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Testosterone Replacement, Low T, HCG, & Beyond
Clomid for PCT, fertility or low T
Diagnosis and Treatment of Infertility in Men
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<blockquote data-quote="madman" data-source="post: 192233" data-attributes="member: 13851"><p><strong>Diagnosis and Treatment of Infertility in Men: <span style="color: rgb(184, 49, 47)">AUA/ASRM Guideline PART II</span> </strong></p><p><span style="color: rgb(44, 130, 201)"><em>Peter N. Schlegel, MD,* Mark Sigman, MD, Barbara Collura, Christopher J. De Jonge, PhD, HCLD (ABB), Michael L. Eisenberg, MD, Dolores J. Lamb, PhD, HCLD (ABB), John P. Mulhall, MD, Craig Niederberger, MD, FACS, Jay I. Sandlow, MD, Rebecca Z. Sokol, MD, MPH, Steven D. Spandorfer, MD, Cigdem Tanrikut, MD, FACS, Jonathan R. Treadwell, PhD, Jeffrey T. Oristaglio, PhD and Armand Zini, MD </em></span></p><p></p><p></p><p></p><p></p><p><strong>Purpose: </strong><span style="color: rgb(184, 49, 47)"><em>The summary presented herein represents Part II of the two-part series dedicated to the Diagnosis and Treatment of Infertility in Men: AUA/ ASRM Guideline. </em></span><span style="color: rgb(44, 130, 201)"><em>Part II outlines the appropriate management of the male in an infertile couple.</em></span> <span style="color: rgb(184, 49, 47)"><em>Medical therapies, surgical techniques, as well as the use of intrauterine insemination (IUI)/in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) are covered to allow for optimal patient management. </em></span><span style="color: rgb(44, 130, 201)"><em>Please refer to Part I for discussion on evaluation of the infertile male and discussion of relevant health conditions that are associated with male infertility. </em></span></p><p></p><p><strong>Materials/Methods:</strong> <em>The Emergency Care Research Institute Evidence-based Practice Center team searched PubMed, Embase, and Medline from January 2000 through May 2019. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (table). This summary is being simultaneously published in Fertility and Sterility and The Journal of Urology.</em></p><p></p><p><strong>Results: </strong><em>This Guideline provides updated, evidence-based recommendations regarding the management of male infertility. Such recommendations are summarized in the associated algorithm (figure).</em></p><p></p><p><strong>Conclusion: </strong><span style="color: rgb(184, 49, 47)"><em>Male contributions to infertility are prevalent, and specific treatment, as well as assisted reproductive techniques, are effective at managing male infertility. </em></span><span style="color: rgb(44, 130, 201)"><em>This document will undergo additional literature reviews and updating as the knowledge regarding current treatments and future treatment options continues to expand. </em></span></p><p></p><p></p><p></p><p></p><p></p><p></p><p><strong>BACKGROUND </strong></p><p></p><p><span style="color: rgb(184, 49, 47)"><em>Failure to conceive within 12 months of attempted conception is due in whole or in part to the male in approximately one-half of all infertile couples. </em></span><span style="color: rgb(44, 130, 201)"><em>Although many couples can achieve a pregnancy with assisted reproductive technologies (ART), evaluation of the male is important to identify conditions that may be medically important, counsel men regarding future health considerations, and most appropriately direct therapy.</em></span> <span style="color: rgb(184, 49, 47)"><em>Most male factor conditions are specifically treatable with medical or surgical therapy, while others may only be managed with donor sperm or adoption.</em></span><span style="color: rgb(44, 130, 201)"><em> In this guideline, the term “male” or “men” is used to refer to biological or genetic men.</em></span></p><p></p><p></p><p></p><p></p><p><strong>Treatment </strong></p><p></p><p><span style="color: rgb(184, 49, 47)">Varicocele Repair/Varicocelectomy</span></p><p><span style="color: rgb(184, 49, 47)"></span></p><p><span style="color: rgb(184, 49, 47)">Sperm Retrieval </span></p><p><span style="color: rgb(184, 49, 47)"></span></p><p><span style="color: rgb(184, 49, 47)">Obstructive Azoospermia, Including PostVasectomy Infertility </span></p><p><span style="color: rgb(184, 49, 47)"></span></p><p><span style="color: rgb(184, 49, 47)">Medical & Nutraceutical Interventions for Fertility </span></p><p><span style="color: rgb(184, 49, 47)"></span></p><p><span style="color: rgb(184, 49, 47)">Gonadotoxic Therapies and Fertility Preservation </span></p><p></p><p></p><p></p><p></p><p><strong>SUMMARY </strong></p><p></p><p><span style="color: rgb(184, 49, 47)"><strong><em>Evaluation and management of men in a couple with infertility involve a step-wise process of evaluation and consultation regarding treatment options.</em></strong></span> <span style="color: rgb(44, 130, 201)"><em><strong>Specific interventions such as varicocele repair, correction of identifiable hormonal abnormalities, microsurgical reconstruction of obstructive conditions, and surgical relief of ejaculatory duct obstruction are effective at increasing fertility for men. </strong></em></span><span style="color: rgb(184, 49, 47)"><em><strong>This recognition supports a thorough evaluation of a man for correctable conditions that may affect his fertility. </strong></em></span><em><strong><span style="color: rgb(44, 130, 201)">The use of ART is an effective intervention for fertility and a critical component for the treatment of some couples, such as men with CBAVD or NOA who also require surgical sperm retrieval.</span></strong></em><span style="color: rgb(184, 49, 47)"><em> <strong>Evaluation should proceed in parallel for both male and female members of a couple to optimize treatment success.</strong></em></span></p><p></p><p></p><p></p><p></p><p><strong>FUTURE DIRECTIONS </strong></p><p></p><p><span style="color: rgb(184, 49, 47)"><strong><em>The causes of male infertility, including their genetic basis, have only been superficially explained at this time.</em></strong></span> <span style="color: rgb(44, 130, 201)"><em><strong>There is a strong suggestion that most cases of apparently idiopathic severe male infertility, including NOA, have a genetic basis that may underlie the impaired sperm production seen for these men. </strong></em></span><span style="color: rgb(184, 49, 47)"><em><strong>A greater understanding of the basis for impaired sperm production could also lead to treatments to enhance sperm production and fertility. </strong></em></span><span style="color: rgb(44, 130, 201)"><strong><em>The interactions of infertility with other health conditions require a deeper understanding as well. Fortunately, progress continues to be made on each of these fronts. </em></strong></span></p></blockquote><p></p>
[QUOTE="madman, post: 192233, member: 13851"] [B]Diagnosis and Treatment of Infertility in Men: [COLOR=rgb(184, 49, 47)]AUA/ASRM Guideline PART II[/COLOR] [/B] [COLOR=rgb(44, 130, 201)][I]Peter N. Schlegel, MD,* Mark Sigman, MD, Barbara Collura, Christopher J. De Jonge, PhD, HCLD (ABB), Michael L. Eisenberg, MD, Dolores J. Lamb, PhD, HCLD (ABB), John P. Mulhall, MD, Craig Niederberger, MD, FACS, Jay I. Sandlow, MD, Rebecca Z. Sokol, MD, MPH, Steven D. Spandorfer, MD, Cigdem Tanrikut, MD, FACS, Jonathan R. Treadwell, PhD, Jeffrey T. Oristaglio, PhD and Armand Zini, MD [/I][/COLOR] [B]Purpose: [/B][COLOR=rgb(184, 49, 47)][I]The summary presented herein represents Part II of the two-part series dedicated to the Diagnosis and Treatment of Infertility in Men: AUA/ ASRM Guideline. [/I][/COLOR][COLOR=rgb(44, 130, 201)][I]Part II outlines the appropriate management of the male in an infertile couple.[/I][/COLOR][I] [/I][COLOR=rgb(184, 49, 47)][I]Medical therapies, surgical techniques, as well as the use of intrauterine insemination (IUI)/in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) are covered to allow for optimal patient management. [/I][/COLOR][COLOR=rgb(44, 130, 201)][I]Please refer to Part I for discussion on evaluation of the infertile male and discussion of relevant health conditions that are associated with male infertility. [/I][/COLOR] [B]Materials/Methods:[/B] [I]The Emergency Care Research Institute Evidence-based Practice Center team searched PubMed, Embase, and Medline from January 2000 through May 2019. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (table). This summary is being simultaneously published in Fertility and Sterility and The Journal of Urology.[/I] [B]Results:[I] [/I][/B][I]This Guideline provides updated, evidence-based recommendations regarding the management of male infertility. Such recommendations are summarized in the associated algorithm (figure).[/I] [B]Conclusion:[I] [/I][/B][COLOR=rgb(184, 49, 47)][I]Male contributions to infertility are prevalent, and specific treatment, as well as assisted reproductive techniques, are effective at managing male infertility. [/I][/COLOR][COLOR=rgb(44, 130, 201)][I]This document will undergo additional literature reviews and updating as the knowledge regarding current treatments and future treatment options continues to expand. [/I][/COLOR] [I][/I] [B]BACKGROUND [/B] [COLOR=rgb(184, 49, 47)][I]Failure to conceive within 12 months of attempted conception is due in whole or in part to the male in approximately one-half of all infertile couples. [/I][/COLOR][COLOR=rgb(44, 130, 201)][I]Although many couples can achieve a pregnancy with assisted reproductive technologies (ART), evaluation of the male is important to identify conditions that may be medically important, counsel men regarding future health considerations, and most appropriately direct therapy.[/I][/COLOR][I] [/I][COLOR=rgb(184, 49, 47)][I]Most male factor conditions are specifically treatable with medical or surgical therapy, while others may only be managed with donor sperm or adoption.[/I][/COLOR][COLOR=rgb(44, 130, 201)][I] In this guideline, the term “male” or “men” is used to refer to biological or genetic men.[/I][/COLOR] [B]Treatment [/B] [COLOR=rgb(184, 49, 47)]Varicocele Repair/Varicocelectomy Sperm Retrieval Obstructive Azoospermia, Including PostVasectomy Infertility Medical & Nutraceutical Interventions for Fertility Gonadotoxic Therapies and Fertility Preservation [/COLOR] [B]SUMMARY [/B] [COLOR=rgb(184, 49, 47)][B][I]Evaluation and management of men in a couple with infertility involve a step-wise process of evaluation and consultation regarding treatment options.[/I][/B][/COLOR][I] [/I][COLOR=rgb(44, 130, 201)][I][B]Specific interventions such as varicocele repair, correction of identifiable hormonal abnormalities, microsurgical reconstruction of obstructive conditions, and surgical relief of ejaculatory duct obstruction are effective at increasing fertility for men. [/B][/I][/COLOR][COLOR=rgb(184, 49, 47)][I][B]This recognition supports a thorough evaluation of a man for correctable conditions that may affect his fertility. [/B][/I][/COLOR][I][B][COLOR=rgb(44, 130, 201)]The use of ART is an effective intervention for fertility and a critical component for the treatment of some couples, such as men with CBAVD or NOA who also require surgical sperm retrieval.[/COLOR][/B][/I][COLOR=rgb(184, 49, 47)][I] [B]Evaluation should proceed in parallel for both male and female members of a couple to optimize treatment success.[/B][/I][/COLOR] [B]FUTURE DIRECTIONS [/B] [COLOR=rgb(184, 49, 47)][B][I]The causes of male infertility, including their genetic basis, have only been superficially explained at this time.[/I][/B][/COLOR][I] [/I][COLOR=rgb(44, 130, 201)][I][B]There is a strong suggestion that most cases of apparently idiopathic severe male infertility, including NOA, have a genetic basis that may underlie the impaired sperm production seen for these men. [/B][/I][/COLOR][COLOR=rgb(184, 49, 47)][I][B]A greater understanding of the basis for impaired sperm production could also lead to treatments to enhance sperm production and fertility. [/B][/I][/COLOR][COLOR=rgb(44, 130, 201)][B][I]The interactions of infertility with other health conditions require a deeper understanding as well. Fortunately, progress continues to be made on each of these fronts. [/I][/B][/COLOR] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
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Diagnosis and Treatment of Infertility in Men
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