The impact of male factors and their correct and early diagnosis in the infertile couple's pathway: 2021 perspectives

doi:10.1007/s40618-022-01778-7

Review

. 2022 Oct;45(10):1807-1822.

doi: 10.1007/s40618-022-01778-7. Epub 2022 Mar 29.

The impact of male factors and their correct and early diagnosis in the infertile couple's pathway: 2021 perspectives

F Pallotti¹, A Barbonetti², G Rastrelli³, D Santi⁴, G Corona⁵, F Lombardo⁶

Affiliations

¹ Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
² Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
³ Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital-Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy.
⁴ Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
⁵ Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, 40139, Bologna, Italy.
⁶ Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. francesco.lombardo@uniroma1.it.

PMID: 35349114
PMCID: PMC8961097
DOI: 10.1007/s40618-022-01778-7

Review

The impact of male factors and their correct and early diagnosis in the infertile couple's pathway: 2021 perspectives

F Pallotti et al. J Endocrinol Invest. 2022 Oct.

. 2022 Oct;45(10):1807-1822.

doi: 10.1007/s40618-022-01778-7. Epub 2022 Mar 29.

Authors

F Pallotti¹, A Barbonetti², G Rastrelli³, D Santi⁴, G Corona⁵, F Lombardo⁶

Affiliations

¹ Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
² Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
³ Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital-Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy.
⁴ Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
⁵ Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, 40139, Bologna, Italy.
⁶ Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. francesco.lombardo@uniroma1.it.

PMID: 35349114
PMCID: PMC8961097
DOI: 10.1007/s40618-022-01778-7

Abstract

Purpose: The current clinical practice in reproductive medicine should pose the couple at the centre of the diagnostic-therapeutic management of infertility and requires intense collaboration between the andrologist, the gynaecologist and the embryologist. The andrologist, in particular, to adequately support the infertile couple, must undertake important biological, psychological, economical and ethical task. Thus, this paper aims to provide a comprehensive overview of the multifaceted role of the andrologist in the study of male factor infertility.

Methods: A comprehensive Medline, Embase and Cochrane search was performed including publications between 1969 and 2021.

Results: Available evidence indicates that a careful medical history and physical examination, followed by semen analysis, always represent the basic starting points of the diagnostic work up in male partner of an infertile couple. Regarding treatment, gonadotropins are an effective treatment in case of hypogonadotropic hypogonadism and FSH may be used in men with idiopathic infertility, while evidence supporting other hormonal and nonhormonal treatments is either limited or conflicting. In the future, pharmacogenomics of FSHR and FSHB as well as innovative compounds may be considered to develop new therapeutic strategies in the management of infertility.

Conclusion: To provide a high-level of care, the andrologist must face several critical diagnostical and therapeutical steps. Even though ART may be the final and decisive stage of this decisional network, neglecting to treat the male partner may ultimately increase the risks of negative outcome, as well as costs and psychological burden for the couple itself.

Keywords: ART; Couple infertility; FSH; Male factor; Semen analysis.

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Conflict of interest statement

AB, GC, GR and DS are members of the editorial board. The remaining Authors have no potential conflicts of interest to disclose.

Figures

**Fig. 1**
Summary of the andrological work up of the male partner from an infertile couple

See this image and copyright information in PMC

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References

1. Lenzi A. The role of the medical andrologist in the assisted reproduction era. J Endocrinol Investig. 2003;26(3):268–273. doi: 10.1007/BF03345169. - DOI - PubMed
1. Hamilton JAM, van der Steeg JW, Hamilton CJCM, de Bruin JP. A concise infertility work-up results in fewer pregnancies. Hum Reprod Open. 2021;2021(4):hoab033. doi: 10.1093/hropen/hoab033. - DOI - PMC - PubMed
1. Ferlin A, Garolla A, Ghezzi M, Selice R, Palego P, Caretta N, et al. Sperm count and hypogonadism as markers of general male health. Eur Urol Focus. 2021;7(1):205–213. doi: 10.1016/j.euf.2019.08.001. - DOI - PubMed
1. Batra NV, DeMarco RT, Bayne CE. A narrative review of the history and evidence-base for the timing of orchidopexy for cryptorchidism. J Pediatr Urol. 2021;17(2):239–245. doi: 10.1016/j.jpurol.2021.01.013. - DOI - PubMed
1. Fode M, Fusco F, Lipshultz L, Weidner W. Sexually transmitted disease and male infertility: a systematic review. Eur Urol Focus. 2016;2(4):383–393. doi: 10.1016/j.euf.2016.08.002. - DOI - PubMed

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[1] Lenzi A. The role of the medical andrologist in the assisted reproduction era. J Endocrinol Investig. 2003;26(3):268–273. doi: 10.1007/BF03345169. - DOI - PubMed

[2] Lenzi A. The role of the medical andrologist in the assisted reproduction era. J Endocrinol Investig. 2003;26(3):268–273. doi: 10.1007/BF03345169. - DOI - PubMed

[3] Hamilton JAM, van der Steeg JW, Hamilton CJCM, de Bruin JP. A concise infertility work-up results in fewer pregnancies. Hum Reprod Open. 2021;2021(4):hoab033. doi: 10.1093/hropen/hoab033. - DOI - PMC - PubMed

[4] Hamilton JAM, van der Steeg JW, Hamilton CJCM, de Bruin JP. A concise infertility work-up results in fewer pregnancies. Hum Reprod Open. 2021;2021(4):hoab033. doi: 10.1093/hropen/hoab033. - DOI - PMC - PubMed

[5] Ferlin A, Garolla A, Ghezzi M, Selice R, Palego P, Caretta N, et al. Sperm count and hypogonadism as markers of general male health. Eur Urol Focus. 2021;7(1):205–213. doi: 10.1016/j.euf.2019.08.001. - DOI - PubMed

[6] Ferlin A, Garolla A, Ghezzi M, Selice R, Palego P, Caretta N, et al. Sperm count and hypogonadism as markers of general male health. Eur Urol Focus. 2021;7(1):205–213. doi: 10.1016/j.euf.2019.08.001. - DOI - PubMed

[7] Batra NV, DeMarco RT, Bayne CE. A narrative review of the history and evidence-base for the timing of orchidopexy for cryptorchidism. J Pediatr Urol. 2021;17(2):239–245. doi: 10.1016/j.jpurol.2021.01.013. - DOI - PubMed

[8] Batra NV, DeMarco RT, Bayne CE. A narrative review of the history and evidence-base for the timing of orchidopexy for cryptorchidism. J Pediatr Urol. 2021;17(2):239–245. doi: 10.1016/j.jpurol.2021.01.013. - DOI - PubMed

[9] Fode M, Fusco F, Lipshultz L, Weidner W. Sexually transmitted disease and male infertility: a systematic review. Eur Urol Focus. 2016;2(4):383–393. doi: 10.1016/j.euf.2016.08.002. - DOI - PubMed

[10] Fode M, Fusco F, Lipshultz L, Weidner W. Sexually transmitted disease and male infertility: a systematic review. Eur Urol Focus. 2016;2(4):383–393. doi: 10.1016/j.euf.2016.08.002. - DOI - PubMed

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The impact of male factors and their correct and early diagnosis in the infertile couple's pathway: 2021 perspectives

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The impact of male factors and their correct and early diagnosis in the infertile couple's pathway: 2021 perspectives

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