Assessing the male in fertility clinics—men undervalued, undermanaged and undertreated

tau.amegroups.com © Translational Andrology and Urology. All rights reserved. Having commenced a specialist career focused on resolving infertility for couples since 1976 (JLY), the following issues have firmed over the 40 years:  Infertility arises as an issue for “couples”, meaning the majority of cases have identifiable issues from both partners.  Such couples should be managed together in a Fertility Clinic which embraces the full gamut of assisted reproductive technologies (ART) including intra-uterine insemination (IUI) and in vitro fertilisation (IVF) along with an integrated Andrology service.  The interaction of the identifiable fertility factors is complex and not fully clarified despite the phenomenal advances in knowledge concerning reproduction over this period.  There is an awakening that the factors impacting on the fertilization of gametes probably has an equivalent likelihood from the perspective of both the male (spermatozoa) as well as the female (oocytes), although the dynamic processes affecting spermatogenesis and oogenesis are very different.  Despite this acknowledgement, the majority of Fertility Clinics worldwide remain focused on the female who always gets a thorough clinical evaluation as well as screening tests and the consideration of numerous treatment options; whereas similar focus for the male generally occurs only when a semen analysis is severely “abnormal”.  The evolution of IVF provided opportunity for pregnancies despite some degree of “male factor” infertility (1), but the process of intracytoplasmic sperm injection (ICSI) curtailed clinical research on the male aspects, almost completely.