Skip to main content Accessibility help
×
Hostname: page-component-7c8c6479df-ws8qp Total loading time: 0 Render date: 2024-03-28T09:46:49.350Z Has data issue: false hasContentIssue false

2 - Clinical assessment and management of the infertile man

Published online by Cambridge University Press:  22 October 2009

David J. Ralph
Affiliation:
Department of Uro-andrology, Middlesex Hospital, London, UK
Paul Serhal
Affiliation:
The University College London Hospitals
Caroline Overton
Affiliation:
Bristol Royal Infirmary
Get access

Summary

Introduction

Of the 10% of couples who are unable to conceive, approximately 20% are affected entirely by the male alone and a further 30% by a combination of male and female factors. Therefore, 50% of couples seeking treatment have a male factor as the underlying cause for their infertility.

The last two decades have seen great technological advances in the development and success of IVF techniques. As a consequence, there has been a shift in the emphasis on surgery in the treatment of male factor infertility. Many couples with causes for their infertility that are readily treatable by surgery are now referred directly for IVF.

All male patients, therefore, with infertility should be thoroughly evaluated and investigated prior to referral for assisted conception. Furthermore, they require a multidisciplinary approach in their assessment and management, involving close liaison between an andrologist, embryologist and gynaecologist, ideally working in a specialized and dedicated assisted conception unit.

This chapter deals firstly with the anatomy and physiology of male reproduction and then gives an account of the aetiology and management of male factor infertility.

Functional anatomy of the male reproductive system

The male reproductive system (Figure 2.1) consists of the penis, testes, ejaculatory ducts and accessory sex glands. The accessory sex glands comprise the prostate, seminal vesicles, Cowper's glands and glands of Littre. The accessory sex glands produce important secretions, which are required to maintain the viability of sperm in the male and female reproductive tract.

Testes

The normal human testis is approximately 15–25 ml in volume and 4.5 cm in length in the adult male. Each testis is oval in shape surrounded by a fibrous layer called the tunica albuginea (Figure 2.2).

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×