Nonsurgical Management of Oligozoospermia.

Male infertility secondary to oligozoospermia is surprisingly common. Although a majority of cases are idiopathic, oligozoospermia can be caused by endocrine dysfunction, anatomic abnormalities, medications, or environmental exposures. The work-up includes excluding reversible factors such as hormonal deficiency, medication effects, and retrograde ejaculation and identifying any underlying genetic syndrome and treating reversible medical causes. If no reversible cause is found, appropriate referrals to urology and assisted reproductive technology should be initiated. Lastly, clinicians should be aware of and respond to the psychological and general health ramifications of a diagnosis of oligozoospermia as part of the comprehensive care of men and couples struggling with a diagnosis of infertility.

Male Infertility and Somatic Health.

Somatic health is associated with male infertility; potential links between infertility and health may arise from genetic, developmental, and lifestyle factors. Studies have explored possible connections between male infertility and oncologic, cardiovascular, metabolic, chronic, and autoimmune diseases. Male infertility also may be a predictor of hospitalization and mortality. Additional research is required to elucidate the mechanisms by which male infertility affects overall health.

Comprehensive men's health and male infertility.

There is increasing evidence that male infertility may be a harbinger of comorbid medical illness. Existing studies have shed light on associations between infertility and the prevalence of cardiovascular, metabolic, and oncologic disease, along with rates of hospitalization and overall mortality. Although theorized mechanisms include genetic, developmental, and behavioral precipitants, the exact nature of these associations remains unclear and warrants further investigation.

Male infertility as a window to health.

There is an emerging body of evidence suggesting that male infertility may be a harbinger of future health. Potential associations between infertility and health may arise from genetic, developmental, and lifestyle factors. Studies have explored possible links between male infertility and oncologic, cardiovascular, metabolic, and autoimmune diseases. Male infertility may also be a predictor of hospitalization and mortality. Additional research is required to elucidate the mechanisms by which male infertility affects overall health.

Fertility Preservation Preferences and Perspectives Among Adult Male Survivors of Pediatric Cancer and Their Parents.

Purpose: In this study, we set out to determine the preferences, concerns, and attitudes toward fertility preservation of adult male survivors of pediatric cancer and their parents. Methods: We conducted 3 focus groups with a total of 15 male survivors of pediatric cancer (age at diagnosis: mean=14, range: 10-20; age at study: mean=35, range: 25-47) and 2 groups with a total of 7 parents of survivors. Grounded theory methodology was used for the identification and analysis of recurrent themes expressed by survivors and their parents in the course of focus group discussions. Results: Themes most frequently expressed by survivors included concern regarding long-term treatment effects and a retrospective desire for fertility impairment to have been discussed when they were originally diagnosed with cancer. Parental themes included the same hindsight desire, as well as reliance upon the treating oncologist for direction in selecting the course of treatment, and an acknowledgment that input from a specialist in fertility preservation would have been beneficial. Conclusions: Although future reproductive potential was not consistently reported as a source of apprehension when diagnosed with cancer, both survivors and their parents noted it to be a paramount concern later in life. Parents and survivors both reported that fertility preservation discussions should be routinely incorporated in the clinical context of a pediatric cancer diagnosis.

The determination of reproductive safety in men during and after cancer treatment.

Fertility-related concerns are frequently encountered in the course of providing care to oncologic patients. Male cancer survivors who desire paternity after cancer treatment face the question of whether their posttherapy sperm can be safely used in either natural or assisted conception attempts. Although the reproductive risks of using sperm genetically compromised by chemotherapy or radiotherapy include impaired embryonal development, pregnancy loss, and congenital anomalies in offspring, there is a general lack of consensus in the literature concerning the persistence of sustained genotoxic effects, making it difficult to assuredly quantify the level of risk involved. Transmission of chemotherapeutic agents via seminal plasma is another potential risk that has not yet been well evaluated. Sperm chromosomal aneuploidy rates and DNA fragmentation indices provide means of assessing genomic damage that could prove useful in genetic counseling efforts. Ultimately, additional research is needed to clarify investigational discrepancies and establish a stronger body of evidence that would allow for the development of clinical guidelines to assist cancer patients considering posttreatment conception in their decision-making processes.

Predictors of spermatogenesis in orchiectomy specimens.

OBJECTIVE: To evaluate the presence of spermatogenesis in orchiectomy specimens of patients with testicular cancer to determine possible predictors of success with oncologic testicular sperm extraction of the cancerous testis at orchiectomy. MATERIALS AND METHODS: We retrospectively reviewed the pathology reports and slides from 83 men who underwent radical orchiectomy for testicular cancer at 2 institutions from 1999 to 2010. The presence or absence of spermatogenesis in each specimen was determined. Data on tumor histopathologic type, serum tumor markers, and tumor size were also obtained and analyzed to detect any associations with the presence of spermatogenesis. RESULTS: The 83 specimens included 41 pure seminomas, 36 nonseminomatous and mixed germ cell tumors, and 6 benign lesions. Overall, spermatogenesis was detected in 48 of 77 (62%) cancerous specimens. Spermatogenesis was present in 22 of 41 (54%) pure seminomas and 26 of 36 (72%) nonseminomatous and mixed germ cell tumors, with no significant difference found between the 2 subtypes (P = .11). No association was found between tumor marker levels and the presence of spermatogenesis. A logistic regression model revealed a statistically significant inverse relationship between tumor size and spermatogenesis presence (P = .004). CONCLUSION: At orchiectomy, most cancerous testes contained active spermatogenesis and, thus, represent a viable source for sperm cryopreservation with oncologic testicular sperm extraction. A small tumor size proved to be a positive prognostic indicator for the presence of spermatogenesis, although a larger tumor size did not preclude the presence of spermatogenesis.

Overview of current approaches to the evaluation and management of male infertility.

Infertility, the inability to conceive after one year of regular, unprotected intercourse, is secondary to male-only factors in 20% and a combination of male and female factors in 30% to 40% of cases. Advances in the identification and management of male factor infertility have provided new and often successful options for paternity.