Male factor infertility and assisted reproductive technologies: indications, minimum access criteria and outcomes

Mazzilli R; Rucci C; Vaiarelli A; Cimadomo D; Ubaldi FM; Foresta C; Ferlin A

doi:10.1007/s40618-022-02000-4

Male Fertility Male Factor Treatment

Male factor infertility and assisted reproductive technologies: indications, minimum access criteria and outcomes

Mazzilli R, Rucci C, Vaiarelli A, Cimadomo D, Ubaldi FM, Foresta C, Ferlin A

Published June 2023 Journal of endocrinological investigation

DOI 10.1007/s40618-022-02000-4 PMID 36633791 PMC PMC10185595

RRM Academy Synopsis

Severe male factor lowers fertilization and blastocyst rates in ART

A 2023 narrative review of assisted reproductive technology (ART) studies reports that severe male factor lowers fertilization and blastocyst rates in the lab. In 1219 cycles, chromosome abnormality rates in blastocysts overlapped across male factor groups. The review says obstetric outcomes do not appear affected by male factor. Severe male factor means very low or absent sperm in the semen.

Key Findings

Fertilization and blastocyst rates were lower with severe oligozoospermia or azoospermia than with normal semen, and the review says this seems related to less mature sperm retrieved from the testis.
Blastocyst chromosome testing in 1219 cycles found an overlapping aneuploidy rate (abnormal chromosome number) across male factor groups; 7549 blastocysts showed no association between male factor and sex chromosome aneuploidy.
The review states that a lower blastocyst rate implies fewer transferable blastocysts and a lower cumulative pregnancy rate per started cycle, with no reduction per single embryo transfer.
One cited study of 320 IVF-candidate couples with a female partner younger than 35 noticed a male factor classed as treatable in 56%; the review says IVF represents overtreatment for them.
A multicenter, prospective, observational survey of clinical practice found that over 35% of men with unexplained infertility received no specific treatment before IVF.

Interpretation

The article is a narrative review. The authors summarize published studies on male factor and ART. Several cited studies are retrospective or observational. The review calls the data on male factor and embryo chromosome abnormalities still controversial. It states that long-term follow-up of newborns, including brain and behavior development, is still necessary. The review raises the possibility that the egg corrects genetic errors from the father, a hypothesis it says deserves deeper investigation. The findings describe couples who entered ART programs.

RRM Context

The 2021 WHO semen manual, as the review reports, states that a semen test alone does not predict fertility. The fertility potential of the couple defines whether they are fertile. Restorative reproductive medicine evaluates both partners to find why fertility is reduced. ART bypasses the reproductive system without resolving why conception fails. The review puts male factor alone at about 30% of infertility cases, with an added 20% as a contributor.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Infertility, which is defined as the inability to conceive after at least 12 months of regular unprotected sexual intercourses, affects about 15-20% of couples worldwide and a male factor is involved in about half of the cases. The development of assisted reproductive technology (ART) made it possible to conceive also to individuals affected from severe oligospermia or azoospermia. However, the impact of the male factor on embryo development, implantation, prevalence of chromosomal abnormalities, genetic and epigenetic alterations, and clinical and obstetric outcomes is still controversial.

Purpose

This narrative review examines the indications, minimum access criteria, and outcomes by individual ART technique in relation to the male factor.

Topics

Male Fertility › Male Factor Treatment › Medical Management · Assisted Reproduction › Outcomes and Effectiveness › Outcomes by Diagnosis

PMID 36633791 36633791 DOI 10.1007/s40618-022-02000-4 10.1007/s40618-022-02000-4 Mazzilli et al. 2023, Mazzilli 2023

Male factor infertility and assisted reproductive technologies: indications, minimum access criteria and outcomes

Severe male factor lowers fertilization and blastocyst rates in ART

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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