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Asian Journal of Andrology (2012) 14, 103-108; doi:10.1038/aja.2011.65; published online 19 December 2011
Male factor infertility and ART
Herman Tournaye1
Centre for Reproductive Medicine, University Hospital of the Dutch-speaking Brussels Free University, Brussels B-1090, Belgium
Correspondence: Dr H Tournaye, (tournaye@az.vub.ac.be)
Received 11 May 2011; Revised 23 August 2011; Accepted 24 August 2011; Published online 19 December 2011.
| Abstract |
For years, the management and treatment of male factor infertility has been ‘experience’ and not ‘evidence’ based. Although not evidence-based, current clinical practice involves extensive use of assisted reproductive techniques (ART). Where specific treatments are not indicated or have failed, ART have become popular adjunctive treatments for alleviating male factor infertility. According to the limited evidence available, intrauterine insemination (IUI) may be considered as a first-line treatment in a couple in which the female partner has a normal fertility status and at least 1×106 progressively motile spermatozoa are recovered after sperm preparation. If no pregnancy is achieved after 3–6 cycles of IUI, optimized in vitro fertilization (IVF) can be proposed. When less than 0.5×106 progressively motile spermatozoa are obtained after seminal fluid processing or sperm are recovered surgically from the testis or epididymis, intracytoplasmic sperm injection (ICSI) should be performed. Although the outcome of no other ART has ever been scrutinized as much before, no large-scale ‘macroproblems’ have as yet been observed after ICSI. Yet, ICSI candidates should be rigorously screened before embarking on IVF or ICSI, and thoroughly informed of the limitations of our knowledge on the hereditary aspects of male infertility and the safety aspects of ART.
Keywords: artificial; intracytoplasmic sperm injection; insemination; in vitro fertilization; male infertility, sperm |
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