20 - Male Factor Infertility: State of the ART

Summary

INTRODUCTION

Andrologists are medical doctors who practice the clinical management of typically male problems, including congenital malformations of the male genital tract, abnormal pubertal development, male infertility, sexual dysfunction, and male aging. In Europe, an andrologist may be a specialist in endocrinology or urology who has acquired and proven his expertise through a well-defined education program sanctioned by an examination before an international jury of the European Academy of Andrology (1).

McLeod has highlighted the importance of the “male factor” in couple infertility in his milestone publications where reference values for “normal” semen quality were established (2). For several decades, male infertility has been considered incurable because the majority of patients were suspected of suffering from an idiopathic condition. Both high-quality clinical research and fundamental biological investigations have revealed that certain diseases may cause male infertility and effective treatments have been developed (3).

The relative importance of the male factor as a cause of couple infertility has become proportionally larger, particularly since biologists and gynecologists using techniques of assisted reproduction detect many more cases with abnormal semen quality. However, the epidemiology of causal factors has changed over time, with particular diseases becoming less frequent (e.g., obstructive azoospermia acquired by infection of the reproductive tract), whereas other diseases are detected more commonly (e.g., varicocele).