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Male reproductive dysfunction is the sole or contributory cause in half of infertile couples. Some health issues are more prevalent in infertile men and must be sought and the opportunity taken to assess and improve general and sexual health. Spontaneous conception may occur in many couples with male factor subfertility. In counseling patients, the severity of the male's reproductive problem, the duration of unprotected intercourse, and its frequency and timing, and the female partner's age and reproductive status are all important variables. There is a substantial background rate of spontaneous conception in subfertile men such that about 30% of couples with sperm densities of 1-5 million/ml as the only apparent fertility issue, achieved pregnancy over a two- to three-year period. Depending on the couple's age and reproductive history, some couples are happy to delay treatment in the hope that they will conceive while others express a wish for immediate intervention.
Sperm cryopreservation plays an important role in the field of male infertility and reproductive medicine. A donor sperm cryopreservation program has been developed and improved in mainland China. The conventional approach to sperm cryopreservation is to simply dilute semen with cryoprotectant and cryopreserve in liquid nitrogen until the sperm samples are thawed for use. Patients with spinal cord injuries often have a problem with poor sperm production as well as ejaculation after the damage. Electroejaculation is usually performed under a general anesthesia while the patient is placed in lateral decubitus. With the advance of new approaches for sperm vitrification, treatment of male infertility will become more effective without using sperm donors. Using vitrification for cryopreservation of sperm obtained from testicular biopsy, epididymal fluid, or a semen sample after electroejaculation could create new hope for infertile men.
Innovative techniques for testis biopsy interpretation continues to generate new and meaningful information regarding the pathophysiology in the infertile male. This chapter outlines the relevant histologic features of both abnormal and normal testis biopsies. It reviews existing, new, and promising technologies that are being applied to testis biopsy. A by-product of the refinement of needle biopsy techniques in the testis is fine-needle aspiration (FNA) for systematic mapping of sites of active spermatogenesis. Cytological assessment of biopsy or aspirate specimens can be performed in several ways. Basement membrane hyalinization refers to concentric thickening of the inner basement membrane, as evidenced by deposition of hyaline. The germinal epithelium of the seminiferous tubule is composed of germ cells in various stages of development and Sertoli cells. The therapeutic nature of the testis biopsy depends on the ability to identify mature spermatids that might be appropriate for IVF/intracytoplasmic sperm injection (ICSI).
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