From Diagnosis to Treatment: Comprehensive Care by Reproductive Urologists in Assisted Reproductive Technology
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Data Sources and Search Strategy
2.3. Search Terms
2.4. Inclusion and Exclusion Criteria
2.5. Study Selection and Data Extraction
3. Understanding the Role of Urologists in Male Infertility Management amid the Advancements in Assisted Reproductive Technology
4. The Urologist’s Role in Evaluation and Diagnosis
4.1. Evaluation and Diagnosis of Male Infertility
4.2. Identification of Patients Who Would Not Require Anything Other than ART
4.2.1. Oligoasthenoteratozoospermia
4.2.2. Isolated Teratozoospermia
4.2.3. Absolute Asthenozoospermia
4.2.4. Antisperm Antibodies
4.2.5. Globozoospermia
4.2.6. Female Aging
4.3. Identifications of Situations Where Donor Insemination or Adoption Is the Only Solution
4.3.1. Y Microdeletions
4.3.2. XX Male Syndrome
4.3.3. Testis-Expressed 11 Gene
5. The Pivotal Role of the Reproductive Urologist in Addressing Male Infertility and Enhancing ART Outcomes
5.1. Implementing Surgical Interventions in the Management of Male Infertility
5.1.1. Addressing Abnormal Sperm Production: A Focus on Non-Obstructive Azoospermia
5.1.2. The Interplay of Varicocele and Assisted Reproductive Technologies
5.1.3. Addressing Post-Testicular Obstructions: Surgical and ART Approaches
5.2. Pharmacological Approaches in the Management of Male Infertility
5.2.1. Genital Tract Infections
5.2.2. Hypogonadotropic Hypogonadism
5.2.3. Endocrine Disorders
5.2.4. Addressing Erectile Dysfunction and Premature Ejaculation for Fertility Enhancement
5.3. Role of Urologists in Managing the Impact of Lifestyle Factors on Male Fertility and Overall Health
5.4. The Reproductive Urologist’s Role in Special Circumstances
5.4.1. Addressing Idiopathic Recurrent Pregnancy Loss
5.4.2. Overcoming Recurrent Failures in Assisted Reproductive Technologies
5.4.3. Implications of DNA Fragmentation on ART Outcomes: Strategies for Sperm Isolation and Recovery
6. Uncovering Conditions That Might Affect the Offspring’s Health
6.1. Advanced Paternal Age
6.2. Effects of Klinefelter Syndrome on the Health of the Offspring
6.3. Consequences of Y-Chromosome Microdeletions
6.4. Impact of ICSI on the Offspring’s Health
7. Barriers to Urologist Involvement in the Era of Assisted Reproductive Technology
- Limited availability and distribution: One of the primary challenges is the limited number and distribution of specialized male reproductive urologists. Certain regions, especially rural or underserved areas, lack access to these experts, making it challenging for patients to seek specialized care [16].
- Lack of awareness and education: There is a significant knowledge gap among healthcare professionals and the general public regarding the role of urologists in male infertility. This lack of awareness leads to under-referral and underutilization of urologist services, with many cases of male infertility going undiagnosed or mismanaged [16].
- Financial constraints: The high costs associated with infertility treatments coupled with the absence of comprehensive health insurance coverage for such services in many regions deter many from seeking specialized care. This financial barrier is further exacerbated by the often-prohibitive costs of ART procedures [221].
- Misconceptions about infertility: A prevailing misconception exists that infertility is primarily a female-centric issue. This skewed perspective often results in a disproportionate focus on female infertility, sidelining male factors that, in reality, contribute to almost half of all infertility cases [16].
- Lifestyle and environmental factors: The modern era has seen a decline in male fertility attributed to various lifestyle and environmental factors. However, the role of urologists in addressing these factors and guiding patients toward healthier lifestyles remains underemphasized [12].
- Rapid advancements in ART: The swift advancements in ART techniques have sometimes overshadowed traditional diagnostic and therapeutic approaches. As a result, the emphasis on understanding and treating the root causes of male infertility, where urologists play a pivotal role, has been diminished [222].
8. The Future of Urologists: What Place Do They Have in the Era of ART?
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Categories/Condition | Description | Assessment/Tests | Treatment/Management |
---|---|---|---|
Male infertility evaluation | Evaluation of male infertility | Semen analysis and genetic testing | Individualized based on the findings |
Semen analysis abnormalities | Any irregularities found during semen analysis such as low sperm count, poor motility, or morphology | Semen analysis | A reproductive urologist can diagnose the underlying cause of the abnormalities and suggest appropriate treatments |
Azoospermia | Complete absence of sperm in the semen | Semen analysis | A reproductive urologist can help identify and treat the cause |
Leukocytospermia | Presence of white blood cells in the semen, which may indicate an infection or inflammation | Semen analysis | A reproductive urologist can determine the cause of the inflammation or infection and prescribe appropriate treatments |
Idiopathic recurrent pregnancy loss | Pregnancy loss due to unknown male factors such as sperm DNA integrity | SDF tests like TUNEL, SCSA, FISH analysis, and the sperm aneuploidy test | Lifestyle changes, antioxidant treatment, and PGT-M with IVF |
Recurrent ART failure | Repeated failure of ART procedures such as IVF | SDF tests like TUNEL and SCSA | A reproductive urologist can evaluate potential male factor causes for the failure of ART procedures and suggest alternatives or adjustments to the treatment plan |
ART results and DNA fragmentation | Impact of sperm DNA fragmentation on conception rates in IVF and ICSI | SDF assays | Lifestyle changes, varicocelectomy, and sperm retrieval |
Klinefelter syndrome | Infertility caused by additional X chromosome in males | Karyotyping | Assisted reproductive techniques and genetic counseling |
Y-chromosome microdeletions | Infertility due to deletions on the Y chromosome | Y deletion test | Assisted reproductive techniques, genetic counseling, and potential ICSI |
Advanced paternal age | Infertility associated with advanced paternal age | General health check-up and genetic tests | Counseling and possibly assisted reproductive techniques |
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Kaltsas, A.; Dimitriadis, F.; Zachariou, D.; Zikopoulos, A.; Symeonidis, E.N.; Markou, E.; Tien, D.M.B.; Takenaka, A.; Sofikitis, N.; Zachariou, A. From Diagnosis to Treatment: Comprehensive Care by Reproductive Urologists in Assisted Reproductive Technology. Medicina 2023, 59, 1835. https://doi.org/10.3390/medicina59101835
Kaltsas A, Dimitriadis F, Zachariou D, Zikopoulos A, Symeonidis EN, Markou E, Tien DMB, Takenaka A, Sofikitis N, Zachariou A. From Diagnosis to Treatment: Comprehensive Care by Reproductive Urologists in Assisted Reproductive Technology. Medicina. 2023; 59(10):1835. https://doi.org/10.3390/medicina59101835
Chicago/Turabian StyleKaltsas, Aris, Fotios Dimitriadis, Dimitrios Zachariou, Athanasios Zikopoulos, Evangelos N. Symeonidis, Eleftheria Markou, Dung Mai Ba Tien, Atsushi Takenaka, Nikolaos Sofikitis, and Athanasios Zachariou. 2023. "From Diagnosis to Treatment: Comprehensive Care by Reproductive Urologists in Assisted Reproductive Technology" Medicina 59, no. 10: 1835. https://doi.org/10.3390/medicina59101835