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An Introduction to Male Reproductive Medicine is written specifically for readers seeking entry into this fast-moving, complex specialty with a solid understanding of the subject. The first chapters cover the anatomy and physiology, clinical evaluation, surgery, medicine, genetics and laboratory testing involved in the current evaluation and treatment of the infertile male, and the final chapter describes the interaction of the field with female reproductive medicine. Throughout the book, references are directly made to the fourth edition of the major text in the specialty, Infertility in the Male, edited by Larry Lipshultz, Stuart Howards and Craig Niederberger, allowing readers to expand their understanding of specific areas where desired. Each chapter is written by a well-renowned expert in an easy to follow, informal style, making the text ideal for students, residents and general physicians who are seeking to increase their general knowledge of the field.
At the heart of the male reproductive physical examination is investigation of the scrotum and its contents. The scrotum itself may be hypoplastic on one or both sides, suggesting lack of contents since birth. This chapter describes the basics of interpreting semen analysis in the context of a man's initial evaluation presenting with concerns about fertility, or a couple who has not conceived within a reasonable period of time. Sperm motility may be difficult to assess, and is often inaccurately reported by labs infrequently performing semen analyses whose technicians may be unfamiliar with the appearance of sperm under the microscope. Sperm morphology can be one of the most frustrating parameters of semen analysis. Sperm shape is highly variable, and a normal man's ejaculate contains a broad assortment of strange-looking sperm. Excessive aromatase activity resulting in abundant estradiol may interfere with the male endocrine axis and sperm production.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
In mammals, spermatogenesis begins with diploid stem cells that resemble other somatic cells; it ends with highly specialized motile haploid cells that are remarkably unique in appearance and function. Continuous production of spermatozoa throughout life requires that spermatogonia replenish themselves. Type B spermatogonia undergo mitosis to give rise to diploid primary spermatocytes. The spermatocytes then cross the blood-testis barrier formed by the Sertoli tight junctions to the adluminal compartment. Spermiogenesis refers to the acquisition by the germ cell of several organelles and accessory structures such as the acrosome and the flagellum. Testosterone and follicle-stimulating hormone (FSH) are the two major regulatory hormones of spermatogenesis. FSH binding to its receptor activates adenylate cyclase, and the resultant rise in cAMP triggers binding of cAMP response element modulator (CREM) to ACT (activator of CREM). The complex then acts as a molecular master-switch for a number of genes involved in spermatogenesis.
This chapter reviews the empiric therapies available today for male infertility and discusses their mode of action. It reviews published literature on outcomes available and analyzes the evidence for use and dosing recommendations. With the exception of low-dose vitamin supplementation and aromatase inhibitors, empiric therapy is seldom recommended in the treatment of the infertile male. Gonadotropin-releasing hormone (GnRH) stimulates the synthesis and release of the gonadotropic hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), in the anterior pituitary. Treatment of hypogonadotropic hypogonadism with exogenous gonadotropins or GnRH has produced good results compared with treatment of other male infertility problems. Exogenous testosterone therapy can produce azoospermia or severe oligospermia through the inhibition of gonadotropin secretion. Glutathione therapy has been used in various pathologic conditions in which reactive oxygen species are thought to play a pathogenic role. Administration of high-dose antioxidants has a potential beneficial effect on male fertility.