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Epidemiological Considerations in Male Infertility

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Male Infertility

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Abstract

The diagnosis of male infertility indicates impairment in male reproductive potential. Unfortunately, there is no gold standard test for assessing male reproductive potential. The diagnostic accuracy of semen analysis is compromised by substantial overlap between the distributions of semen characteristics in empirically fertile and infertile men. Novel assays, including seminal reactive oxygen species levels, may prove to be of greater clinical utility for identifying men with below-average reproductive potential. Efforts to identify and treat modifiable risk factors should ideally be targeted toward these individuals. Although economic analyses have demonstrated that pathology-directed treatment for male infertility is often more cost-effective than immediate use of assisted reproductive technology, there is a declining trend in surgical treatment of male infertility.

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References

  1. Tremellen K. Oxidative stress and male infertility—a clinical perspective. Hum Reprod Update. 2008;14:243–58.

    Article  PubMed  CAS  Google Scholar 

  2. Sharma RK, Said T, Agarwal A. Sperm DNA damage and its clinical relevance in assessing reproductive outcome. Asian J Androl. 2004;6:139–48.

    PubMed  CAS  Google Scholar 

  3. Athayde KS, Cocuzza M, Agarwal A, et al. Development of normal reference values for seminal reactive oxygen species and their correlation with leukocytes and semen parameters in a fertile population. J Androl. 2007;28:613–20.

    Article  PubMed  CAS  Google Scholar 

  4. Agarwal A, Sharma RK, Nallella KP, Thomas AJ, Alvarez JG, Sikka SC. Reactive oxygen species as an independent marker of male factor infertility. Fertil Steril. 2006;86:878–85.

    Article  PubMed  CAS  Google Scholar 

  5. Lumley J. Epidemiological approaches to infertility. Reprod Fertil Dev. 1998;10:17–21.

    Article  PubMed  CAS  Google Scholar 

  6. Alukal JP, Lipshultz LI. Why treat the male in the era of assisted reproduction? Semin Reprod Med. 2009;27:109–14.

    Article  PubMed  Google Scholar 

  7. Habbema JDF, Collins J, Leridon H, Evers JLH, Lunenfeld B, te Velde ER. Towards less confusing terminology in reproductive medicine: a proposal. Hum Reprod. 2004;19:1497–501.

    Article  PubMed  CAS  Google Scholar 

  8. Davies MJ, De Lacey SL, Norman RJ. Towards less confusing terminology in reproductive medicine: clarifying medical ambiguities to the benefit of all. Hum Reprod. 2005;20:2669–71.

    Article  PubMed  Google Scholar 

  9. Greenhall E, Vessey M. The prevalence of subfertility: a review of the current confusion and a report of two new studies. Fertil Steril. 1990;54:978–83.

    PubMed  CAS  Google Scholar 

  10. Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud AMA. WHO manual for the standardized investigation, diagnosis and management of the infertile male. New York, NY: Cambridge University Press; 2000.

    Google Scholar 

  11. Sigman M, Jarow JP. Male infertility. In: Wein AJ, Kavoussi LR, et al., editors. Campbell-Walsh urology. 9th ed. Philadelphia, PA: Saunders Elsevier; 2007. p. 609–53.

    Google Scholar 

  12. Simpson JL, Jauniaux ERM. Pregnancy loss. In: Gabbe SG, Niebyl JR, Simpson JL, editors. Obstetrics: normal and problem pregnancies. 5th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2007. p. 628–49.

    Chapter  Google Scholar 

  13. Stephen EH, Chandra A. Declining estimates of infertility in the United States: 1982–2002. Fertil Steril. 2006;86:516–23.

    Article  PubMed  Google Scholar 

  14. te Velde ER, Eijkemans R, Habbema HDF. Variation in couple fecundity and time to pregnancy, an essential concept in human reproduction. Lancet. 2000;355:1928–9.

    Article  Google Scholar 

  15. Rutstein SO, Shah IH. Infecundity, infertility, and childlessness in developing countries. DHS Comparative Reports No. 9. Calverton, MD: ORC Macro and the World Health Organization; 2004.

    Google Scholar 

  16. Lunenfeld B, van Steirteghem A. Infertility in the third millennium: implications for the individual, family and society: condensed meeting report from the Bertarelli Foundation’s Second Global Conference. Hum Reprod Update. 2004;10:317–26.

    Article  PubMed  CAS  Google Scholar 

  17. Kefer JC, Agarwal A, Sabanegh E. Role of antioxidants in the treatment of male infertility. Int J Urol. 2009;16:449–57.

    Article  PubMed  CAS  Google Scholar 

  18. van Noord-Zaadstra BM, Looman CWN, Alsbach H, Habbema JDF, te Velde ER, Karbaat J. Delaying childbearing: effect of age on fecundity and outcome of pregnancy. BMJ. 1991;302:1361–5.

    Article  PubMed  Google Scholar 

  19. Ford WCL, North K, Taylor H, Farrow A, Hull MGR, Golding J. Increasing paternal age is associated with delayed conception in a large population of fertile couples: evidence for declining fecundity in older men. The ALSPAC Study Team. Hum Reprod. 2000;15: 1703.

    Article  PubMed  CAS  Google Scholar 

  20. Evers JLH. Female subfertility. Lancet. 2002;350:151–9.

    Article  Google Scholar 

  21. Spira A. Epidemiology of human reproduction. Hum Reprod. 1986;1:111–5.

    PubMed  CAS  Google Scholar 

  22. Leridon H, Spira A. Problems in measuring the effectiveness of infertility therapy. Fertil Steril. 1984;41:580–6.

    PubMed  CAS  Google Scholar 

  23. Evers JL, te Velde ER. Vruchtbaarheidsstoornissen. In: Heineman MJ, Bleker OP, Evers JL, Heintz AP, editors. Obstetrie en Gynaecologie, de voortplanting van de mens. Maarssen: Elsevier Science; 2001. p. 435–71.

    Google Scholar 

  24. Bongaarts J. A method for estimation of fecundability. Demography. 1975;12:645–60.

    Article  PubMed  CAS  Google Scholar 

  25. Dunson DB, Colombo B, Baird DD. Changes with age in the level and duration of fertility in the menstrual cycle. Hum Reprod. 2002;17:1399–403.

    Article  PubMed  Google Scholar 

  26. Gnoth C, Godehardt D, Godehardt E, Frank-Herrmann PF, Freundl G. Time to pregnancy: results of the German prospective study and impact on the management of infertility. Hum Reprod. 2003;188: 1959–66.

    Article  Google Scholar 

  27. Sharlip ID, Jarow JP, Belker AM, et al. Best practice policies for male infertility. Fertil Steril. 2002;77:873–82.

    Article  PubMed  Google Scholar 

  28. Muller CH. Rationale, interpretation, validation, and uses of sperm function tests. J Androl. 2000;21:10–30.

    PubMed  CAS  Google Scholar 

  29. Kobayashi H, Gil-Guzman E, Mahran AM, et al. Quality control of reactive oxygen species measurement by luminol-dependent chemiluminescence assay. J Androl. 2001;22:568–74.

    PubMed  CAS  Google Scholar 

  30. Barratt CLR, Aitken RJ, Björndahl L, et al. Sperm DNA: organization, protection and vulnerability: from basic science to clinical applications—a position report. Hum Reprod. 2010;25:824–38.

    Article  PubMed  Google Scholar 

  31. Menkveld R. Clinical significance of the low normal sperm morphology value as proposed in the fifth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen. Asian J Androl. 2010;12:47–58.

    Article  PubMed  Google Scholar 

  32. Cooper TG, Noonan E, von Eckardstein S, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16:231–45.

    Article  PubMed  Google Scholar 

  33. Guzick DS, Overstreet JW, Factor-Litvak P, et al.; for the National Cooperative Reproductive Medicine Network. Sperm morphology, motility, and concentration in fertile and infertile men. NEJM. 2001; 345:1388–93.

    Google Scholar 

  34. Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem. 1993;39:561–77.

    PubMed  CAS  Google Scholar 

  35. MacLeod J. Semen quality in one thousand men of known fertility and in eight hundred cases of infertile marriage. Fertil Steril. 1951;2:115–39.

    PubMed  CAS  Google Scholar 

  36. Niederberger CS. Understanding the epidemiology of fertility treatments. Urol Clin North Am. 2002;29:829–40.

    Article  PubMed  Google Scholar 

  37. Ombelet W, Bosmans E, Janssen M, et al. Semen parameters in a fertile versus subfertile population: a need for change in the interpretation of semen testing. Hum Reprod. 1997;12:987–93.

    Article  PubMed  CAS  Google Scholar 

  38. Gunalp S, Onculoglu C, Gurgan T, Kruger TF, Lombard CJ. A study of semen parameters with emphasis on sperm morphology in a fertile population: an attempt to develop clinical thresholds. Hum Reprod. 2001;16:110–4.

    Article  PubMed  CAS  Google Scholar 

  39. Menkveld R, Wong WY, Lombard CJ, et al. Semen parameters, including WHO and strict criteria morphology, in a fertile and subfertile population: an effort towards standardization of in-vivo thresholds. Hum Reprod. 2001;16:1165–71.

    Article  PubMed  CAS  Google Scholar 

  40. Jedrzejczak P, Taszarek-Hauke G, Hauke J, Pawelczyk L, Duleba AJ. Prediction of spontaneous conception based on semen parameters. Int J Androl. 2008;31:499–507.

    Article  PubMed  Google Scholar 

  41. van der Merwe FH, Kruger TF, Oehninger SC, Lombard CJ. The use of semen parameters to identify the subfertile male in the general population. Gynecol Obstet Invest. 2005;59:86–91.

    Article  PubMed  Google Scholar 

  42. Zinaman MJ, Brown CC, Selevan SG, Clegg ED. Semen quality and human fertility: a prospective study with healthy couples. J Androl. 2000;21:145–53.

    PubMed  CAS  Google Scholar 

  43. Bonde JPE, Ernst E, Jensen TK, et al. Relation between semen quality and fertility: a population-based study of 430 first-pregnancy planners. Lancet. 1998;352:1172–7.

    Article  PubMed  CAS  Google Scholar 

  44. Skakkebaek N. Normal reference ranges for semen quality and their relations to fecundity. Asian J Androl. 2010;12:95–8.

    Article  PubMed  Google Scholar 

  45. Leushuis E, van der Steeg JW, Steures P, et al. Prediction models in reproductive medicine: a critical appraisal. Hum Reprod Update. 2009;15:537–52.

    Article  PubMed  Google Scholar 

  46. van der Steeg JW, Steures P, Eijkemans MJC, et al. Pregnancy is predictable: a large-scale prospective external validation of the prediction of spontaneous pregnancy in subfertile couples. Hum Reprod. 2007;22:536–42.

    Article  PubMed  Google Scholar 

  47. Zorn B, Vidmar G, Meden-Vrtovec H. Seminal reactive oxygen species as predictors of fertilization, embryo quality and pregnancy rates after conventional in vitro fertilization and intracytoplasmic sperm injection. Int J Androl. 2003;26:279–85.

    Article  PubMed  CAS  Google Scholar 

  48. Mercan R, Lanzendorf SE, Mayer J, Nassar A, Muasher SJ, Oehninger S. The outcome of clinical pregnancies following intracytoplasmic sperm injection is not affected by semen quality. Andrologia. 1998;30:91–5.

    Article  PubMed  CAS  Google Scholar 

  49. Ombelet W, Deblaere K, Bosmans E, et al. Semen quality and intrauterine insemination. Reprod Biomed Online. 2003;7:485–92.

    Article  PubMed  Google Scholar 

  50. Allamaneni SS, Bandaranayake I, Agarwal A. Use of semen quality scores to predict pregnancy rates in couples undergoing intrauterine insemination with donor sperm. Fertil Steril. 2004;82:606–11.

    Article  PubMed  Google Scholar 

  51. Shibahara H, Obara H, Ayustawati, et al. Prediction of pregnancy by intrauterine insemination using CASA estimates and strict criteria in patients with male factor infertility. Int J Androl. 2004; 27:63–8.

    Google Scholar 

  52. Aitken RJ. Whither must spermatozoa wander? The future of laboratory seminology. Asian J Androl. 2010;12:99–103.

    Article  PubMed  Google Scholar 

  53. Deepinder F, Chowdary HT, Agarwal A. Role of metabolomic analysis of biomarkers in the management of male infertility. Expert Rev Mol Diagn. 2007;7:351–8.

    Article  PubMed  CAS  Google Scholar 

  54. Desai N, Sharma R, Makker K, Sabanegh E, Agarwal A. Physiologic and pathologic levels of reactive oxygen species in neat semen of infertile men. Fertil Steril. 2009;92:1626–31.

    Article  PubMed  Google Scholar 

  55. Carlsen E, Giwercman A, Keiding N, Skakkebaek NE. Evidence for decreasing quality of semen during past 50 years. BMJ. 1992;305:609–13.

    Article  PubMed  CAS  Google Scholar 

  56. de Kretser DM. Declining sperm counts: environmental chemicals may be to blame. BMJ. 1996;312:457–8.

    Article  PubMed  Google Scholar 

  57. Sharpe RM, Skakkebaek NE. Are oestrogens involved in falling sperm counts and disorders of the male reproductive tract? Lancet. 1993;341:1392–5.

    Article  PubMed  CAS  Google Scholar 

  58. Fisch H. Declining worldwide sperm counts: disproving a myth. Urol Clin N Am. 2008;35:137–46.

    Article  Google Scholar 

  59. Sherins RJ. Are semen quality and male fertility changing? NEJM. 1995;332:327–8.

    Article  PubMed  CAS  Google Scholar 

  60. Fisch H, Goluboff ET. Geographic variations in sperm counts: a potential cause of bias in studies of semen quality. Fertil Steril. 1996;65:1044–6.

    PubMed  CAS  Google Scholar 

  61. Fisch H, Goluboff ET, Olson JH, Feldshuh J, Broder SJ, Barad DH. Semen analyses in 1,283 men from the United States over a 25-year period: no decline in quality. Fertil Steril. 1996;65:1009–14.

    PubMed  CAS  Google Scholar 

  62. Saidi JA, Chang DT, Goluboff ET, Bagiella E, Olsen G, Fisch H. Declining sperm counts in the United States? A critical review. J Urol. 1999;161:460–2.

    Article  PubMed  CAS  Google Scholar 

  63. Niederberger CS, Joyce GF, Wise M, Meacham RB. Male infertility. In: Litwin MS, Saigal CS, editors. Urologic diseases in America. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: U.S. Government Printing Office; 2007, NIH Publication No. 07-5512. p. 461–81.

    Google Scholar 

  64. Centers for Disease Control and Prevention (CDC), American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2007 assisted reproductive technology success rates: national summary and fertility clinic reports. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2009.

    Google Scholar 

  65. Wright VC, Schieve LA, Reynolds MA, Jeng G. Assisted reproductive technology surveillance—United States, 2000. MMWR Surveill Summ. 2003;52(No. SS-9):1–16.

    PubMed  Google Scholar 

  66. Drummond MF, Schulpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. 3rd ed. New York, NY: Oxford University Press; 2005. p. 277–322.

    Google Scholar 

  67. Shin D, Honig SC. Economics of treatments for male infertility. Urol Clin N Am. 2002;29:841–53.

    Article  Google Scholar 

  68. Robb P, Sandlow JI. Cost-effectiveness of vasectomy reversal. Urol Clin N Am. 2009;36:391–6.

    Article  Google Scholar 

  69. Lee R, Li PS, Goldstein M, Schattman G, Schlegel PN. A decision analysis of treatments for nonobstructive azoospermia associated with varicocele. Fertil Steril. 2009;92:188–96.

    Article  PubMed  Google Scholar 

  70. Penson DF, Paltiel AD, Krumholz HM, Palter S. The cost-effectiveness of treatment for varicocele related infertility. J Urol. 2002;168: 2490–4.

    Article  PubMed  Google Scholar 

  71. Meng MV, Greene KL, Turek PJ. Surgery or assisted reproduction? A decision analysis of treatment costs in male infertility. J Urol. 2005;174:1926–31.

    Article  PubMed  Google Scholar 

  72. Hsieh MH, Meng MV, Turek PJ. Markov modeling of vasectomy reversal and ART for infertility: how do obstructive interval and female partner age influence cost effectiveness? Fertil Steril. 2007;88:840–6.

    Article  PubMed  Google Scholar 

  73. Esteves SC, Oliveira FV, Bertolla RP. Clinical outcome of intracytoplasmic sperm injection in infertile men with treated and untreated clinical varicocele. J Urol. 2010;184:1442–6.

    Article  PubMed  Google Scholar 

  74. Boyd JC. Defining laboratory reference values and decision limits: populations, intervals, and interpretations. Asian J Androl. 2010;12:83–90.

    Article  PubMed  Google Scholar 

  75. Niederberger C. Responses to semen analysis CART report. J Androl. 2003;24:329–31.

    PubMed  Google Scholar 

  76. Thompson IM, Ankerst DP, Etzioni R, Wang T. It’s time to abandon an upper limit of normal for prostate specific antigen: assessing the risk of prostate cancer. J Urol. 2008;180:1218–22.

    Google Scholar 

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Acknowledgments

The author would like to thank Kelli M. Mulder-Westrate and Ranya N. Sweis for critically reviewing several drafts of this chapter and offering helpful advice. Jonathan L. Faasse and Kristin M. Faasse provided valuable assistance with the figures.

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Authors and Affiliations

  1. Department of Urology, University of Illinois at Chicago, 840 South Wood Street, M/C 955, Chicago, IL, 60616, USA

    Mark A. Faasse MD

  2. Department of Urology, University of Illinois at Chicago College of Medicine and Department of Bioengineering, University of Illinois at Chicago College of Engineering, Chicago, IL, 60616, USA

    Craig S. Niederberger MD, FACS

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  1. Mark A. Faasse MD
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Correspondence to Mark A. Faasse MD .

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Editors and Affiliations

  1. University of Florida, Director, Robotic Surgery, Winter Haven Hospital &, 200 Avenue F. N.E., Winter Haven, 33881, Florida, USA

    Sijo J. Parekattil

  2. Center for Reproductive Medicine, Department of Urology, Cleveland Clinic, Euclid Avenue 9500, Cleveland, 44195, Ohio, USA

    Ashok Agarwal

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Faasse, M.A., Niederberger, C.S. (2012). Epidemiological Considerations in Male Infertility. In: Parekattil, S., Agarwal, A. (eds) Male Infertility. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3335-4_14

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  • DOI: https://doi.org/10.1007/978-1-4614-3335-4_14

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