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SYMPOSIUM-EDITORIAL
Year : 2011  |  Volume : 27  |  Issue : 1  |  Page : 39-40
 

Male infertility - Current concepts


Department of Urology, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication29-Mar-2011

Correspondence Address:
Rajeev Kumar
Department of Urology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.78419

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How to cite this article:
Kumar R. Male infertility - Current concepts. Indian J Urol 2011;27:39-40

How to cite this URL:
Kumar R. Male infertility - Current concepts. Indian J Urol [serial online] 2011 [cited 2019 Oct 20];27:39-40. Available from: http://www.indianjurol.com/text.asp?2011/27/1/39/78419


Among the various pathologies that afflict humans, infertility has a special place. It usually does not result in physical morbidity, pain, limitation of activity or longevity. However, its impact on the psychological and social wellbeing of not only the index patient but also his or her partner makes it a major concern for health professionals. In the US, more than four in five practicing urologists admit to treating infertility. Considering its high prevalence and widespread impact, it has been included as a part of the national program for reproductive and child health in India.

There are a number of problems in evaluating and treating male infertility. These begin with a lack of standard tests for assessing fertility. Unexplained infertility occurs even when all known tests are normal. There are issues with performing a basic semen analysis since semen is exquisitely sensitive to storage conditions and reporting often does not follow guidelines. The etiologic factors in male infertility continue to be debated and there is incomplete knowledge about its pathophysiology.

Next comes the issue of trained specialists and resource availability. There is a severe shortage of established and recognized training centers in andrology and male infertility in India. Most practitioners learn andrology as a part of their urology training with no additional fellowships. Infertility evaluation, and even surgery, is often performed perfunctorily. Microsurgery for male infertility is a difficult surgical skill and, in the face of already low success rates, performance by non-trained surgeons heightens the cynicism against it. Added to this is the lack of proven pharmacotherapy. When most drugs do not seem to work, there is a tendency to try even more!

While these problems dog the management of male factor abnormalities, there have been massive developments in the field of assisted reproduction. All it needs now is a single immature sperm or even a spermatid for the embryologist to produce an embryo in the laboratory. Since the bulk of infertility patients are evaluated and treated by gynecologists, there is an increasing trend to bypass the male entirely and use him simply as a sperm donor. Infertility is therefore one of the rare conditions where disease in one- an azoospermic male- may result in the healthy partner undergoing extensive, painful and life-threatening interventions such as ovarian stimulation and ovum harvest for in-vitro fertilization (IVF).

The symposium on male infertility in this issue of the Journal contains 11 articles on the current concepts of evaluating and managing male infertility. The first article on semen analysis details the conduct of a proper laboratory evaluation and the indications for additional testing. There is wide variability in the practice of andrology and the article on guidelines-based management discusses the need for uniform practice patterns and the lacunae in the existing guidelines. Varicoceles continue to be a topic for debate and this is addressed in two different articles which present current knowledge about the pathophysiology of varicocele-induced infertility and the options for their management. The lack of established treatment for idiopathic infertility has resulted in aggressive marketing of poorly researched molecules. The article on oxidative stress looks at a number of these molecules and their true value. Obstructive azoospermia is one of the curable causes of male infertility and the surgical techniques for its correction are presented with extensive diagrams by authors who are pioneers in these techniques.

The male infertility specialist has a role to play even in cases where he cannot cure his patient. Evaluating the underlying genetic abnormalities has become important because assisted reproduction bypasses natural selection and allows defective genetic material to be transmitted to the offspring. The andrologist is also required when sperm need to be harvested from the epididymis or the testis. Both these issues are discussed in two articles and finally the article on IVF and intracytopaslmic sperm injection aims at making these techniques better understood by the urologists.

The authors for this symposium are international luminaries and include urologists, andrologists, IVF specialists and basic scientists. All have contributed personal research to the international literature and the articles in this symposium are specific to their areas of expertise. I was pleasantly surprised when every single one of our invitations to contribute was accepted. It is a testimony to the commitment of these individuals to science that they provided such excellent manuscripts within six to eight weeks. I am grateful to them for their contribution and to the Journal for providing us this opportunity.




 

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