How can we check male fertility?

Abstract:

Objectives:

To determine the predictive role of preoperative semen analysis on both seminal improvement and pregnancy rates following varicocelectomy.

Design:

Retrospective data analysis.

Setting:

Two academic medical "center" infertility clinics.

Patients:

One hundred ten consecutive patients who underwent varicocelectomies. Seminal improvement data were available for 84 patients, and pregnancy data were available for 58 patients.

Interventions:

Stratification of patients based on preoperative total motile sperm count (TM). Varicocelectomy was performed on all patients.

Main Outcome Measure(s):

TMs, pregnancy rates, and conception techniques following varicocelectomy of each preoperative group.

Results:

Men with mild to moderate oligoasthenospermia (TM<5 million) had significantly better seminal improvement following varicocelectomy. While preoperative stratification showed no difference in pregnancy rates (when assisted reproductive techniques were included), men who achieved a postoperative TM >20 million were more likely to achieve conception by less invasive techniques (natural and intrauterine insemination vs. in vitro fertilization [IVF]).

Conclusion(s):

Varicocelectomy may be the most cost-effective initial intervention in males with TM >5 million. Patients with TM<5 million and concomitant female factor infertility may be better initial candidates for IVF.

Please click on the required question.

• 1 What is infertility?
• 2 How prevalent are infertility problems?
• 3 What are the main causes of infertility?
• 4 What are the objectives of our infertility investigations?
• 5 Have there been any noticeable changes in fertility requirements in recent years?
• 6  What is the effect of our age on fertility?
• 7 I smoke cigarettes. Can this have an effect on my fertility?
• 8 Does my weight influence fertility?
• 8A Obesity! How can I lose weight?
• 9 I have fibroids. Could these reduce my fertility?
• 10 I have been told that my womb has an abnormal shape and that was the way that I was born. Could this reduce my fertility?
• 11 I have endometriosis. Could this reduce my fertility?
• 12 I have been told that I have cervicitis or a cervical ectopy (erosion). Could this impair my fertility?
• 13 My doctor tells me that my womb is retroverted (tilts backwards). Could this reduce my fertility?
• 14 I have had an ectopic pregnancy. Does this affect my future fertility?
• 15  We are worried that we may have a fertility problem. What should we do?
• 16 How will our doctor be able to identify the cause of our infertility?
• 17 How can we tell if I am releasing my eggs (ovulating)?
• 18 Investigations have shown that I have a problem releasing my eggs (anovulation). What could be the cause of this?
• 19 How important are my Fallopian tubes in fertility?
• 20 How can we tell if my Fallopian tubes are functioning?
• 21a What are the causes of male factor infertility?
• 21 How can we assess male fertility?
• 22  What is the purpose of a post-coital test (PCT)?
• 23 We have had our infertility investigations and our problem remains unexplained. How can this be?
• 24 What are our chances of achieving a pregnancy?
• 25 Where can I obtain more information?
• 26 Could we have some recommended infertility support groups?
  

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

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