This page contains a Flash digital edition of a book.
on to the child through IVF and we now have the technology to genetically screen embryos.


TESTING The semen analysis is an excellent screening tool for


male infertility in that it identifies most men who might have a problem conceiving. The semenalysis is quite variable and normally fluctuates to some degree over time, which is why it is recommended that at least 2 tests be performed separated by some degree of time. Unfortunately, the semen analysis is a poor predictive tool as to who will eventually be able to father a child. The reason is that the test is observational, not functional, meaning we can tell patients how many sperm are present compared to normal (sperm count), how many are moving (motility) and what the sperm look like (morphology) but unless a patient is at the very low ends of the spectrum, we can’t tell much about how the sperm will work or how damaged they really are. Newer tests have been developed that measure the level of sperm susceptibility to DNA damage, the degree of sperm maturity and the level of oxidative stress in the semen sample. All of these parameters independently correlate with infertility and give some predictive information as to how and in what ways we should be using the sperm to most efficiently establish a healthy pregnancy and who might be at higher risk for miscarriage. They also allow us to differentiate those patients who will most benefit from attempting to improve their sperm quality versus those who might go directly to ART with an expected high level of success. Of course no single test has 100% positive predictive value and all give a different piece of the puzzle that allows us to draw conclusions and make recommendations to patients. With fertility things get even more complicated because there are so many variables or “moving parts” including timing and the ability of a woman’s egg to overcome certain deficiencies within a given sperm cell.


The exciting thing is that with these newer tests, our understanding of the causes of infertility have increased, more research is being undertaken and with


that, our ability to tailor treatment to a patient’s situation is leading to higher pregnancy rates and couples achieving their ultimate goal.


WHO SHOULD BE EVALUATED


The recommendation of the ASRM and AUA joint panel on best practice policies for male infertility is that all men with 2 abnormal semen analyses be evaluated by a physician with expertise in treating male infertility. The evaluation should consist of a detailed patient history and well as a complete physical examination. Advanced sperm testing as well as hormone evaluation, genetic testing and radiological imaging may be performed as indicated


NEW TREATMENT STRATEGIES Research on sperm DNA fragmentation has led to the


development of new treatment alternatives for men with abnormal sperm. It ha shown that men with high


THE RESOURCES LISTED IN THIS DIRECTORY ARE UNSCREENED AND SHOULD NOT BE VIEWED AS RECOMMENDATIONS OR ENDORSEMENTS, EITHER EXPRESS OR IMPLIED, BY THE AFA. 51


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132  |  Page 133  |  Page 134  |  Page 135  |  Page 136  |  Page 137  |  Page 138  |  Page 139  |  Page 140  |  Page 141  |  Page 142  |  Page 143  |  Page 144  |  Page 145  |  Page 146  |  Page 147  |  Page 148  |  Page 149  |  Page 150  |  Page 151  |  Page 152  |  Page 153  |  Page 154  |  Page 155  |  Page 156  |  Page 157  |  Page 158  |  Page 159  |  Page 160  |  Page 161  |  Page 162  |  Page 163  |  Page 164  |  Page 165  |  Page 166  |  Page 167  |  Page 168