Step by Step® Management of Male InfertilityManish R Pandya MD, FICOG Associate Professor CU Shah Medical College Surendranagar, Gujarat India Sudhir R Shah MD DGO, FICOG Head of Obstetrics and Gynecology Department Dasha Shrimali Hospital Kotharia Naka, Rajkot, Gujarat (India)
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Step by Step® Management of Male Infertility
© 2008, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher.
First Edition: 2008
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
Who kept full faith in us and Encouraged us indirectly to write
This small booklet.
Our family members Without whose constant inspiration and Cooperation
This attempt would not have been completed.Foreword
It is indeed a pleasure and an honour for me to write a Foreword for this extremely informative and much needed reference guide on Male infertility. As a result of the rapid development of in vitro fertilization (IVF) for treating both male and female infertility, male infertility has become just as important for a consultant gynecologist assessing an infertile couple as it has for a specialist andrologist. Consequently, the detailed and intricate tests that consultant andrologist developed to identify the cause of male infertility and proposed treatments have drifted into the clinical realm of consultant gynecologists who need to assess couples rather than simply infertile women.
Infertility is believed to affect some 60–80 million couples worldwide. This guide is intended to be a practical, accessible guide to male infertility and its treatments. Dr Sudhir R Shah and Dr Manish Pandya have ensured that the sequence of the chapters is logical. The first chapter provide an overview of anatomy and reproductive physiology of male, in particular the importance of sperm as related to fertilization. Next come chapters on the causes of male infertility and the clinical evaluation of the infertile couple, medical surgical management. These are followed by chapters describing techniques of assisted reproduction including intrauterine insemination (IUI), with both husband and donor sperm, intra-cytoplasm sperm injection (ICSI), alluding to surgical sperm retrieval. Newer drugs, currently being used are also discussed. There is a final chapter on the practical aspects of semen examination which, I believe to be the most important chapter of the text as correct and accurate semen analysis will make a difference between patients being subjected to an ICSI cycle as opposed to a simple IUI cycle.
The guide has an aesthetic appeal from its content and layout to its illustrations and diagrams. The judicious use of photographs for diagnostic procedures and surgery enhances the understanding of these sections. There are many illustrations—almost every page has a photograph or diagram. Perhaps the greatest attribute is the completeness in addressing topics relating to male infertility. Most chapters deliver a succinct, focused approach.
The chapters on treatments all have a brief conclusion in which Dr Sudhir and Dr Manish assess the contribution of the treatment. Those with basic knowledge about reproductive physiology will probably skim the first few chapters, but from Chapter 4 (on evaluation of the infertile couple) onwards both authors' expertise comes to the fore. They stress the importance of carrying out investigations that do not waste what may be precious time to the couple, and demonstrate how delays are unnecessary since all of the basic infertility investigations can take place within 1 month.
I congratulate both Dr Sudhir and Dr Manish for being very meticulous on sections describing treatments include step by step instructions for the procedures, including a sometimes surprising level of details. Their vision as stated in their Preface is that there are “institutional as well as regional differences in the manner of evaluating and treating infertile couples” and hope that these will diminish when evidence-based protocols become more widely used.
I am sure that medical students, residents, fellows, and clinicians will find this guide very helpful. Perhaps the greatest benefit is for fellows and clinicians, since the level of detail probably exceeds that needed for medical students and residents. However, the interested student or resident should be able to comprehend this readable text from editors with credibility. Dr Sudhir and Dr Manish also note couples who are affected by infertility may find it helpful in dealing with the problem and making decisions about their treatments.
Jayant G Mehta
• Reproductive Care — London, UK
• Nawaloka Fertility Centre — Colombo, Sri Lanka
• Sub-Fertility, Queen's Hospital — Romford, UK
• Al-Mashari Hospital — Riyadh, Saudi Arabia
118, Cherrywood Lane
Morden. Surrey. SM4 4HB. UK.
Tel: +44 208 5422191
Mobile: +44 7954161488
Infertility, in a broader sense is inability to conceive by a couple in spite of regular normal coitus by the couple involved. The time limit stamped as one year. Looking to the physiology of pregnancy both the partners are involved in this procedure.
In practice, females are considered to be the primary cause of it but the truth is different. Husband or a Male partner is responsible in 33% cases, and hence Male infertility Management is a key part in the practice of Total Infertility Management.
Numbers of books are written and read on Female problems and its managements on infertile couple. Problems of Male partners are equally important and should be thoroughly understood to manage it perfectly. Gone are the days when husband used to remain away when a case of sterility is being managed by an expert in the field. The time has changed now. Many pregnancies are not possible only because of the problems related to Male Partner. Change in the life style, tensions in professions and business, irregular and wrong habits, congenital factors and infections in childhood may interfere in sperm production and migration.
We have touched this untouched subject to give you the basics of such problems.
Reading this small booklet, confidence of managing male partner in your day to day practice will be doubled.
Make it a point to treat male partners at your own clinic routinely unless the need of some surgical rectification is needed.
We hope this book will enrich your knowledge in your day to day infertility practice.
Manish R Pandya
Sudhir R ShahAcknowledgements
We are thankful to our idols and friends in this fraternity who encouraged penning this book.
Jaypee Brothers Medical Publishers for encouraging us and keeping full faith in us.
Mrs Jyoti Shah, Dr Nehal Manish Pandya MD DV and D (DERMATOLOGIST), better halves of the team of authors.
Numbers of our friends and colleagues who helped us in many ways.