Abstract：
BACKGROUND: Among couples consulting for infertility, there is a male component, either alone or associated with a female aetiology in around one in 2 cases.
METHODS: Bibliographic search in PubMed using the keywords \"male infertility\", \"diagnosis\", \"management\" and \"evaluation\" limited to clinical articles in English and French prior to 1/01/2023.
RESULTS: The AFU recommends: (1) a complete medical history including: family history, patient history affecting fertility, lifestyle habits (toxicity), treatments, symptoms, sexual dysfunctions; (2) a physical examination including: BMI, signs of hypogonadism, secondary sexual characteristics, scrotal examination (volume and consistency of testes, vas deferens, epididymal or testicular nodules, presence of varicocele); (3) two spermograms, if abnormal on the first; (4) a systematic scrotal ultrasound,± an endorectal ultrasound depending on the clinic; (5) a hormonal work-up (testosterone, FSH; if testosterone is low: LH assay to differentiate between central or peripheral hypogonadism); (6) karyotype if sperm concentration≤10 million/mL; (7) evaluation of Y chromosome microdeletions if concentration≤1 million/mL; (8) evaluation of the CFTR gene in cases of suspected bilateral or unilateral agenesis of the vas deferens and seminal vesicles. The role and usefulness of direct and indirect tests to assess the effects of oxidative stress on sperm DNA will also be explained.
CONCLUSIONS: This review complements and updates the AFU/SALF 2021 recommendations.
METHODS: Bibliographic search in PubMed using the keywords \"male infertility\", \"diagnosis\", \"management\" and \"evaluation\" limited to clinical articles in English and French prior to 1/01/2023.
RESULTS: The AFU recommends: (1) a complete medical history including: family history, patient history affecting fertility, lifestyle habits (toxicity), treatments, symptoms, sexual dysfunctions; (2) a physical examination including: BMI, signs of hypogonadism, secondary sexual characteristics, scrotal examination (volume and consistency of testes, vas deferens, epididymal or testicular nodules, presence of varicocele); (3) two spermograms, if abnormal on the first; (4) a systematic scrotal ultrasound,± an endorectal ultrasound depending on the clinic; (5) a hormonal work-up (testosterone, FSH; if testosterone is low: LH assay to differentiate between central or peripheral hypogonadism); (6) karyotype if sperm concentration≤10 million/mL; (7) evaluation of Y chromosome microdeletions if concentration≤1 million/mL; (8) evaluation of the CFTR gene in cases of suspected bilateral or unilateral agenesis of the vas deferens and seminal vesicles. The role and usefulness of direct and indirect tests to assess the effects of oxidative stress on sperm DNA will also be explained.
CONCLUSIONS: This review complements and updates the AFU/SALF 2021 recommendations.
摘要：
背景：在咨询不孕症的夫妇中，有一个男性成分，单独或与女性病因相关，约有2例。
方法：在PubMed中使用关键字“男性不育”进行书目搜索，\"诊断\",“管理”和“评估”仅限于2023年1月1日之前的英语和法语临床文章。
结果：AFU建议：（1）完整的病史，包括：家族史，影响生育能力的患者病史，生活习惯（毒性），治疗,症状,性功能障碍；(2)体检包括：BMI，性腺机能减退的迹象,第二性征,阴囊检查(睾丸的体积和一致性，输精管,附睾或睾丸结节，精索静脉曲张的存在）；（3）两个精子图，如果第一次异常；(4)系统的阴囊超声，±取决于临床的直肠内超声检查；(5)激素检查(睾酮，FSH;如果睾丸激素低：LH测定以区分中枢或外周性腺功能减退症）；（6）如果精子浓度≤10百万/mL，则核型；（7）如果浓度≤1百万/mL，则评估Y染色体微缺失；（8）在怀疑输精管和精囊双侧或单侧发育不全的情况下评估CFTR基因。还将解释评估氧化应激对精子DNA影响的直接和间接测试的作用和有用性。
结论：本综述补充和更新了AFU/SALF2021建议。
方法：在PubMed中使用关键字“男性不育”进行书目搜索，\"诊断\",“管理”和“评估”仅限于2023年1月1日之前的英语和法语临床文章。
结果：AFU建议：（1）完整的病史，包括：家族史，影响生育能力的患者病史，生活习惯（毒性），治疗,症状,性功能障碍；(2)体检包括：BMI，性腺机能减退的迹象,第二性征,阴囊检查(睾丸的体积和一致性，输精管,附睾或睾丸结节，精索静脉曲张的存在）；（3）两个精子图，如果第一次异常；(4)系统的阴囊超声，±取决于临床的直肠内超声检查；(5)激素检查(睾酮，FSH;如果睾丸激素低：LH测定以区分中枢或外周性腺功能减退症）；（6）如果精子浓度≤10百万/mL，则核型；（7）如果浓度≤1百万/mL，则评估Y染色体微缺失；（8）在怀疑输精管和精囊双侧或单侧发育不全的情况下评估CFTR基因。还将解释评估氧化应激对精子DNA影响的直接和间接测试的作用和有用性。
结论：本综述补充和更新了AFU/SALF2021建议。
