News Article

‘A Clinic Dedicated to the Diagnosis and Treatment of Male Fertility’ Is male fertility on the increase? Probably not, but male-factors are more frequently recognised as the cause of a couple’s infertility. Gynaecologists are to be congratulated for increasing the success rates of IVF, using the intracytoplasmic sperm injection technique (ICSI), which has provided a ‘solution’ and a happy outcome to thousands of couples. However, ICSI merely circumvents some of the male-factor problems, without addressing the possible causes. Most fertility clinics- often not located in NHS hospitals – have developed without urological specialists interested in male fertility, and not surprisingly these clinics are more concerned with a ‘successful’ outcome than spending time and money investigating and diagnosing male-factor problems. This clinic is dedicated to the diagnosis and treatment of male infertility. It is easily accessible with free parking on a Saturday morning, and provides all of the necessary investigations in one visit. Semen analysis and interpretation of the results are available on the same day, and facilities for sperm storage can also easily be arranged. One of the most important areas for diagnosis and treatment is ‘azoospermia’ – or the absence of any sperm in the ejaculate. It is important to discover whether the cause is ‘obstructive’ or ‘non-obstructive’. Obstructive azoospermia, in which there is a blockage to the outflow of sperm, is always open to proper diagnosis and explanation and can often be corrected by microsurgical reconstructive techniques. Even when the eventual solution is IVF, most couples prefer to understand the reasons for the azoospermia, and if possible to attempt treatment. Non-obstructive azoospermia, as a cause for infertility, represents challenges both in diagnosis and treatment. Although there have been very significant advances in microsurgical techniques to retrieve sperm from within the testicle (micro-TESE), care is needed both to identify any genetic abnormalities, and to protect the hormone producing function of the testicles. Some sub-fertile men may also have a wide range of unusual medical, hormonal, and even urological problems; it is certainly important that these conditions are recognised, as some men might benefit from other medical and surgical treatments. Fertility is about the next generation, and we must not lose the opportunity for research into the causes of this generation’s fertility problems. Whilst offering current patients the benefits of past research, we must encourage as much participation as possible into clinical research programmes. Finally, support and counselling specifically for men, but also for couples, may inadvertently have been overlooked in the past. Generally, we need to be more sensitive to the impact of that ‘male factor diagnosis’. We need to prepare patients when we all suspect that a sperm retrieval might fail, and be ready at least to talk about the alternatives, including the possible use of donor sperm. In time, it should be possible to develop support groups for a significant number of men previously lost to treatment, who can contribute to others similarly affected, and who can usefully contribute to our knowledge to at least help the next generation. We welcome couples to visit us on a Saturday morning, and appointments can be made through Alison Lenny (alison.lenny@imperial.nhs.uk or jonathan.ramsay@imperial.nhs.uk Tel: 020 3311 7669 Fax: 020 3311 7696). Jonathan Ramsay Consultant Urologist & Andrologist