of clinical help in infertile men (Ombelet et al Hum Reprod 12987ndash993 1997)
O Diagnosis of Infertility
O Edoardo S Pescatori MD
O Get Access
O Abstract
O Male factors of infertility accounts as sole or contributoryfactors in approximately 50 of causes of couple infertility A minimum andrologic evaluation of the male partner of the couple having difficulty conceiving is mandatory and it shouldcomprise medical history physical examination and interpretation of sperm analysis To only conduct a spermanalysis is not acceptable The benefits of a sound male workup are to identify treatable causes of infertility and the possibility to detect underlying pathologic factors posing a riskto male health in general in addition to male fertility itself The extent of male diagnostic investigations must always be appraised in light of the possible presence of female factorinfertility
Prevalence Definition and Classification of Infertility
Paolo Turchi
Abstract
Infertility defined by the World Health Organization as ldquoa disease of the
reproductive system defined by the failure to achieve a clinical pregnancy after
12 months or more of regular unprotected sexual intercourserdquo is considered by
experts in the field to be a problem that affects 15ndash20 of couples Another
fact on which there is substantial convergence of views is that a male cause is
present in about 50 of cases These data however are questionable and not
measurable in a direct way although several indirect methods have been used
In fact in most cases of couple infertility the presence of a male factor is
established on the basis of the seminal data that is on laboratory data
characterized by a high coefficient of variability In addition time to pregnancy a
parameter that can identify cases of a couplersquos subfecundity has been shown
to correlate with sperm quality and quantity sexual activity and a number of
other conditions The current trend to refer the infertile couple to in vitro
fertilization programs without a comprehensive male evaluation reduces the
possibility of understanding the real impact of male infertility namely his
biological incapacity to reproduce on the function of a couple-based concept
such as fertility
OGeneral Therapeutic Approach to Male Infertility
O Giorgio Cavallini
O Abstract
O Severe oligoasthenospermia seems to be a more crucial aspect than moderate dyspermiain the restoration of couple fertility Femaleage is a further critical aspect in the correctionof male factor infertility Many lifestyle factorssuch as vigorous exercise psychologicalstress cigarette smoking illicit drug use and alcohol negatively influence fertility whereasothers such as Mediterranean diet and moderate exercise may be beneficial
O Azoospermia
O Giorgio Franco Leonardo Misuraca Gabriele Tuderti
O Get Access
O Abstract
O Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation With a prevalence of 1 among the general male population and 10ndash15 among infertile men it can be classified in two large groups obstructive and non-obstructive azoospermia (OA and NOA) The first is caused by an obstruction in the seminal tract (epididymis vas ejaculatory ducts) and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic hormonal and acquired conditions Diagnostic workup of azoospermia includes personal and familiar history clinical evaluation hormonal and semen biochemical assessment scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration open biopsy and in selected cases vasography OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART NOA treatment is represented by sperm retrieval for ART Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA and we describe a novel stepwise approach of this technique to reduce invasivity
O Varicocele and Infertility
O Giovanni Beretta
O Abstract
O Many authors have argued over the relationship betweeninfertility and varicocele over the last 100 years In the first century ad Celsus first documented this pathology stating thatldquothe testicle of varicocele is smaller than the unaffected siderdquo Most investigators have suggested that the presence of a varicocele could result in lower fertility rates The incidence of varicocele is greater in subfertile males than in the general population A review of incidental varicoceles found in the general population approximately 60 were associated with semen abnormalities (Johnson et al South Med J 6334ndash36 1970) However the facts that not all men with varicocele are infertile and that surgical management does not improve fertilityin 100 of cases has prompted some doubt as to role of surgery laparoscopy or subinguinal microscopicvaricocelectomy in this abnormality (Al-Kandari et al Urology 69417ndash420 2007) These points are reviewed and discussed in this chapter
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
Introduction Paolo Turchi MD Giovanni Beretta Giorgio Cavallini Look Inside Get Access
Prevalence Definition and Classification of Infertility Paolo Turchi Look Inside Get Access
Interpretation of Sperm Analysis Giovanni Beretta Look Inside Get Access
Diagnosis of Infertility Edoardo S Pescatori MD Look Inside Get Access
General Therapeutic Approach to Male Infertility Giorgio Cavallini Look Inside Get Access
Giovanni Beretta
Azoospermia Giorgio Franco Leonardo Misuraca Gabriele Tuderti Look Inside Get Access
Varicocele and Infertility Giovanni Beretta Look Inside Get Access
Chromosomic Causes of Infertility Gianni Paulis Look Inside Get Access
Male Idiopathic (Oligo) plusmn (Astheno) plusmn (Terato)-Spermia Giorgio Cavallini Look Inside Get Access
Obesity and Male Infertility Carlo Maretti Look Inside Get Access
O
Giovanni Beretta
Unexplained Couple Infertility (Male Role) Giorgio Cavallini Look Inside Get Access
Inflammatory Infertility Giorgio Cavallini Gianni Paulis Look Inside Get Access
Testicular Pathology Fulvio Colombo Giorgio Gentile Alessandro Franceschelli Look Inside Get Access
Endocrine Infertility Giorgio D Piubello Look Inside Get Access
O
Giovanni Beretta
Iatrogenic Infertility Giovanni Beretta Look Inside Get Access
Dietary Complements and Phytotherapy Bruno Giammusso Look Inside Get Access
Environmental Pollution and Infertility Giorgio Cavallini Look Inside Get Access
The Role of the Andrologist in Assisted Reproduction Giorgio Cavallini Giovanni Beretta Look Inside Get
Access
Sexual Problems and Infertility Giovanni Beretta Look Inside Get Access
Giovanni Beretta
O IntroductionO Paolo Turchi MD Giovanni Beretta
Giorgio Cavallini
O Get Access
O Abstract
O The clinical management of infertility suffers from a way of thinking still widely propagated today by thoseworking in the field who often consider the understanding of the male factor of infertility too vagueand its remedies not yet supported by solid scientificevidence With respect to such uncertainty assistedreproduction techniques (ART) are recommended to couples these offer the possibility of having a child in a reasonably short time and at little cost even in the presence of a male factor [1 2] Unilateral handling of reproductive care according to this common way of thinking might provide the couple with the best chances of procreation In fact there are four strong reasons to favor bilateral management of the infertile couple including an assessment of the male
Interpretation of Sperm AnalysisGiovanni Beretta
AbstractSemen analysis is used to measure the amount and quality of a manrsquos semen and sperm and can provide information about sperm production Sperm analysis should follow the Laboratory Manual for the Examination and Processing of Human Semen by the World Health Organization (World Health Organisation (2010) WHO laboratory manual for the examination and processing of human semen 5th edn WHO Geneva) A decrease in the number of spermatozoa to fewer than 15 millionmL is called oligospermia a decrease in motility is termed asthenozoospermia and a percentage of abnormal forms exceeding 96 is known as teratozoospermia These abnormalities if found together are described as the oligoasthenoteratozoospermia (OAT) syndrome Seminal volume and pH can indicate several pathologic conditions such as agenesis of seminal vesicles and vasa deferentiaSemen analysis is not a predictor of pregnancy but a routine semen analysis is still the first step in male fertility investigation Over the years a large number of sperm function tests have been used to determine whether the spermatozoa have the biological capacity to reach and fertilize ovocytes resulting in live births A variety of tests are available to evaluate different aspects of these functions This chapter describes sperm function tests that are relatively simple to carry out and are of clinical help in infertile men (Ombelet et al Hum Reprod 12987ndash993 1997)
O Diagnosis of Infertility
O Edoardo S Pescatori MD
O Get Access
O Abstract
O Male factors of infertility accounts as sole or contributoryfactors in approximately 50 of causes of couple infertility A minimum andrologic evaluation of the male partner of the couple having difficulty conceiving is mandatory and it shouldcomprise medical history physical examination and interpretation of sperm analysis To only conduct a spermanalysis is not acceptable The benefits of a sound male workup are to identify treatable causes of infertility and the possibility to detect underlying pathologic factors posing a riskto male health in general in addition to male fertility itself The extent of male diagnostic investigations must always be appraised in light of the possible presence of female factorinfertility
Prevalence Definition and Classification of Infertility
Paolo Turchi
Abstract
Infertility defined by the World Health Organization as ldquoa disease of the
reproductive system defined by the failure to achieve a clinical pregnancy after
12 months or more of regular unprotected sexual intercourserdquo is considered by
experts in the field to be a problem that affects 15ndash20 of couples Another
fact on which there is substantial convergence of views is that a male cause is
present in about 50 of cases These data however are questionable and not
measurable in a direct way although several indirect methods have been used
In fact in most cases of couple infertility the presence of a male factor is
established on the basis of the seminal data that is on laboratory data
characterized by a high coefficient of variability In addition time to pregnancy a
parameter that can identify cases of a couplersquos subfecundity has been shown
to correlate with sperm quality and quantity sexual activity and a number of
other conditions The current trend to refer the infertile couple to in vitro
fertilization programs without a comprehensive male evaluation reduces the
possibility of understanding the real impact of male infertility namely his
biological incapacity to reproduce on the function of a couple-based concept
such as fertility
OGeneral Therapeutic Approach to Male Infertility
O Giorgio Cavallini
O Abstract
O Severe oligoasthenospermia seems to be a more crucial aspect than moderate dyspermiain the restoration of couple fertility Femaleage is a further critical aspect in the correctionof male factor infertility Many lifestyle factorssuch as vigorous exercise psychologicalstress cigarette smoking illicit drug use and alcohol negatively influence fertility whereasothers such as Mediterranean diet and moderate exercise may be beneficial
O Azoospermia
O Giorgio Franco Leonardo Misuraca Gabriele Tuderti
O Get Access
O Abstract
O Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation With a prevalence of 1 among the general male population and 10ndash15 among infertile men it can be classified in two large groups obstructive and non-obstructive azoospermia (OA and NOA) The first is caused by an obstruction in the seminal tract (epididymis vas ejaculatory ducts) and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic hormonal and acquired conditions Diagnostic workup of azoospermia includes personal and familiar history clinical evaluation hormonal and semen biochemical assessment scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration open biopsy and in selected cases vasography OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART NOA treatment is represented by sperm retrieval for ART Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA and we describe a novel stepwise approach of this technique to reduce invasivity
O Varicocele and Infertility
O Giovanni Beretta
O Abstract
O Many authors have argued over the relationship betweeninfertility and varicocele over the last 100 years In the first century ad Celsus first documented this pathology stating thatldquothe testicle of varicocele is smaller than the unaffected siderdquo Most investigators have suggested that the presence of a varicocele could result in lower fertility rates The incidence of varicocele is greater in subfertile males than in the general population A review of incidental varicoceles found in the general population approximately 60 were associated with semen abnormalities (Johnson et al South Med J 6334ndash36 1970) However the facts that not all men with varicocele are infertile and that surgical management does not improve fertilityin 100 of cases has prompted some doubt as to role of surgery laparoscopy or subinguinal microscopicvaricocelectomy in this abnormality (Al-Kandari et al Urology 69417ndash420 2007) These points are reviewed and discussed in this chapter
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
Azoospermia Giorgio Franco Leonardo Misuraca Gabriele Tuderti Look Inside Get Access
Varicocele and Infertility Giovanni Beretta Look Inside Get Access
Chromosomic Causes of Infertility Gianni Paulis Look Inside Get Access
Male Idiopathic (Oligo) plusmn (Astheno) plusmn (Terato)-Spermia Giorgio Cavallini Look Inside Get Access
Obesity and Male Infertility Carlo Maretti Look Inside Get Access
O
Giovanni Beretta
Unexplained Couple Infertility (Male Role) Giorgio Cavallini Look Inside Get Access
Inflammatory Infertility Giorgio Cavallini Gianni Paulis Look Inside Get Access
Testicular Pathology Fulvio Colombo Giorgio Gentile Alessandro Franceschelli Look Inside Get Access
Endocrine Infertility Giorgio D Piubello Look Inside Get Access
O
Giovanni Beretta
Iatrogenic Infertility Giovanni Beretta Look Inside Get Access
Dietary Complements and Phytotherapy Bruno Giammusso Look Inside Get Access
Environmental Pollution and Infertility Giorgio Cavallini Look Inside Get Access
The Role of the Andrologist in Assisted Reproduction Giorgio Cavallini Giovanni Beretta Look Inside Get
Access
Sexual Problems and Infertility Giovanni Beretta Look Inside Get Access
Giovanni Beretta
O IntroductionO Paolo Turchi MD Giovanni Beretta
Giorgio Cavallini
O Get Access
O Abstract
O The clinical management of infertility suffers from a way of thinking still widely propagated today by thoseworking in the field who often consider the understanding of the male factor of infertility too vagueand its remedies not yet supported by solid scientificevidence With respect to such uncertainty assistedreproduction techniques (ART) are recommended to couples these offer the possibility of having a child in a reasonably short time and at little cost even in the presence of a male factor [1 2] Unilateral handling of reproductive care according to this common way of thinking might provide the couple with the best chances of procreation In fact there are four strong reasons to favor bilateral management of the infertile couple including an assessment of the male
Interpretation of Sperm AnalysisGiovanni Beretta
AbstractSemen analysis is used to measure the amount and quality of a manrsquos semen and sperm and can provide information about sperm production Sperm analysis should follow the Laboratory Manual for the Examination and Processing of Human Semen by the World Health Organization (World Health Organisation (2010) WHO laboratory manual for the examination and processing of human semen 5th edn WHO Geneva) A decrease in the number of spermatozoa to fewer than 15 millionmL is called oligospermia a decrease in motility is termed asthenozoospermia and a percentage of abnormal forms exceeding 96 is known as teratozoospermia These abnormalities if found together are described as the oligoasthenoteratozoospermia (OAT) syndrome Seminal volume and pH can indicate several pathologic conditions such as agenesis of seminal vesicles and vasa deferentiaSemen analysis is not a predictor of pregnancy but a routine semen analysis is still the first step in male fertility investigation Over the years a large number of sperm function tests have been used to determine whether the spermatozoa have the biological capacity to reach and fertilize ovocytes resulting in live births A variety of tests are available to evaluate different aspects of these functions This chapter describes sperm function tests that are relatively simple to carry out and are of clinical help in infertile men (Ombelet et al Hum Reprod 12987ndash993 1997)
O Diagnosis of Infertility
O Edoardo S Pescatori MD
O Get Access
O Abstract
O Male factors of infertility accounts as sole or contributoryfactors in approximately 50 of causes of couple infertility A minimum andrologic evaluation of the male partner of the couple having difficulty conceiving is mandatory and it shouldcomprise medical history physical examination and interpretation of sperm analysis To only conduct a spermanalysis is not acceptable The benefits of a sound male workup are to identify treatable causes of infertility and the possibility to detect underlying pathologic factors posing a riskto male health in general in addition to male fertility itself The extent of male diagnostic investigations must always be appraised in light of the possible presence of female factorinfertility
Prevalence Definition and Classification of Infertility
Paolo Turchi
Abstract
Infertility defined by the World Health Organization as ldquoa disease of the
reproductive system defined by the failure to achieve a clinical pregnancy after
12 months or more of regular unprotected sexual intercourserdquo is considered by
experts in the field to be a problem that affects 15ndash20 of couples Another
fact on which there is substantial convergence of views is that a male cause is
present in about 50 of cases These data however are questionable and not
measurable in a direct way although several indirect methods have been used
In fact in most cases of couple infertility the presence of a male factor is
established on the basis of the seminal data that is on laboratory data
characterized by a high coefficient of variability In addition time to pregnancy a
parameter that can identify cases of a couplersquos subfecundity has been shown
to correlate with sperm quality and quantity sexual activity and a number of
other conditions The current trend to refer the infertile couple to in vitro
fertilization programs without a comprehensive male evaluation reduces the
possibility of understanding the real impact of male infertility namely his
biological incapacity to reproduce on the function of a couple-based concept
such as fertility
OGeneral Therapeutic Approach to Male Infertility
O Giorgio Cavallini
O Abstract
O Severe oligoasthenospermia seems to be a more crucial aspect than moderate dyspermiain the restoration of couple fertility Femaleage is a further critical aspect in the correctionof male factor infertility Many lifestyle factorssuch as vigorous exercise psychologicalstress cigarette smoking illicit drug use and alcohol negatively influence fertility whereasothers such as Mediterranean diet and moderate exercise may be beneficial
O Azoospermia
O Giorgio Franco Leonardo Misuraca Gabriele Tuderti
O Get Access
O Abstract
O Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation With a prevalence of 1 among the general male population and 10ndash15 among infertile men it can be classified in two large groups obstructive and non-obstructive azoospermia (OA and NOA) The first is caused by an obstruction in the seminal tract (epididymis vas ejaculatory ducts) and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic hormonal and acquired conditions Diagnostic workup of azoospermia includes personal and familiar history clinical evaluation hormonal and semen biochemical assessment scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration open biopsy and in selected cases vasography OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART NOA treatment is represented by sperm retrieval for ART Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA and we describe a novel stepwise approach of this technique to reduce invasivity
O Varicocele and Infertility
O Giovanni Beretta
O Abstract
O Many authors have argued over the relationship betweeninfertility and varicocele over the last 100 years In the first century ad Celsus first documented this pathology stating thatldquothe testicle of varicocele is smaller than the unaffected siderdquo Most investigators have suggested that the presence of a varicocele could result in lower fertility rates The incidence of varicocele is greater in subfertile males than in the general population A review of incidental varicoceles found in the general population approximately 60 were associated with semen abnormalities (Johnson et al South Med J 6334ndash36 1970) However the facts that not all men with varicocele are infertile and that surgical management does not improve fertilityin 100 of cases has prompted some doubt as to role of surgery laparoscopy or subinguinal microscopicvaricocelectomy in this abnormality (Al-Kandari et al Urology 69417ndash420 2007) These points are reviewed and discussed in this chapter
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
Unexplained Couple Infertility (Male Role) Giorgio Cavallini Look Inside Get Access
Inflammatory Infertility Giorgio Cavallini Gianni Paulis Look Inside Get Access
Testicular Pathology Fulvio Colombo Giorgio Gentile Alessandro Franceschelli Look Inside Get Access
Endocrine Infertility Giorgio D Piubello Look Inside Get Access
O
Giovanni Beretta
Iatrogenic Infertility Giovanni Beretta Look Inside Get Access
Dietary Complements and Phytotherapy Bruno Giammusso Look Inside Get Access
Environmental Pollution and Infertility Giorgio Cavallini Look Inside Get Access
The Role of the Andrologist in Assisted Reproduction Giorgio Cavallini Giovanni Beretta Look Inside Get
Access
Sexual Problems and Infertility Giovanni Beretta Look Inside Get Access
Giovanni Beretta
O IntroductionO Paolo Turchi MD Giovanni Beretta
Giorgio Cavallini
O Get Access
O Abstract
O The clinical management of infertility suffers from a way of thinking still widely propagated today by thoseworking in the field who often consider the understanding of the male factor of infertility too vagueand its remedies not yet supported by solid scientificevidence With respect to such uncertainty assistedreproduction techniques (ART) are recommended to couples these offer the possibility of having a child in a reasonably short time and at little cost even in the presence of a male factor [1 2] Unilateral handling of reproductive care according to this common way of thinking might provide the couple with the best chances of procreation In fact there are four strong reasons to favor bilateral management of the infertile couple including an assessment of the male
Interpretation of Sperm AnalysisGiovanni Beretta
AbstractSemen analysis is used to measure the amount and quality of a manrsquos semen and sperm and can provide information about sperm production Sperm analysis should follow the Laboratory Manual for the Examination and Processing of Human Semen by the World Health Organization (World Health Organisation (2010) WHO laboratory manual for the examination and processing of human semen 5th edn WHO Geneva) A decrease in the number of spermatozoa to fewer than 15 millionmL is called oligospermia a decrease in motility is termed asthenozoospermia and a percentage of abnormal forms exceeding 96 is known as teratozoospermia These abnormalities if found together are described as the oligoasthenoteratozoospermia (OAT) syndrome Seminal volume and pH can indicate several pathologic conditions such as agenesis of seminal vesicles and vasa deferentiaSemen analysis is not a predictor of pregnancy but a routine semen analysis is still the first step in male fertility investigation Over the years a large number of sperm function tests have been used to determine whether the spermatozoa have the biological capacity to reach and fertilize ovocytes resulting in live births A variety of tests are available to evaluate different aspects of these functions This chapter describes sperm function tests that are relatively simple to carry out and are of clinical help in infertile men (Ombelet et al Hum Reprod 12987ndash993 1997)
O Diagnosis of Infertility
O Edoardo S Pescatori MD
O Get Access
O Abstract
O Male factors of infertility accounts as sole or contributoryfactors in approximately 50 of causes of couple infertility A minimum andrologic evaluation of the male partner of the couple having difficulty conceiving is mandatory and it shouldcomprise medical history physical examination and interpretation of sperm analysis To only conduct a spermanalysis is not acceptable The benefits of a sound male workup are to identify treatable causes of infertility and the possibility to detect underlying pathologic factors posing a riskto male health in general in addition to male fertility itself The extent of male diagnostic investigations must always be appraised in light of the possible presence of female factorinfertility
Prevalence Definition and Classification of Infertility
Paolo Turchi
Abstract
Infertility defined by the World Health Organization as ldquoa disease of the
reproductive system defined by the failure to achieve a clinical pregnancy after
12 months or more of regular unprotected sexual intercourserdquo is considered by
experts in the field to be a problem that affects 15ndash20 of couples Another
fact on which there is substantial convergence of views is that a male cause is
present in about 50 of cases These data however are questionable and not
measurable in a direct way although several indirect methods have been used
In fact in most cases of couple infertility the presence of a male factor is
established on the basis of the seminal data that is on laboratory data
characterized by a high coefficient of variability In addition time to pregnancy a
parameter that can identify cases of a couplersquos subfecundity has been shown
to correlate with sperm quality and quantity sexual activity and a number of
other conditions The current trend to refer the infertile couple to in vitro
fertilization programs without a comprehensive male evaluation reduces the
possibility of understanding the real impact of male infertility namely his
biological incapacity to reproduce on the function of a couple-based concept
such as fertility
OGeneral Therapeutic Approach to Male Infertility
O Giorgio Cavallini
O Abstract
O Severe oligoasthenospermia seems to be a more crucial aspect than moderate dyspermiain the restoration of couple fertility Femaleage is a further critical aspect in the correctionof male factor infertility Many lifestyle factorssuch as vigorous exercise psychologicalstress cigarette smoking illicit drug use and alcohol negatively influence fertility whereasothers such as Mediterranean diet and moderate exercise may be beneficial
O Azoospermia
O Giorgio Franco Leonardo Misuraca Gabriele Tuderti
O Get Access
O Abstract
O Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation With a prevalence of 1 among the general male population and 10ndash15 among infertile men it can be classified in two large groups obstructive and non-obstructive azoospermia (OA and NOA) The first is caused by an obstruction in the seminal tract (epididymis vas ejaculatory ducts) and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic hormonal and acquired conditions Diagnostic workup of azoospermia includes personal and familiar history clinical evaluation hormonal and semen biochemical assessment scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration open biopsy and in selected cases vasography OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART NOA treatment is represented by sperm retrieval for ART Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA and we describe a novel stepwise approach of this technique to reduce invasivity
O Varicocele and Infertility
O Giovanni Beretta
O Abstract
O Many authors have argued over the relationship betweeninfertility and varicocele over the last 100 years In the first century ad Celsus first documented this pathology stating thatldquothe testicle of varicocele is smaller than the unaffected siderdquo Most investigators have suggested that the presence of a varicocele could result in lower fertility rates The incidence of varicocele is greater in subfertile males than in the general population A review of incidental varicoceles found in the general population approximately 60 were associated with semen abnormalities (Johnson et al South Med J 6334ndash36 1970) However the facts that not all men with varicocele are infertile and that surgical management does not improve fertilityin 100 of cases has prompted some doubt as to role of surgery laparoscopy or subinguinal microscopicvaricocelectomy in this abnormality (Al-Kandari et al Urology 69417ndash420 2007) These points are reviewed and discussed in this chapter
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
Iatrogenic Infertility Giovanni Beretta Look Inside Get Access
Dietary Complements and Phytotherapy Bruno Giammusso Look Inside Get Access
Environmental Pollution and Infertility Giorgio Cavallini Look Inside Get Access
The Role of the Andrologist in Assisted Reproduction Giorgio Cavallini Giovanni Beretta Look Inside Get
Access
Sexual Problems and Infertility Giovanni Beretta Look Inside Get Access
Giovanni Beretta
O IntroductionO Paolo Turchi MD Giovanni Beretta
Giorgio Cavallini
O Get Access
O Abstract
O The clinical management of infertility suffers from a way of thinking still widely propagated today by thoseworking in the field who often consider the understanding of the male factor of infertility too vagueand its remedies not yet supported by solid scientificevidence With respect to such uncertainty assistedreproduction techniques (ART) are recommended to couples these offer the possibility of having a child in a reasonably short time and at little cost even in the presence of a male factor [1 2] Unilateral handling of reproductive care according to this common way of thinking might provide the couple with the best chances of procreation In fact there are four strong reasons to favor bilateral management of the infertile couple including an assessment of the male
Interpretation of Sperm AnalysisGiovanni Beretta
AbstractSemen analysis is used to measure the amount and quality of a manrsquos semen and sperm and can provide information about sperm production Sperm analysis should follow the Laboratory Manual for the Examination and Processing of Human Semen by the World Health Organization (World Health Organisation (2010) WHO laboratory manual for the examination and processing of human semen 5th edn WHO Geneva) A decrease in the number of spermatozoa to fewer than 15 millionmL is called oligospermia a decrease in motility is termed asthenozoospermia and a percentage of abnormal forms exceeding 96 is known as teratozoospermia These abnormalities if found together are described as the oligoasthenoteratozoospermia (OAT) syndrome Seminal volume and pH can indicate several pathologic conditions such as agenesis of seminal vesicles and vasa deferentiaSemen analysis is not a predictor of pregnancy but a routine semen analysis is still the first step in male fertility investigation Over the years a large number of sperm function tests have been used to determine whether the spermatozoa have the biological capacity to reach and fertilize ovocytes resulting in live births A variety of tests are available to evaluate different aspects of these functions This chapter describes sperm function tests that are relatively simple to carry out and are of clinical help in infertile men (Ombelet et al Hum Reprod 12987ndash993 1997)
O Diagnosis of Infertility
O Edoardo S Pescatori MD
O Get Access
O Abstract
O Male factors of infertility accounts as sole or contributoryfactors in approximately 50 of causes of couple infertility A minimum andrologic evaluation of the male partner of the couple having difficulty conceiving is mandatory and it shouldcomprise medical history physical examination and interpretation of sperm analysis To only conduct a spermanalysis is not acceptable The benefits of a sound male workup are to identify treatable causes of infertility and the possibility to detect underlying pathologic factors posing a riskto male health in general in addition to male fertility itself The extent of male diagnostic investigations must always be appraised in light of the possible presence of female factorinfertility
Prevalence Definition and Classification of Infertility
Paolo Turchi
Abstract
Infertility defined by the World Health Organization as ldquoa disease of the
reproductive system defined by the failure to achieve a clinical pregnancy after
12 months or more of regular unprotected sexual intercourserdquo is considered by
experts in the field to be a problem that affects 15ndash20 of couples Another
fact on which there is substantial convergence of views is that a male cause is
present in about 50 of cases These data however are questionable and not
measurable in a direct way although several indirect methods have been used
In fact in most cases of couple infertility the presence of a male factor is
established on the basis of the seminal data that is on laboratory data
characterized by a high coefficient of variability In addition time to pregnancy a
parameter that can identify cases of a couplersquos subfecundity has been shown
to correlate with sperm quality and quantity sexual activity and a number of
other conditions The current trend to refer the infertile couple to in vitro
fertilization programs without a comprehensive male evaluation reduces the
possibility of understanding the real impact of male infertility namely his
biological incapacity to reproduce on the function of a couple-based concept
such as fertility
OGeneral Therapeutic Approach to Male Infertility
O Giorgio Cavallini
O Abstract
O Severe oligoasthenospermia seems to be a more crucial aspect than moderate dyspermiain the restoration of couple fertility Femaleage is a further critical aspect in the correctionof male factor infertility Many lifestyle factorssuch as vigorous exercise psychologicalstress cigarette smoking illicit drug use and alcohol negatively influence fertility whereasothers such as Mediterranean diet and moderate exercise may be beneficial
O Azoospermia
O Giorgio Franco Leonardo Misuraca Gabriele Tuderti
O Get Access
O Abstract
O Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation With a prevalence of 1 among the general male population and 10ndash15 among infertile men it can be classified in two large groups obstructive and non-obstructive azoospermia (OA and NOA) The first is caused by an obstruction in the seminal tract (epididymis vas ejaculatory ducts) and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic hormonal and acquired conditions Diagnostic workup of azoospermia includes personal and familiar history clinical evaluation hormonal and semen biochemical assessment scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration open biopsy and in selected cases vasography OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART NOA treatment is represented by sperm retrieval for ART Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA and we describe a novel stepwise approach of this technique to reduce invasivity
O Varicocele and Infertility
O Giovanni Beretta
O Abstract
O Many authors have argued over the relationship betweeninfertility and varicocele over the last 100 years In the first century ad Celsus first documented this pathology stating thatldquothe testicle of varicocele is smaller than the unaffected siderdquo Most investigators have suggested that the presence of a varicocele could result in lower fertility rates The incidence of varicocele is greater in subfertile males than in the general population A review of incidental varicoceles found in the general population approximately 60 were associated with semen abnormalities (Johnson et al South Med J 6334ndash36 1970) However the facts that not all men with varicocele are infertile and that surgical management does not improve fertilityin 100 of cases has prompted some doubt as to role of surgery laparoscopy or subinguinal microscopicvaricocelectomy in this abnormality (Al-Kandari et al Urology 69417ndash420 2007) These points are reviewed and discussed in this chapter
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O IntroductionO Paolo Turchi MD Giovanni Beretta
Giorgio Cavallini
O Get Access
O Abstract
O The clinical management of infertility suffers from a way of thinking still widely propagated today by thoseworking in the field who often consider the understanding of the male factor of infertility too vagueand its remedies not yet supported by solid scientificevidence With respect to such uncertainty assistedreproduction techniques (ART) are recommended to couples these offer the possibility of having a child in a reasonably short time and at little cost even in the presence of a male factor [1 2] Unilateral handling of reproductive care according to this common way of thinking might provide the couple with the best chances of procreation In fact there are four strong reasons to favor bilateral management of the infertile couple including an assessment of the male
Interpretation of Sperm AnalysisGiovanni Beretta
AbstractSemen analysis is used to measure the amount and quality of a manrsquos semen and sperm and can provide information about sperm production Sperm analysis should follow the Laboratory Manual for the Examination and Processing of Human Semen by the World Health Organization (World Health Organisation (2010) WHO laboratory manual for the examination and processing of human semen 5th edn WHO Geneva) A decrease in the number of spermatozoa to fewer than 15 millionmL is called oligospermia a decrease in motility is termed asthenozoospermia and a percentage of abnormal forms exceeding 96 is known as teratozoospermia These abnormalities if found together are described as the oligoasthenoteratozoospermia (OAT) syndrome Seminal volume and pH can indicate several pathologic conditions such as agenesis of seminal vesicles and vasa deferentiaSemen analysis is not a predictor of pregnancy but a routine semen analysis is still the first step in male fertility investigation Over the years a large number of sperm function tests have been used to determine whether the spermatozoa have the biological capacity to reach and fertilize ovocytes resulting in live births A variety of tests are available to evaluate different aspects of these functions This chapter describes sperm function tests that are relatively simple to carry out and are of clinical help in infertile men (Ombelet et al Hum Reprod 12987ndash993 1997)
O Diagnosis of Infertility
O Edoardo S Pescatori MD
O Get Access
O Abstract
O Male factors of infertility accounts as sole or contributoryfactors in approximately 50 of causes of couple infertility A minimum andrologic evaluation of the male partner of the couple having difficulty conceiving is mandatory and it shouldcomprise medical history physical examination and interpretation of sperm analysis To only conduct a spermanalysis is not acceptable The benefits of a sound male workup are to identify treatable causes of infertility and the possibility to detect underlying pathologic factors posing a riskto male health in general in addition to male fertility itself The extent of male diagnostic investigations must always be appraised in light of the possible presence of female factorinfertility
Prevalence Definition and Classification of Infertility
Paolo Turchi
Abstract
Infertility defined by the World Health Organization as ldquoa disease of the
reproductive system defined by the failure to achieve a clinical pregnancy after
12 months or more of regular unprotected sexual intercourserdquo is considered by
experts in the field to be a problem that affects 15ndash20 of couples Another
fact on which there is substantial convergence of views is that a male cause is
present in about 50 of cases These data however are questionable and not
measurable in a direct way although several indirect methods have been used
In fact in most cases of couple infertility the presence of a male factor is
established on the basis of the seminal data that is on laboratory data
characterized by a high coefficient of variability In addition time to pregnancy a
parameter that can identify cases of a couplersquos subfecundity has been shown
to correlate with sperm quality and quantity sexual activity and a number of
other conditions The current trend to refer the infertile couple to in vitro
fertilization programs without a comprehensive male evaluation reduces the
possibility of understanding the real impact of male infertility namely his
biological incapacity to reproduce on the function of a couple-based concept
such as fertility
OGeneral Therapeutic Approach to Male Infertility
O Giorgio Cavallini
O Abstract
O Severe oligoasthenospermia seems to be a more crucial aspect than moderate dyspermiain the restoration of couple fertility Femaleage is a further critical aspect in the correctionof male factor infertility Many lifestyle factorssuch as vigorous exercise psychologicalstress cigarette smoking illicit drug use and alcohol negatively influence fertility whereasothers such as Mediterranean diet and moderate exercise may be beneficial
O Azoospermia
O Giorgio Franco Leonardo Misuraca Gabriele Tuderti
O Get Access
O Abstract
O Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation With a prevalence of 1 among the general male population and 10ndash15 among infertile men it can be classified in two large groups obstructive and non-obstructive azoospermia (OA and NOA) The first is caused by an obstruction in the seminal tract (epididymis vas ejaculatory ducts) and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic hormonal and acquired conditions Diagnostic workup of azoospermia includes personal and familiar history clinical evaluation hormonal and semen biochemical assessment scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration open biopsy and in selected cases vasography OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART NOA treatment is represented by sperm retrieval for ART Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA and we describe a novel stepwise approach of this technique to reduce invasivity
O Varicocele and Infertility
O Giovanni Beretta
O Abstract
O Many authors have argued over the relationship betweeninfertility and varicocele over the last 100 years In the first century ad Celsus first documented this pathology stating thatldquothe testicle of varicocele is smaller than the unaffected siderdquo Most investigators have suggested that the presence of a varicocele could result in lower fertility rates The incidence of varicocele is greater in subfertile males than in the general population A review of incidental varicoceles found in the general population approximately 60 were associated with semen abnormalities (Johnson et al South Med J 6334ndash36 1970) However the facts that not all men with varicocele are infertile and that surgical management does not improve fertilityin 100 of cases has prompted some doubt as to role of surgery laparoscopy or subinguinal microscopicvaricocelectomy in this abnormality (Al-Kandari et al Urology 69417ndash420 2007) These points are reviewed and discussed in this chapter
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
Interpretation of Sperm AnalysisGiovanni Beretta
AbstractSemen analysis is used to measure the amount and quality of a manrsquos semen and sperm and can provide information about sperm production Sperm analysis should follow the Laboratory Manual for the Examination and Processing of Human Semen by the World Health Organization (World Health Organisation (2010) WHO laboratory manual for the examination and processing of human semen 5th edn WHO Geneva) A decrease in the number of spermatozoa to fewer than 15 millionmL is called oligospermia a decrease in motility is termed asthenozoospermia and a percentage of abnormal forms exceeding 96 is known as teratozoospermia These abnormalities if found together are described as the oligoasthenoteratozoospermia (OAT) syndrome Seminal volume and pH can indicate several pathologic conditions such as agenesis of seminal vesicles and vasa deferentiaSemen analysis is not a predictor of pregnancy but a routine semen analysis is still the first step in male fertility investigation Over the years a large number of sperm function tests have been used to determine whether the spermatozoa have the biological capacity to reach and fertilize ovocytes resulting in live births A variety of tests are available to evaluate different aspects of these functions This chapter describes sperm function tests that are relatively simple to carry out and are of clinical help in infertile men (Ombelet et al Hum Reprod 12987ndash993 1997)
O Diagnosis of Infertility
O Edoardo S Pescatori MD
O Get Access
O Abstract
O Male factors of infertility accounts as sole or contributoryfactors in approximately 50 of causes of couple infertility A minimum andrologic evaluation of the male partner of the couple having difficulty conceiving is mandatory and it shouldcomprise medical history physical examination and interpretation of sperm analysis To only conduct a spermanalysis is not acceptable The benefits of a sound male workup are to identify treatable causes of infertility and the possibility to detect underlying pathologic factors posing a riskto male health in general in addition to male fertility itself The extent of male diagnostic investigations must always be appraised in light of the possible presence of female factorinfertility
Prevalence Definition and Classification of Infertility
Paolo Turchi
Abstract
Infertility defined by the World Health Organization as ldquoa disease of the
reproductive system defined by the failure to achieve a clinical pregnancy after
12 months or more of regular unprotected sexual intercourserdquo is considered by
experts in the field to be a problem that affects 15ndash20 of couples Another
fact on which there is substantial convergence of views is that a male cause is
present in about 50 of cases These data however are questionable and not
measurable in a direct way although several indirect methods have been used
In fact in most cases of couple infertility the presence of a male factor is
established on the basis of the seminal data that is on laboratory data
characterized by a high coefficient of variability In addition time to pregnancy a
parameter that can identify cases of a couplersquos subfecundity has been shown
to correlate with sperm quality and quantity sexual activity and a number of
other conditions The current trend to refer the infertile couple to in vitro
fertilization programs without a comprehensive male evaluation reduces the
possibility of understanding the real impact of male infertility namely his
biological incapacity to reproduce on the function of a couple-based concept
such as fertility
OGeneral Therapeutic Approach to Male Infertility
O Giorgio Cavallini
O Abstract
O Severe oligoasthenospermia seems to be a more crucial aspect than moderate dyspermiain the restoration of couple fertility Femaleage is a further critical aspect in the correctionof male factor infertility Many lifestyle factorssuch as vigorous exercise psychologicalstress cigarette smoking illicit drug use and alcohol negatively influence fertility whereasothers such as Mediterranean diet and moderate exercise may be beneficial
O Azoospermia
O Giorgio Franco Leonardo Misuraca Gabriele Tuderti
O Get Access
O Abstract
O Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation With a prevalence of 1 among the general male population and 10ndash15 among infertile men it can be classified in two large groups obstructive and non-obstructive azoospermia (OA and NOA) The first is caused by an obstruction in the seminal tract (epididymis vas ejaculatory ducts) and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic hormonal and acquired conditions Diagnostic workup of azoospermia includes personal and familiar history clinical evaluation hormonal and semen biochemical assessment scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration open biopsy and in selected cases vasography OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART NOA treatment is represented by sperm retrieval for ART Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA and we describe a novel stepwise approach of this technique to reduce invasivity
O Varicocele and Infertility
O Giovanni Beretta
O Abstract
O Many authors have argued over the relationship betweeninfertility and varicocele over the last 100 years In the first century ad Celsus first documented this pathology stating thatldquothe testicle of varicocele is smaller than the unaffected siderdquo Most investigators have suggested that the presence of a varicocele could result in lower fertility rates The incidence of varicocele is greater in subfertile males than in the general population A review of incidental varicoceles found in the general population approximately 60 were associated with semen abnormalities (Johnson et al South Med J 6334ndash36 1970) However the facts that not all men with varicocele are infertile and that surgical management does not improve fertilityin 100 of cases has prompted some doubt as to role of surgery laparoscopy or subinguinal microscopicvaricocelectomy in this abnormality (Al-Kandari et al Urology 69417ndash420 2007) These points are reviewed and discussed in this chapter
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O Diagnosis of Infertility
O Edoardo S Pescatori MD
O Get Access
O Abstract
O Male factors of infertility accounts as sole or contributoryfactors in approximately 50 of causes of couple infertility A minimum andrologic evaluation of the male partner of the couple having difficulty conceiving is mandatory and it shouldcomprise medical history physical examination and interpretation of sperm analysis To only conduct a spermanalysis is not acceptable The benefits of a sound male workup are to identify treatable causes of infertility and the possibility to detect underlying pathologic factors posing a riskto male health in general in addition to male fertility itself The extent of male diagnostic investigations must always be appraised in light of the possible presence of female factorinfertility
Prevalence Definition and Classification of Infertility
Paolo Turchi
Abstract
Infertility defined by the World Health Organization as ldquoa disease of the
reproductive system defined by the failure to achieve a clinical pregnancy after
12 months or more of regular unprotected sexual intercourserdquo is considered by
experts in the field to be a problem that affects 15ndash20 of couples Another
fact on which there is substantial convergence of views is that a male cause is
present in about 50 of cases These data however are questionable and not
measurable in a direct way although several indirect methods have been used
In fact in most cases of couple infertility the presence of a male factor is
established on the basis of the seminal data that is on laboratory data
characterized by a high coefficient of variability In addition time to pregnancy a
parameter that can identify cases of a couplersquos subfecundity has been shown
to correlate with sperm quality and quantity sexual activity and a number of
other conditions The current trend to refer the infertile couple to in vitro
fertilization programs without a comprehensive male evaluation reduces the
possibility of understanding the real impact of male infertility namely his
biological incapacity to reproduce on the function of a couple-based concept
such as fertility
OGeneral Therapeutic Approach to Male Infertility
O Giorgio Cavallini
O Abstract
O Severe oligoasthenospermia seems to be a more crucial aspect than moderate dyspermiain the restoration of couple fertility Femaleage is a further critical aspect in the correctionof male factor infertility Many lifestyle factorssuch as vigorous exercise psychologicalstress cigarette smoking illicit drug use and alcohol negatively influence fertility whereasothers such as Mediterranean diet and moderate exercise may be beneficial
O Azoospermia
O Giorgio Franco Leonardo Misuraca Gabriele Tuderti
O Get Access
O Abstract
O Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation With a prevalence of 1 among the general male population and 10ndash15 among infertile men it can be classified in two large groups obstructive and non-obstructive azoospermia (OA and NOA) The first is caused by an obstruction in the seminal tract (epididymis vas ejaculatory ducts) and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic hormonal and acquired conditions Diagnostic workup of azoospermia includes personal and familiar history clinical evaluation hormonal and semen biochemical assessment scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration open biopsy and in selected cases vasography OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART NOA treatment is represented by sperm retrieval for ART Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA and we describe a novel stepwise approach of this technique to reduce invasivity
O Varicocele and Infertility
O Giovanni Beretta
O Abstract
O Many authors have argued over the relationship betweeninfertility and varicocele over the last 100 years In the first century ad Celsus first documented this pathology stating thatldquothe testicle of varicocele is smaller than the unaffected siderdquo Most investigators have suggested that the presence of a varicocele could result in lower fertility rates The incidence of varicocele is greater in subfertile males than in the general population A review of incidental varicoceles found in the general population approximately 60 were associated with semen abnormalities (Johnson et al South Med J 6334ndash36 1970) However the facts that not all men with varicocele are infertile and that surgical management does not improve fertilityin 100 of cases has prompted some doubt as to role of surgery laparoscopy or subinguinal microscopicvaricocelectomy in this abnormality (Al-Kandari et al Urology 69417ndash420 2007) These points are reviewed and discussed in this chapter
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
Prevalence Definition and Classification of Infertility
Paolo Turchi
Abstract
Infertility defined by the World Health Organization as ldquoa disease of the
reproductive system defined by the failure to achieve a clinical pregnancy after
12 months or more of regular unprotected sexual intercourserdquo is considered by
experts in the field to be a problem that affects 15ndash20 of couples Another
fact on which there is substantial convergence of views is that a male cause is
present in about 50 of cases These data however are questionable and not
measurable in a direct way although several indirect methods have been used
In fact in most cases of couple infertility the presence of a male factor is
established on the basis of the seminal data that is on laboratory data
characterized by a high coefficient of variability In addition time to pregnancy a
parameter that can identify cases of a couplersquos subfecundity has been shown
to correlate with sperm quality and quantity sexual activity and a number of
other conditions The current trend to refer the infertile couple to in vitro
fertilization programs without a comprehensive male evaluation reduces the
possibility of understanding the real impact of male infertility namely his
biological incapacity to reproduce on the function of a couple-based concept
such as fertility
OGeneral Therapeutic Approach to Male Infertility
O Giorgio Cavallini
O Abstract
O Severe oligoasthenospermia seems to be a more crucial aspect than moderate dyspermiain the restoration of couple fertility Femaleage is a further critical aspect in the correctionof male factor infertility Many lifestyle factorssuch as vigorous exercise psychologicalstress cigarette smoking illicit drug use and alcohol negatively influence fertility whereasothers such as Mediterranean diet and moderate exercise may be beneficial
O Azoospermia
O Giorgio Franco Leonardo Misuraca Gabriele Tuderti
O Get Access
O Abstract
O Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation With a prevalence of 1 among the general male population and 10ndash15 among infertile men it can be classified in two large groups obstructive and non-obstructive azoospermia (OA and NOA) The first is caused by an obstruction in the seminal tract (epididymis vas ejaculatory ducts) and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic hormonal and acquired conditions Diagnostic workup of azoospermia includes personal and familiar history clinical evaluation hormonal and semen biochemical assessment scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration open biopsy and in selected cases vasography OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART NOA treatment is represented by sperm retrieval for ART Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA and we describe a novel stepwise approach of this technique to reduce invasivity
O Varicocele and Infertility
O Giovanni Beretta
O Abstract
O Many authors have argued over the relationship betweeninfertility and varicocele over the last 100 years In the first century ad Celsus first documented this pathology stating thatldquothe testicle of varicocele is smaller than the unaffected siderdquo Most investigators have suggested that the presence of a varicocele could result in lower fertility rates The incidence of varicocele is greater in subfertile males than in the general population A review of incidental varicoceles found in the general population approximately 60 were associated with semen abnormalities (Johnson et al South Med J 6334ndash36 1970) However the facts that not all men with varicocele are infertile and that surgical management does not improve fertilityin 100 of cases has prompted some doubt as to role of surgery laparoscopy or subinguinal microscopicvaricocelectomy in this abnormality (Al-Kandari et al Urology 69417ndash420 2007) These points are reviewed and discussed in this chapter
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
OGeneral Therapeutic Approach to Male Infertility
O Giorgio Cavallini
O Abstract
O Severe oligoasthenospermia seems to be a more crucial aspect than moderate dyspermiain the restoration of couple fertility Femaleage is a further critical aspect in the correctionof male factor infertility Many lifestyle factorssuch as vigorous exercise psychologicalstress cigarette smoking illicit drug use and alcohol negatively influence fertility whereasothers such as Mediterranean diet and moderate exercise may be beneficial
O Azoospermia
O Giorgio Franco Leonardo Misuraca Gabriele Tuderti
O Get Access
O Abstract
O Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation With a prevalence of 1 among the general male population and 10ndash15 among infertile men it can be classified in two large groups obstructive and non-obstructive azoospermia (OA and NOA) The first is caused by an obstruction in the seminal tract (epididymis vas ejaculatory ducts) and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic hormonal and acquired conditions Diagnostic workup of azoospermia includes personal and familiar history clinical evaluation hormonal and semen biochemical assessment scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration open biopsy and in selected cases vasography OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART NOA treatment is represented by sperm retrieval for ART Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA and we describe a novel stepwise approach of this technique to reduce invasivity
O Varicocele and Infertility
O Giovanni Beretta
O Abstract
O Many authors have argued over the relationship betweeninfertility and varicocele over the last 100 years In the first century ad Celsus first documented this pathology stating thatldquothe testicle of varicocele is smaller than the unaffected siderdquo Most investigators have suggested that the presence of a varicocele could result in lower fertility rates The incidence of varicocele is greater in subfertile males than in the general population A review of incidental varicoceles found in the general population approximately 60 were associated with semen abnormalities (Johnson et al South Med J 6334ndash36 1970) However the facts that not all men with varicocele are infertile and that surgical management does not improve fertilityin 100 of cases has prompted some doubt as to role of surgery laparoscopy or subinguinal microscopicvaricocelectomy in this abnormality (Al-Kandari et al Urology 69417ndash420 2007) These points are reviewed and discussed in this chapter
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O Azoospermia
O Giorgio Franco Leonardo Misuraca Gabriele Tuderti
O Get Access
O Abstract
O Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation With a prevalence of 1 among the general male population and 10ndash15 among infertile men it can be classified in two large groups obstructive and non-obstructive azoospermia (OA and NOA) The first is caused by an obstruction in the seminal tract (epididymis vas ejaculatory ducts) and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic hormonal and acquired conditions Diagnostic workup of azoospermia includes personal and familiar history clinical evaluation hormonal and semen biochemical assessment scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration open biopsy and in selected cases vasography OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART NOA treatment is represented by sperm retrieval for ART Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA and we describe a novel stepwise approach of this technique to reduce invasivity
O Varicocele and Infertility
O Giovanni Beretta
O Abstract
O Many authors have argued over the relationship betweeninfertility and varicocele over the last 100 years In the first century ad Celsus first documented this pathology stating thatldquothe testicle of varicocele is smaller than the unaffected siderdquo Most investigators have suggested that the presence of a varicocele could result in lower fertility rates The incidence of varicocele is greater in subfertile males than in the general population A review of incidental varicoceles found in the general population approximately 60 were associated with semen abnormalities (Johnson et al South Med J 6334ndash36 1970) However the facts that not all men with varicocele are infertile and that surgical management does not improve fertilityin 100 of cases has prompted some doubt as to role of surgery laparoscopy or subinguinal microscopicvaricocelectomy in this abnormality (Al-Kandari et al Urology 69417ndash420 2007) These points are reviewed and discussed in this chapter
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O Varicocele and Infertility
O Giovanni Beretta
O Abstract
O Many authors have argued over the relationship betweeninfertility and varicocele over the last 100 years In the first century ad Celsus first documented this pathology stating thatldquothe testicle of varicocele is smaller than the unaffected siderdquo Most investigators have suggested that the presence of a varicocele could result in lower fertility rates The incidence of varicocele is greater in subfertile males than in the general population A review of incidental varicoceles found in the general population approximately 60 were associated with semen abnormalities (Johnson et al South Med J 6334ndash36 1970) However the facts that not all men with varicocele are infertile and that surgical management does not improve fertilityin 100 of cases has prompted some doubt as to role of surgery laparoscopy or subinguinal microscopicvaricocelectomy in this abnormality (Al-Kandari et al Urology 69417ndash420 2007) These points are reviewed and discussed in this chapter
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O Chromosomic Causes of Infertility
O Gianni Paulis
O Get Access
O Abstract
O The genetics of infertility is very complex and is dependent on various factors A large number of infertility phenotypes havebeen associated with specific genetic abnormalities Chromosomal anomalies account for about 5 of infertility in males and the prevalence reaches approximately 15ndash20 of the azoospermic males and 5ndash10 of the oligozoospermic males Klinefelter syndrome and Y-chromosomal microdeletions are the most frequent genetic cause of male infertility For the purposesof this chapter the author has chosen to focus mainly on the mostcommon chromosomic causes of infertility Klinefelter syndrome structural chromosomal aberrations PraderndashWilli syndrome and Angelman syndrome Genetic counseling is strongly recommended in couples with a genetic anomaly found in clinical investigations or genetic tests and in patients with a potential hereditary disease alike a genetic screening is mandatory especially for candidates to the assisted reproductive techniques
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O Male Idiopathic (Oligo) plusmn (Astheno) plusmn(Terato)-Spermia
O Giorgio Cavallini
O Get Access
O Abstract
O Idiopathic oligoasthenoteratozoospermia (iOAT) affectsapproximately 30 of all infertile men This chapter discussesrecent data in this field Age noninflammatory functionalalterations in post-testicular organs alterations in gamete genome mitochondrial alterations environmental pollutants and ldquosubtlerdquo hormonal alterations are all considered possiblecauses of iOAT Increases in reactive oxygen species in tubulesand seminal plasma as well as apoptosis are reputed to affectsperm concentration motility and morphology iOAT iscommonly diagnosed by exclusion nevertheless spectraltraces of the main testicular artery may be used as a diagnostictool for iOAT The following can be considered reasonablyefficient therapies for iOAT (1) aromatase inhibitors whentestosterone17-β2-estradiol ratio is lt10 (2) l-carnitine (2 gday) in combination with acetyl-l-carnitine (1 gday) and one 30-mg cinnoxicam tablet every 4 days (3) recombinant follicle-stimulating hormone 75ndash100 UIday when serum follicle-stimulating hormone is lt2 mIUmL
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
OObesity and Male Infertility
O Carlo Maretti
O Get Access
O Abstract
O Overweight and obese men have a 50 higher rate of subfertility when compared to normal-weight men Thiseffect persists even when confounding factors such asdiseases age smoking alcohol use and obese femalepartner have been controlled Obesity is strongly linked to reduced spermatogenesis poor quality of sperm and a reduced percentage of normal sperm morphology A lastingweight loss allows significant improvements of all the metabolic syndrome parameters and in particular the reduction of visceral fat is associated with an improvementof the male reproductive function Dietary antioxidants maybe beneficial in reducing sperm DNA damage in infertile obese men In obese male with a reduced fertility and hypogonadotropic hypogonadism it is possible to evaluatea treatment with antiestrogens or aromatase inhibitors The pharmacological effect on spermatogenesis should be manifested through an increased concentration of FSH LH and testosterone
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O Unexplained Couple Infertility (Male Role)
O Giorgio Cavallini
O Get Access
O Abstract
O Unexplained male infertility (UMI) the inability to reproducedespite having a normal sexual history physical examination and semen analysis may be genetic Robertsonian translocations somatic gene mutations mitochondrial gene mutations spermaneuploidy and histone (epigenetic) modifications are regardedas putative causes of UMI Karyotyping fluorescence in situ hybridization gene sequencing comparative genomichybridization array whole-genome sequencing and noncodingribonucleic acid arrays are all diagnostic tools that unfortunately are not widely available at present The only therapy for UMI isassisted reproduction
O
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O Inflammatory Infertility
O Giorgio Cavallini Gianni Paulis
O Get Access
O Abstract
Approximately 10ndash15 of infertile men have genital tract inflammation most
often chronic prostatitis Prostatitis is classified according to five categories
acute prostatitis chronic bacterial prostatitis abacterial inflammatory
prostatitis abacterial noninflammatory prostatitis and asymptomatic
prostatitis Urinary or lymphatic (transrectal) ascendent infections by
Escherichia coli Klebsiella sp Proteus mirabilis Enterococcus faecalis
Pseudomonas aeruginosa Chlamydia trachomatis and Ureaplasma
urealiticum are the most common causes Urine culture and expressed
prostatic secretion (EPS) represent the most important investigations for the
diagnosis and categorization of prostatitis EPS has been fully described in
the literature Antibiotic treatment often eradicates microorganisms but cannot
reverse anatomic dysfunctions and it might improve sperm quality which
does not necessarily enhance the probability of conception
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
Testicular Pathology
Fulvio Colombo Giorgio Gentile
Alessandro Franceschelli
Abstract
Testicular pathology is a very broad topic in andrology which includes
several benign and non-benign diseases In this chapter we have
stressed the importance of some of them excluding others (such as
varicocele or inflammatory diseases) that will be discussed in another part
of the book
We have focus on
Cryptorchidism especially on the need of an early diagnosis and
treatment in order to minimize the negative effect on spermatogenesis
and hormonal function
Testicular microlithiasis emphasizing its association with different
urological diseases (such as testicular cancer cryptorchidism varicocele
Klinefelterrsquos syndrome hypogonadism and infertility) and the need for a
regular follow-up of these patients
Testicular cancer reporting recent guidelines for treatment stage by
stage both for seminoma and non-seminomatous germ cell cancer
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O Endocrine Infertility
O Giorgio D Piubello
O Get Access
O Abstract
O This chapter encompasses all
spermatogenesis-altering conditions affecting
the normal male endocrine balance Such
conditions can be caused by either testicular
abnormalities (or other endocrine gland or
pituitary-hypothalamus disorders) or the effect
of exogenous substances (endocrine
disruptors)
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O Iatrogenic Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Nowadays toxic agents and physical agents are becoming an important cause of male infertility They can act directly on the testis and interfere with the normal function of the pituitary-hypothalamic axis Preservation of fertility may not be a criticalconcern for many patients being treated for serious medicalconditions especially malignancy Nevertheless iatrogenicreduction in fertility potential can often be prevented Carefulattention to surgical detail during retroperitoneal inguinal and scrotal procedures can prevent inadvertent injury to the sympathetic nerve fibers vas deferens or epididymis Becausechemotherapy andor radiotherapy may result in permanentsterility it is imperative to offer sperm cryopreservation to allmen before starting therapy Fortunately recent advances in urological microsurgery and assisted reproductive technologyallow patients with even the most severe iatrogenic decrease in fertility to achieve paternity (Carrol et al J Urol 137420 1987 Richie J Urol 144160 1990 Lee et al J Clin Oncol 242917ndash2931 2006)
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O Dietary Complements and Phytotherapy
O Bruno Giammusso
O Get Access
O Abstract
O Men with idiopathic infertility are usually treated with empirical therapies Many over-the-counter (OTC) therapieshave been historically used for male fertility includingherbs vitamins and nutritional supplements Many studiesdemonstrate the positive effects of dietary supplementationon semen parameters and pregnancy outcomes Conversely many studies also demonstrate a lack of improvement and potential complications with supplementation Oxidative stress has been a well-studiedaetiology of abnormal semen parameters Because of this many of the current OTC therapies rely on antioxidantproperties The practice of prescribing oral antioxidant issupported by the lack of serious side effects related to thistherapy although few studies have carefully evaluated the risk of overtreatment The most commonly studied dietarysupplements include vitamin E vitamin C carnitines lycopene glutathione selenium omega-3 and omega-6 fatty acids zinc arginine and coenzyme-Q10
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O Environmental Pollution and Infertility
O Giorgio Cavallini
O Get Access
O Abstract
O A decline in sperm counts that has emerged over the years has
led to the argument that male fertility is declining and it is also
proposed that environmental pollutants may play a role in such a
decline It has been hypothesized that environmental chemicals
with estrogenic properties constitute detrimental factors for sperm
count Endocrine disruptors affect the male genital tract during
fetal testis and germinal cell development (testicular dysgenesis
syndrome) targeting pituitary gonadotropins or the genetic
regulation of steroidogenesis at either the genomic or proteomic
levels The critical window of exposure is the perinatal period
Pesticides fungicides heavy metals defoliants and other
chemical weapons in addition to oils and cleaning agents are
regarded as the main environmental pollutants capable of
disrupting human spermatogenesis
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O The Role of the Andrologist in AssistedReproduction
O Giorgio Cavallini Giovanni Beretta
O Get Access
O Abstract
O Any medical or surgical therapy for male infertilityis useless in the following cases globozoospermia aged female partner and polycystic ovary syndrome Y microdeletions high follicle-stimulating hormone (FSH) and unexplained male infertility thus ART should be immediately started When there is no identifiablecause of infertility and the results of the semenanalysis are normal the patients are categorizedas having unexplained male infertility Geneticdefects may be involved in the cause of infertility Thus ART might be the only way to conceive (seeChap 10)
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
O Sexual Problems and Infertility
O Giovanni Beretta
O Get Access
O Abstract
O Although sexual problems can occur during infertility sometimes even causing infertility sexual difficulties are notuniversally experienced by infertile males Some studies havesuggested that infertile men experience fewer disturbancesthan women because pregnancy has a lower emotional impact on males than on females It is unclear whether thisobservation is due to a general tendency for men to underreport their emotions The medical assessment and treatment for infertility may interfere with the infertile couplersquossexual pleasure due to performance demand treatment requirements or emotional response to infertility diagnosis
O When sexual dysfunction is the cause of infertility assessmentand therapy are necessary and should preclude medicaltreatment
