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Created Date: پنج شنبه 11 تیر 1392 Visit Count: 1085 Comments: 0 Author: host
Counseling the Infertile Male
Counseling men with a sperm problem has been hampered by the high proportion of cases with no definite diagnosis, categorized under the euphemism of “idiopathic” abnormal semen analysis.

Counseling men with a sperm problem has been hampered by the high proportion of cases with no definite diagnosis, categorized under the euphemism of “idiopathic” abnormal semen analysis. This has turned the efforts for therapeutic interventions into a mess of different and often contradicting empiric treatments, aiming at activating or superactivating different components of the system. Moreover, most of these interventions did not satisfy the evidence-based criteria and had completely ignored the female partner’s role by not including pregnancy as the main outcome measure. A precise diagnosis, when feasible, is the cornerstone of any attempt to council the male partner of a couple with infertility. Instrumental in this effort and in devising a proper therapeutic strategy is the consideration of the reproductive history of the couple. Moreover, in managing male infertility and since normalization or restoration of sperm is possible only on a few occasions, all efforts should be focused toward improving semen’s quality, thus making the best possible use of the spermatozoa available. Normalization or treatment of undisputedly recognized causal factors produce generally satisfactory results, depending on the individual diagnostic category. Thus, for example, normalizing an endocrine deviation is apparently the best prospect for this diagnostic category, whereas in other classes the prospects range from low to very low to nonexistent. On the other hand, in the largest category of all, the idiopathic oligozoospermia (low sperm count), empiric treatment, aiming at improving sperm parameters, has been proposed and tested, sometimes successfully. The importance of simultaneous monitoring of the female partner with intervention, if need be, is a sine-qua non and cannot be stressed adequately. Obviously, when sperm improvement is substantial, there is no need but only for the normal partner’s monitoring. However, very often sperm improvement may be partial so that, although natural conception has some reasonable chances to occur, downgrading of the requirements for assisted reproductive techniques (ART) application may be a legitimate task with all the economic, psychological, etc., advantages ensuing. Such an approach would reduce not only the treatment load for the female partner but also the pregnancy and offspring-related problems. An important issue not adequately addressed so far is the overall future of dyspermic (abnormal sperm count, motility and/or morphology) men not only in terms of genital organ morbidities but also regarding their gonadal hormone secretion in the years to come. It is therefore essential that these subjects are advised to keep-up their periodic visits to the clinic irrespective of their reproductive problem’s outcome.

Clinical recommendations

Based on the information presented, a number of clinical recommendations may be of help for the reader; these are as follows:

–The fertility potential of the male partner after pregnancy failure in efforts for more than a year should be investigated, although this period should not necessarily be exhausted on certain occasions.

– An effort to arrive to a precise diagnosis is of paramount importance and no investigative tools should not only be spared toward accurately establishing it for patients benefit, selection of therapeutic approach, prognosis, and therapeutic outcome but also for establishing a sound basis of reliable data for proper use in future.

– A possible impact on a man’s reproductive health should be investigated meticulously a, particularly in relation to his individual, local or general, conditions of life.

–A proper estimation of the cost for any therapeutic intervention on evidence-based grounds should be made, so that the expense required is justified in terms of effectiveness both for the patient and the society at large.

– It is essential to council prospective fathers of advanced paternal age about the risks regarding pregnancy and the offspring at this period of their life.
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