WHO Manual for the Standardized Investigation

The treatment of male infertility has been revolutionised by advances in assisted reproductive technology. This concise and structured account, prepared by an authoritative international panel of experts, provides a consensus on the most effective and logical approach to the investigation and management of male infertility. It focuses attention on three key areas: history taking; clinical assessment of male fertility; and objective criteria for diagnostic categories. This approach complements the areas covered in the companion volume WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction (CUP, fourth edition, 1999) and significantly expands upon the section on male infertility in the previous volume on the infertile couple, WHO Manual for the Standardized Investigation and Diagnosis of the Infertile Couple (CUP, 1993). This new, practical consensus will be an indispensable guide to good clinical management of all forms of male infertility.

Preface

ix

International board of experts

x

Introduction

1

(4)

History-taking

5

(12)

The definition of infertility

5

(3)

Primary male infertility

6

(1)

Impregnation

6

(1)

Secondary male infertility

6

(1)

The duration of involuntary infertility

7

(1)

Previous investigations and/or treatment for infertility

8

(1)

History of diseases with possible adverse effect on fertility

8

(5)

Fever

8

(2)

Medical interventions

10

(1)

History of surgery

10

(2)

Urinary tract infection

12

(1)

Sexually transmitted disease

12

(1)

Epidiymitis

13

(1)

Pathology possibly causing testicular damage

13

(1)

Mumps orchitis

13

(1)

Testicular injury

13

(1)

Testicular torsion

13

(1)

History of varicocele

14

(1)

Testicular maldescent

14

(1)

Other factors with possible adverse effect on fertility

14

(3)

Sexual and ejaculatory function

15

(2)

Clinical assessment of male fertility

17

(20)

Physical examination

17

(8)

General examination

17

(1)

Gynecomastia

17

(1)

Examination of the penis

18

(1)

Examination of the testes

18

(3)

Examination of the epididymides

21

(1)

Examination of the vasa deferentia

22

(1)

Scrotal swelling

22

(2)

Varicocele

24

(1)

Inguinal examination

24

(1)

Examination of the prostate gland and seminal vesicles

24

(1)

Laboratory investigations

25

(6)

Semen analysis

25

(1)

Other laboratory investigations

26

(1)

Tests on blood and serum

26

(1)

Tests on urine

27

(1)

Prostatic expressed fluid

28

(1)

Hormone determinations

28

(2)

Chromosome and genetic analysis

30

(1)

Additional technical investigations

31

(6)

Scrotal thermography

31

(1)

Doppler investigations

32

(1)

Doppler ultrasonography

32

(1)

Duplex Doppler

33

(1)

Other imaging techniques

33

(1)

Ultrasonography (echography)

33

(1)

Imaging of the hypothalamo-pituitary region

33

(1)

Testicular biopsy

33

(4)

Objective criteria for diagnostic categories in the standardized management of male infertility

37

(40)

Semen classification

37

(3)

Interpretation of the result of semen analysis

37

(3)

Diagnostic categories and management

40

(18)

Sexual and/or ejaculatory dysfunction

43

(2)

Immunological cause

45

(1)

No demonstrable cause

46

(1)

Isolated seminal plasma abnormalities

47

(1)

Iatrogenic causes

47

(1)

Systemic causes

48

(1)

Congenital abnormalities

48

(2)

Acquired testicular damage

50

(1)

Varicocele

51

(1)

Male accessory gland infection (MAGI)

52

(2)

Endocrine causes

54

(1)

Idiopathic oligozoospermia

55

(1)

Idiopathic asthenozoospermia

55

(1)

Idiopathic teratozoospermia

56

(1)

Idiopathic cryptozoospermia

56

(1)

Obstructive azoospermia

56

(1)

Idiopathic azoospermia

57

(1)

General comments

58

(3)

General treatment strategy

58

(1)

Notes on assisted reproduction

59

(2)

Appendices

I Data collection form and flowchart

61

(8)

II Tanner pubertal stage

69

(4)

III Reference values for semen variables

73

(2)

IV Methods for spermatozoa selection for use in insemination or assisted reproduction

75

(2)

References

77

(10)

Index

87

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WHO Manual for the Standardized Investigation and Diagnosis of the Infertile Male

Summary

Table of Contents

Supplemental Materials