Assisted Reproduction for Male Infertility

Abstract

Male factor is the main cause of infertility in about 20% of infertile couples and contribute to 50% of all cases. Only a limited number of causes of male infertility are potentially treatable and the majority of male infertility is idiopathic. Meta-analyses have shown that empirical medical treatments for unexplained male infertility are merely of unproven benefit. The last decades have witnessed expansion of assisted reproduction techniques (ART) both in terms of advanced technology used and its availability. 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 x 106 progressively motile spermatozoa are recovered after sperm preparation. If no pregnancy is achieved after 3–6 IUI cycles of IUI, IVF can be proposed. When less than 0.5 x 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. ICSI-candidates should be rigorously screened before embarking on treatment and thoroughly informed of the limitations of our knowledge on the hereditary aspects of male infertility and the safety aspects of ART. The vast expansion of especially ICSI treatments demands for global guidelines and inclusion policies for both IVF and ICSI procedures. There is an urgency for improved sperm selection methods and in particular clinical applicability of sperm DNA fragmentation assessment. The medical infertility society should strive towards using the best technology that is available to treat patients in most effective, evidence-based and efficient patient-friendly way.