[Assisted procreation for male indication]

Area of Science:

• Reproductive Medicine and Endocrinology
• Urology and Andrology

Context:

• Male infertility diagnosis and treatment strategies require balancing efficacy, complexity, risks, and costs.
• Female fertility and infertility duration significantly influence strategic decision-making.
• Specific conditions like hypogonadotropic hypogonadism, anejaculation, or retrograde ejaculation may benefit from targeted therapies.

Purpose:

• To outline a strategic approach for managing male infertility, encompassing diagnostic methods and treatment options.
• To discuss the role of assisted reproductive technologies (ART) in cases of non-specific sperm alterations.
• To evaluate the efficacy of different insemination methods, including intra-cervical and intra-uterine artificial insemination with husband semen (AIH), and in vitro fertilization (IVF).

Summary:

• Intra-cervical AIH is proposed for specific conditions, requiring confirmation of specific test results.
• Intra-uterine AIH enhances fertilization probability by bypassing the cervical step, with optimized sperm counts and synchronized timing improving pregnancy rates.
• In vitro fertilization (IVF) addresses male factor infertility in approximately 15% of cases, demonstrating accepted fertilization and pregnancy rates despite parameter heterogeneity.

Impact:

• Provides a framework for clinical decision-making in male infertility management.
• Highlights the effectiveness of ART, particularly intrauterine insemination and IVF, in improving pregnancy outcomes for male factor infertility.
• Acknowledges the diagnostic value of IVF while noting limitations in fully explaining fertilization failures due to parameter heterogeneity.