eMedicine Specialties > Urology > Male Infertility

Infertility, Male: Follow-up

Author: Jonathan Rubenstein, MD, Staff Physician, Department of Urology, University of California, San Francisco
Coauthor(s): Robert E Brannigan, MD, Associate Professor, Department of Urology, Northwestern Memorial Hospital
Contributor Information and Disclosures

Updated: Mar 26, 2008

Follow-up

Prognosis

  • Prognosis of a patient with infertility depends on the underlying cause of infertility. The appropriate workup must be performed, and then the appropriate intervention may be used. Prognosis is individualized depending on these results.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • With the technological advancements in assisted reproductive techniques, a new host of ethical issues has followed.
    • Although much more research needs to be done, increasing evidence suggests that children born by IVF are at increased risk of congenital anomalies. This supports addressing a male factor, if treatable, rather than using IVF as a first-line therapy in infertile couples.24,25
    • Gamete donation has enabled infertile couples to conceive, and many use family members as the donors to keep genetic linkages alive. However, laws and published guidelines directing these donations do not exist; rather, decisions are left up to the individual, physician, or program. The legal battles over the rights to embryos from donated eggs or sperm or to embryos, eggs, or sperm after divorce are still being fought.26
    • Technology has now proven the ability to clone animals, and future advances may provide the ability to choose a child's sex and physical characteristics.
    • All of these and other issues are still controversial, and the rate of evolution of these technologies hopefully will not exceed society's capacity to deal with the potential consequences.
 


More on Infertility, Male

Overview: Infertility, Male
Differential Diagnoses & Workup: Infertility, Male
Treatment & Medication: Infertility, Male
Follow-up: Infertility, Male
Multimedia: Infertility, Male
References
Further Reading
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References

  1. Matorras R, Diez J, Corcóstegui B, Gutiérrez de Terán G, García JM, Pijoan JI, et al. Spontaneous pregnancy in couples waiting for artificial insemination donor because of severe male infertility. Eur J Obstet Gynecol Reprod Biol. Dec 27 1996;70(2):175-8. [Medline].

  2. Carlsen E, Giwercman A, Keiding N, Skakkebaek NE. Evidence for decreasing quality of semen during past 50 years. BMJ. Sep 12 1992;305(6854):609-13. [Medline].

  3. Jacobsen KD, Ous S, Waehre H, Trasti H, Stenwig AE, Lien HH, et al. Ejaculation in testicular cancer patients after post-chemotherapy retroperitoneal lymph node dissection. Br J Cancer. Apr 1999;80(1-2):249-55. [Medline].

  4. Wang C, McDonald V, Leung A, Superlano L, Berman N, Hull L, et al. Effect of increased scrotal temperature on sperm production in normal men. Fertil Steril. Aug 1997;68(2):334-9. [Medline].

  5. Schatte EC, Orejuela FJ, Lipshultz LI, Kim ED, Lamb DJ. Treatment of infertility due to anejaculation in the male with electroejaculation and intracytoplasmic sperm injection. J Urol. Jun 2000;163(6):1717-20. [Medline].

  6. Brackett NL, Lynne CM, Aballa TC, Ferrell SM. Sperm motility from the vas deferens of spinal cord injured men is higher than from the ejaculate. J Urol. Sep 2000;164(3 Pt 1):712-5. [Medline].

  7. Bouloux P, Warne DW, Loumaye E; FSH Study Group in Men's Infertility. Efficacy and safety of recombinant human follicle-stimulating hormone in men with isolated hypogonadotropic hypogonadism. Fertil Steril. Feb 2002;77(2):270-3. [Medline].

  8. Whitten SJ, Nangia AK, Kolettis PN. Select patients with hypogonadotropic hypogonadism may respond to treatment with clomiphene citrate. Fertil Steril. Dec 2006;86(6):1664-8. [Medline].

  9. Rucker GB, Mielnik A, King P, Goldstein M, Schlegel PN. Preoperative screening for genetic abnormalities in men with nonobstructive azoospermia before testicular sperm extraction. J Urol. Dec 1998;160(6 Pt 1):2068-71. [Medline].

  10. Zahalsky MP, Berman AJ, Nagler HM. Evaluating the risk of epididymal injury during hydrocelectomy and spermatocelectomy. J Urol. Jun 2004;171(6 Pt 1):2291-2. [Medline].

  11. Purohit RS, Wu DS, Shinohara K, Turek PJ. A prospective comparison of 3 diagnostic methods to evaluate ejaculatory duct obstruction. J Urol. Jan 2004;171(1):232-5; discussion 235-6. [Medline].

  12. Pierik FH, Dohle GR, van Muiswinkel JM, Vreeburg JT, Weber RF. Is routine scrotal ultrasound advantageous in infertile men?. J Urol. Nov 1999;162(5):1618-20. [Medline].

  13. Raman JD, Nobert CF, Goldstein M. Increased incidence of testicular cancer in men presenting with infertility and abnormal semen analysis. J Urol. Nov 2005;174(5):1819-22; discussion 1822. [Medline].

  14. Yanagimachi R, Yanagimachi H, Rogers BJ. The use of zona-free animal ova as a test-system for the assessment of the fertilizing capacity of human spermatozoa. Biol Reprod. Nov 1976;15(4):471-6. [Medline].

  15. Reynolds JC, McCall A, Kim ED, Lipshultz LI. Bladder neck collagen injection restores antegrade ejaculation after bladder neck surgery. J Urol. Apr 1998;159(4):1303. [Medline].

  16. Belker AM, Thomas AJ, Fuchs EF. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. Mar 1991;145(3):505-11. [Medline].

  17. Anger JT, Goldstein M. Intravasal "toothpaste" in men with obstructive azoospermia is derived from vasal epithelium, not sperm. J Urol. Aug 2004;172(2):634-6. [Medline].

  18. Berger RE. Triangulation end-to-side vasoepididymostomy. J Urol. Jun 1998;159(6):1951-3. [Medline].

  19. Hauser R, Yogev L, Paz G, Yavetz H, Azem F, Lessing JB, et al. Comparison of efficacy of two techniques for testicular sperm retrieval in nonobstructive azoospermia: multifocal testicular sperm extraction versus multifocal testicular sperm aspiration. J Androl. Jan-Feb 2006;27(1):28-33. [Medline].

  20. Silver RI, Rodriguez R, Chang TS, Gearhart JP. In vitro fertilization is associated with an increased risk of hypospadias. J Urol. Jun 1999;161(6):1954-7. [Medline].

  21. Van Steirteghem AC, Liu J, Joris H, Nagy Z, Janssenswillen C, Tournaye H, et al. Higher success rate by intracytoplasmic sperm injection than by subzonal insemination. Report of a second series of 300 consecutive treatment cycles. Hum Reprod. Jul 1993;8(7):1055-60. [Medline].

  22. Wald M, Ross LS, Prins GS, Cieslak-Janzen J, Wolf G, Niederberger CS. Analysis of outcomes of cryopreserved surgically retrieved sperm for IVF/ICSI. J Androl. Jan-Feb 2006;27(1):60-5. [Medline].

  23. Scott R, MacPherson A, Yates RW, Hussain B, Dixon J. The effect of oral selenium supplementation on human sperm motility. Br J Urol. Jul 1998;82(1):76-80. [Medline].

  24. Klemetti R, Gissler M, Sevon T, Koivurova S, Ritvanen A, Hemminki E. Children born after assisted fertilization have an increased rate of major congenital anomalies. Fertil Steril. Nov 2005;84(5):1300-7. [Medline].

  25. Olson CK, Keppler-Noreuil KM, Romitti PA, Budelier WT, Ryan G, Sparks AE, et al. In vitro fertilization is associated with an increase in major birth defects. Fertil Steril. Nov 2005;84(5):1308-15. [Medline].

  26. Marshall LA. Intergenerational gamete donation: ethical and societal implications. Am J Obstet Gynecol. Jun 1998;178(6):1171-6. [Medline].

  27. Baccetti BM, Bruni E, Capitani S, Collodel G, Mancini S, Piomboni P, et al. Studies on varicocele III: ultrastructural sperm evaluation and 18, X and Y aneuploidies. J Androl. Jan-Feb 2006;27(1):94-101. [Medline].

  28. Baker HW. Reproductive effects of nontesticular illness. Endocrinol Metab Clin North Am. Dec 1998;27(4):831-50. [Medline].

  29. Belker AM, Sherins RJ, Dennison-Lagos L, Thorsell LP, Schulman JD. Percutaneous testicular sperm aspiration: a convenient and effective office procedure to retrieve sperm for in vitro fertilization with intracytoplasmic sperm injection. J Urol. Dec 1998;160(6 Pt 1):2058-62. [Medline].

  30. Berardinucci D, Zini A, Jarvi K. Outcome of microsurgical reconstruction in men with suspected epididymal obstruction. J Urol. Mar 1998;159(3):831-4. [Medline].

  31. Bhasin S, Mallidis C, Ma K. The genetic basis of infertility in men. Baillieres Best Pract Res Clin Endocrinol Metab. Sep 2000;14(3):363-388. [Medline].

  32. Carmignani G, Gallucci M, Puppo P, De Stefani S, Simonato A, Maffezzini M. Video laparoscopic excision of a seminal vesicle cyst associated with ipsilateral renal agenesis. J Urol. Feb 1995;153(2):437-9. [Medline].

  33. Carmignani L, Gadda F, Mancini M, Gazzano G, Nerva F, Rocco F, et al. Detection of testicular ultrasonographic lesions in severe male infertility. J Urol. Sep 2004;172(3):1045-7. [Medline].

  34. Cavallini G. Minoxidil versus nitroglycerin: a prospective double-blind controlled trial in transcutaneous erection facilitation for organic impotence. J Urol. Jul 1991;146(1):50-3. [Medline].

  35. Foresta C, Galeazzi C, Bettella A, Marin P, Rossato M, Garolla A, et al. Analysis of meiosis in intratesticular germ cells from subjects affected by classic Klinefelter's syndrome. J Clin Endocrinol Metab. Oct 1999;84(10):3807-10. [Medline].

  36. Forti G, Krausz C. Clinical review 100: Evaluation and treatment of the infertile couple. J Clin Endocrinol Metab. Dec 1998;83(12):4177-88. [Medline].

  37. Giwercman A, Petersen PM. Cancer and male infertility. Baillieres Best Pract Res Clin Endocrinol Metab. Sep 2000;14(3):453-471. [Medline].

  38. Griswold MD. Interactions between germ cells and Sertoli cells in the testis. Biol Reprod. Feb 1995;52(2):211-6. [Medline].

  39. Hauser R, Yogev L, Amit A, Yavetz H, Botchan A, Azem F, et al. Severe hypospermatogenesis in cases of nonobstructive azoospermia: should we use fresh or frozen testicular spermatozoa?. J Androl. Nov-Dec 2005;26(6):772-8. [Medline].

  40. Herr HW, Bar-Chama N, O'Sullivan M, Sogani PC. Paternity in men with stage I testis tumors on surveillance. J Clin Oncol. Feb 1998;16(2):733-4. [Medline].

  41. Hjort T. Treatment of infertility associated with auto-antibodies to sperm. Int J Androl. Apr 1983;6(2):113-5. [Medline].

  42. Houlgatte A, De La Taille A, Fournier R, Goluboff ET, Camporo P, Houdelette P. Paternity in a patient with seminoma and carcinoma in situ in a solitary testis treated by partial orchidectomy. BJU Int. Aug 1999;84(3):374-5. [Medline].

  43. Jacobsen KD, Theodorsen L, Fossa SD. Spermatogenesis after unilateral orchiectomy for testicular cancer in patients following surveillance policy. J Urol. Jan 2001;165(1):93-6. [Medline].

  44. Keel BA. Within- and between-subject variation in semen parameters in infertile men and normal semen donors. Fertil Steril. Jan 2006;85(1):128-34. [Medline].

  45. Krausz C, Quintana-Murci L, Barbaux S, Siffroi JP, Rouba H, Delafontaine D, et al. A high frequency of Y chromosome deletions in males with nonidiopathic infertility. J Clin Endocrinol Metab. Oct 1999;84(10):3606-12. [Medline].

  46. Lencioni R, Ortori S, Cioni D, Morelli G, Ceretti E, Cosottini M, et al. Endorectal coil MR imaging findings in hemospermia. MAGMA. May 1999;8(2):91-7. [Medline].

  47. McCallum TJ, Milunsky JM, Cunningham DL, Harris DH, Maher TA, Oates RD. Fertility in men with cystic fibrosis: an update on current surgical practices and outcomes. Chest. Oct 2000;118(4):1059-62. [Medline].

  48. McDougall EM, Clayman RV, Bowles WT. Laparoscopic excision of mullerian duct remnant. J Urol. Aug 1994;152(2 Pt 1):482-4. [Medline].

  49. Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet. Jul 4 1992;340(8810):17-8. [Medline].

  50. Pasqualotto FF, Sobreiro BP, Hallak J, Pasqualotto EB, Lucon AM. Induction of spermatogenesis in azoospermic men after varicocelectomy repair: an update. Fertil Steril. Mar 2006;85(3):635-9. [Medline].

  51. Potashnik G, Yanai-Inbar I. Dibromochloropropane (DBCP): an 8-year reevaluation of testicular function and reproductive performance. Fertil Steril. Feb 1987;47(2):317-23. [Medline].

  52. Salzhauer EW, Sokol A, Glassberg KI. Paternity after adolescent varicocele repair. Pediatrics. Dec 2004;114(6):1631-3. [Medline].

  53. Schlegel PN, Shin D, Goldstein M. Urogenital anomalies in men with congenital absence of the vas deferens. J Urol. May 1996;155(5):1644-8. [Medline].

  54. Spitz A, Kim ED, Lipshultz LI. Contemporary approach to the male infertility evaluation. Obstet Gynecol Clin North Am. Sep 2000;27(3):487-516, v. [Medline].

  55. Takihara H, Sakatoku J, Fujii M, Nasu T, Cosentino MJ, Cockett AT. Significance of testicular size measurement in andrology. I. A new orchiometer and its clinical application. Fertil Steril. Jun 1983;39(6):836-40. [Medline].

  56. Vicdan A, Vicdan K, Günalp S, Kence A, Akarsu C, Isik AZ, et al. Genetic aspects of human male infertility: the frequency of chromosomal abnormalities and Y chromosome microdeletions in severe male factor infertility. Eur J Obstet Gynecol Reprod Biol. Nov 10 2004;117(1):49-54. [Medline].

  57. Yoshida A, Miura K, Nagao K, Hara H, Ishii N, Shirai M. Sexual function and clinical features of patients with Klinefelter's syndrome with the chief complaint of male infertility. Int J Androl. Apr 1997;20(2):80-5. [Medline].

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Further Reading

For additional information, see Medscape’s Male Infertility Resource Center

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Keywords

male infertility, infertility, difficulty conceiving, sperm formation, ejaculate volume, sperm concentration, oligospermia, too few sperm, low sperm count, azoospermia, sperm transportation, no sperm in the ejaculate, sperm motility, sperm morphology, gonad, testis, testes, testicles, fertilization, impotence, semen analysis, spermatogenesis, cryptorchidism, diethylstilbestrol, DES, testicular torsion, retrograde ejaculation, in vitro fertilization, IVF, intracytoplasmic sperm injection, ICSI, testicular cancer, hypogonadotropism, testicular atrophy, cystic fibrosis, hypogonadism, anejaculation, electroejaculation, sperm retrieval, orchitis, varicocele, pretesticular infertility, testicular infertility, posttesticular infertility, primary infertility, secondary infertility, idiopathic hypogonadotropic hypogonadism, prolactinoma, Klinefelter syndrome, assisted reproduction, hypospermatogenesis, Sertoli-cell-only syndrome, germinal cell aplasia, varicocelectomy, testicular biopsy, vasovasostomy,vasoepididymostomy, transurethral resection of the ejaculatory ducts, TURED, artificial insemination

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Contributor Information and Disclosures

Author

Jonathan Rubenstein, MD, Staff Physician, Department of Urology, University of California, San Francisco
Jonathan Rubenstein, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Coauthor(s)

Robert E Brannigan, MD, Associate Professor, Department of Urology, Northwestern Memorial Hospital
Robert E Brannigan, MD is a member of the following medical societies: American Medical Association, American Urological Association, Chicago Medical Society, Endocrine Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Daniel B Rukstalis, MD, Director of Urological Services, Geisinger Medical Center, Geisinger Medical Group
Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Urological Association, New York Academy of Sciences, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark Jeffrey Noble, MD, Consulting Staff, Urologic Institute, Cleveland Clinic Foundation
Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, and Southwestern Oncology Group
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Stephen W Leslie, MD, FACS, Founder and Medical Director of the Lorain Kidney Stone Research Center, Clinical Assistant Professor, Department of Urology, Medical College of Ohio
Stephen W Leslie, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, National Kidney Foundation, and Ohio State Medical Association
Disclosure: Nothing to disclose.

 
 
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