12/12/2020
Updated review for male factor infertility...
1. Never rely on a single abnormal semen analysis. Time-to-time and lab-to-lab variations are obviously frequent in semen analysis...
2. Always request semen analysis in one of the well-known infertility centers. Semen analysis highly depends on the analyst's view. Embryologists who check tens of analyses per day have by far much more experience than technicians or even physicans in general labs...
3. Computer-assisted semen analysis offers no added diagnostic yield when compared to conventional semen analysis...
4. Only 4 parameters that actually count in a semen analysis: volume (>= 1.5 ml), concentration (>= 15 million per ml), progressive motility (>= 32%) and morphology (>= 4% normal forms)... Other parameters (e.g. viscosity) are of no predictive value..
5. The more parameters which show abnormality, the more serious is testicular disease...
6. The single most important parameter is s***m concentration. Values below 10 million per ml should be actively managed. Values below 5 million per ml should be labelled as severe oligozoos***mia...
7. Karyotyping should be asked for in any man who has severe oligozoos***mia, to exclude Y chromosome abnormalities...
8. Low semen volume in a diabetic or neuropathic man usually implies retrograde ej*******on. There is no effective medical treatment for retrograde ej*******on.. ICSI (with testicular FNA) is the only known effective treatment for infertile men with retrograde ej*******on..
9. Unless there is a detectable endocrine abnormality (e.g. hyperprolactinemia, hypogonadotropic hypogonadism), there is no value of any hormonal treatment for semen analysis abnormalities... Indeed, in severely low s***m comcentrations, hormonal treatment might actually worsen the condition and cause transient or permanent testicular failure and complete azoos***mia in some cases...
10. Varicocelectomy might have some benefit in men with borderline concentration and/or motility, and ONLY when varicoceles are clinically detectable. This procedure should always be performed by skilled hands as it may end in serious untreatable complications up to tesicular atrophy and necrosis. This procedure should CAUTIOUSLY be performed in men with severe oligozoos***mia... This procedure should NEVER BE repeately performed...
11. There is NO medical treatment for abnormal s***m morphology. Antioxidants and adjuvant treatment are actually useless in such cases... The key factor that counts in such cases if they are subjected to ICSI is meticulous s***m selection by the most senior embryologist. Such men also do benefit from freezing more than semen specimen and getting two fresh ej******es on the same day of o**m pickup...
12. IUI is a good choice for men with mild semen abnormalities and men with erectile dysfunction..
13. ICSI should not be delayed as a fertility treatment choice in obvious and repeated poor semen analysis..
14. The standard practice is to have s***ms in hand (through either frozen semen specimen or frozen tesicular biopsy from elective TESE) before ICSI cycle is started...
15. Fresh TESE/ICSI can be considered only when obstuctive (rather than nonobstructive) azoos***mia is DEFINITELY diagnosed and when the husband is diagnosed as Kleinfelter's syndrome. In this latter diagnosis, the few s***ms retrieved from an elective TESE usually do not withstand vitrification...
16. Intentionally induce women whose husbands have semen abnormalities with higher gonadotropin doses, so that more oocytes are retrieved.. Fertilization rates in such couples are generally suboptimal... The more oocytes retrieved, the better chance to have good number of good quality embryos to transfer...
