CLINICAL FOCUS 39 library at ausdoc . com . au / therapy-update
CF ausdoc LEARN . com . MORE au ONLINE X MONTH Visit 2020 our Therapy Update
CLINICAL FOCUS 39 library at ausdoc . com . au / therapy-update
home-based kits could also be employed in large-scale population studies examining the impact of lifestyle modifications or environmental influences on sperm parameters — potentially aiding identification and management of male infertility . 8
Azoospermia About one in 100 healthy men are azoospermic , and in around 70 – 80 % of these cases , the cause is non-obstructive . 9 In cases of obstructive azoospermia , surgical treatment may be an initial treatment option — for example , reanastomosis of prior vasectomy or microsurgical repair of epidydimal duct or vas deferens defects .
In many cases of non-obstructive azoospermia , isolated regions of spermatogenesis are still present within the testis , making sperm retrieval the only option to address infertility and enable these men to conceive their biological offspring . This may also be a suitable approach for complete obstructive conditions , such as congenital bilateral absence of the vas deferentia .
Microdissection testicular sperm extraction ( microTESE ) is a refined technique that involves microscopic dissection of the testis to identify nests of isolated spermatogenesis to extract with open biopsy . This targeted biopsy approach is more effective for sperm retrieval than open TESE and offers successful sperm retrieval rates between 30 %
10 , 11 and 60 %.
AI in sperm analysis Innovative AI methodologies are currently under development , aiming to employ machine learning – based analysis for evaluating sperm . 12 These utilise advanced deep-learning classification techniques that focus on routinely measured semen parameters , such as morphology and motility .
Notably , an AI-powered software has been devised that demonstrates an
astounding capability to identify sperm in samples extracted from severely infertile men at a rate 1000 times faster than highly trained human observers . This breakthrough in technology enables potentially viable sperm to be flagged well before a human evaluator can process the information comprehensively . 13
Table 1 . WHO semen analysis lower reference limits — changes across editions Semen characteristics 1999 2010 2021 Volume ( mL ) 2 1.5 1.4 Sperm concentration ( 10 6 / mL ) 20 15 16 Total motility (%) 50 40 42 Normal morphology (%) 14 4 4
Antioxidants for intracytoplasmic sperm injection ICSI involves injection of a single sperm into an oocyte , a technique that may be recommended in cases of male factor infertility . New Australian data suggest that adding antioxidants to the embryo culture fluid can boost ICSI fertilisation rates by 10 %. 14 It is theorised that antioxidants may have protective effects during embryogenesis .
On the horizon
Precision medicine The field of male infertility is witnessing a paradigm shift , marked by unprecedented
About one in 100 healthy men are azoospermic , and in around 70-80 % of these cases , the cause is non-obstructive .
advancements in understanding , diagnostics and therapeutic interventions . The introduction of advanced next-generation sequencing techniques — encompassing whole exome and whole genome sequencing — has initiated a significant upsurge in research pertaining to the molecular , cellular and systemic aberrations observed in a diverse range of male reproductive impairments . Close to 17,000 genes have been rigorously examined to establish causative roles beyond mere associations and to unravel mechanisms of action . 15 This deeper understanding is crucial for elucidating comprehensive patient phenotypes and , in some cases , for drug discovery — thereby facilitating the development of novel medical therapies .
The anticipated outcome is a wealth of knowledge that will likely prove instrumental in future applications . Ongoing research will contribute to translating this knowledge , enhancing the evaluation of male reproductive health through refined clinical diagnostics and personalised medicine-based approaches to patient care . These advancements in precision medicine hold the promise of delivering tailored and highly effective solutions for couples facing challenges in conceiving .
Stem cell therapy For nearly a century , researchers have endeavoured to achieve complete spermatogenesis in vitro . Despite substantial advancements since the 1960s , primarily seen in mouse models , translating these successes directly to humans has remained a challenge , and recent accomplishments in this endeavour have been limited . 16 The ongoing pursuit of in vitro systems to support the entire process of spermatogenesis holds considerable potential to address secondary infertility and specific spermatogenic failures .
Conclusion
Male infertility is a complex issue affecting many couples globally . An in-depth understanding of its causes and available treatments is imperative in providing the best possible care to those facing this challenge .
The evolving landscape — from lifestyle modifications to cutting-edge assisted reproductive techniques — promises a brighter future for male infertility treatments , with even more effective and personalised solutions .
References on request from kate . kelso @ adg . com . au
Micrograph showing normal sperm count ( left ) and azoospermia ( right ).