2022 - Lesson 33 Male Infertility

Question 1

When is sperm DNA fragmentation analysis recommended in male infertility workup?

Answer 1

Sperm DNA fragmentation analysis is used for specific indications such as recurrent pregnancy loss.

Question 2

What are Selective Estrogen Receptor Modulators (SERMs), and how are they used in male infertility?

Answer 2

SERMs like Clomiphene are recommended for idiopathic oligozoospermia.

Question 3

What is the stance on antioxidant therapy in the management of male factor infertility?

Answer 3

Evidence supports the use of antioxidant supplements in specific cases, with caution against overuse due to a lack of robust evidence.

Question 4

What are the considerations for testosterone therapy in male infertility with low testosterone?

Answer 4

Testosterone therapy is considered for patients with low testosterone, weighing the risks and benefits.

Question 5

What is the guideline’s stance on genetic testing in male infertility workup?

Answer 5

Genetic testing, including sperm DNA fragmentation analysis, chromosomal abnormalities, and Y-chromosome microdeletions, is recommended for specific indications.

Question 6

What hormonal treatments are suggested for abnormal semen parameters in male infertility?

Answer 6

The guideline recommends testosterone therapy for patients with low testosterone and Selective Estrogen Receptor Modulators (SERMs) like Clomiphene for idiopathic oligozoospermia.

Question 7

What does the document define as the timing for the initial evaluation of infertility?

Answer 7

: Infertility is defined as the failure to conceive after 1 year of unprotected sexual intercourse, and couples should be evaluated by a fertility specialist at that point.

Question 8

What does the document recommend for men in couples experiencing recurrent pregnancy loss (RPL)?

Answer 8

The document recommends that men in couples with RPL be evaluated with a karyotype and SDF analysis.

Question 9

What does the 2020 guideline recommend regarding the initial evaluation of infertility in couples?

Answer 9

The 2020 guideline recommends concurrent assessment of both male and female partners as part of the initial infertility evaluation.

Question 10

What are the potential consequences of advanced paternal age in relation to fertility and offspring health?

Answer 10

Advanced paternal age can contribute to genetic mutations, chromosomal abnormalities, worsened semen parameters, an increased rate of miscarriage, and greater morbidity in offspring, including associations with certain malignancies and neuropsychiatric conditions.

Question 11

What is the recommended evaluation timing for couples where the female partner is 35 or older?

Answer 11

The recommendation is for couples to be evaluated after 6 months of failure to conceive if the female partner is 35 or older.

Question 12

Age-related decline in ovarian reserve and oocyte quality leads to the recommendation for earlier evaluation.

Answer 12

Earlier evaluation is recommended due to age-related decline in ovarian reserve and oocyte quality.

Question 13

What challenges are associated with women aged 35 or older in terms of fertility?

Answer 13

There is a decline in fertility potential and an increased time to conception in women of this age.

Question 14

What is new about the 6-month time interval for evaluation in the AUA/ASRM guideline?

Answer 14

The specific time interval of 6 months for evaluation had not been previously explicitly stated in the AUA/ASRM guideline.

Question 15

What does the 2020 guideline recommend regarding the concurrent assessment of male and female partners?

Answer 15

The 2020 guideline recommends that male and female partners undergo concurrent assessment as part of the initial infertility evaluation, focusing on abnormal semen parameters or concerns for male factor infertility.

Question 16

When is male evaluation specifically recommended in infertility cases?

Answer 16

Male evaluation is recommended for couples with failed assisted reproductive technology (ART) cycles or recurrent pregnancy losses (RPLs), defined as 2 or more losses.

Question 17

Why is emphasizing male partner evaluation in infertility cases important?

Answer 17

Emphasizing male partner evaluation is important because it is often delayed or altogether overlooked.

Question 18

What did a 2019 study by Samplaski et al reveal about male infertility evaluation?

Answer 18

The study revealed that only 4.8% of men seen at centers specializing in male infertility had previously undergone an evaluation by a reproductive urologist.

Question 19

What disparity does the text highlight between couples treated with ART and men evaluated by a reproductive urologist?

Answer 19

Despite 17% of couples being treated with ART, only 4.8% of men were evaluated by a reproductive urologist.

Question 20

Who are the main referring parties for men in male infertility evaluations?

Answer 20

Approximately 60% of men were referred by reproductive endocrinologists, and 20% by primary care providers.

Question 21

Why is a definitive recommendation for the timely evaluation of the male partner necessary?

Answer 21

It is necessary to effect improvements in clinical practice.

Question 22

What specific changes are highlighted in the 2020 guideline regarding male infertility?

Answer 22

The 2020 guideline emphasizes the association of medical comorbidities with male infertility and specifically discusses advanced paternal age.

Question 23

How is advanced paternal age defined in the context of male infertility?

Answer 23

Advanced paternal age is defined as a male partner aged 40 years or older.

Question 24

What genetic factors are associated with advanced paternal age?

Answer 24

Advanced paternal age contributes to more de novo genetic mutations and chromosomal abnormalities.

Question 25

How does advanced paternal age affect semen parameters?

Answer 25

Advanced paternal age leads to worsened semen parameters.

Question 26

What are the broader health implications of advanced paternal age on offspring?

Answer 26

It is associated with an increased rate of miscarriage, greater offspring morbidity, and likely associations with some childhood malignancies, rare musculoskeletal syndromes, and neuropsychiatric conditions such as schizophrenia and autism spectrum disorders.

Question 27

What are the primary considerations in the evaluation of male infertility, leading to the discussion of genetic testing?

Answer 27

Physical examination and semen analysis are paramount, and based on these, hormonal evaluation may be warranted as part of the fertility evaluation.

Question 28

For which conditions is genetic testing advised?

Answer 28

For which conditions is genetic testing advised?

Question 29

When is testing for Y chromosome microdeletions recommended?

Answer 29

In specific clinical scenarios, including nonobstructive azoospermia and severe oligospermia.

Question 30

When is CFTR mutation analysis recommended?

Answer 30

For men with congenital bilateral absence of the vas deferens (CBAVD).