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Approximately one in twenty men have sperm counts low enough to impair fertility but little progress has been made in answering fundamental questions in andrology or in developing new diagnostic tools or management strategies in infertile men. Many of these problems increase with age, leading to a growing population of men seeking help. To address this, there is a strong movement towards integrating male reproductive and sexual healthcare involving clinicians such as andrologists, urologists, endocrinologists and counselors. This book will emphasize this integrated approach to male reproductive and sexual health throughout the lifespan. Practical advice on how to perform both clinical and laboratory evaluations of infertile men is given, as well as a variety of methods for medically and surgically managing common issues. This text ties together the three major pillars of clinical andrology: clinical care, the andrology laboratory, and translational research.
Varicoceles are the most common correctable cause of male factor infertility. Varicocele repair, therefore, has an important role in the treatment of infertility. Performing varicocelectomy prior to assisted reproductive technology has the potential to improve male fertility and increase pregnancy and live birth rates. It can also be a cost-effective treatment method in infertile men with clinical varicoceles.
The prevalence of azoospermia in the general population is 1% and azoospermic men constitute approximately 10–15% of all infertile men. While the advent of microTESE substantially improved sperm recovery compared to standard biopsy or other techniques, the procedure remains inefficient, costly, and very time consuming, both in retrieval and separation/sorting. Three conventional sperm sorting techniques are commonly used in andrology clinics: density gradient centrifugation, sperm washing, and swim-up, all of which have provided reliable solutions to isolate normal sperm from highly concentrated semen samples. The field of microfluidics is the most rapidly developing field for sperm selection related to the field of ART. It is particularly powerful when considering applications in single-cell or low-cell number analyses. Magnetically activated cell sorting and fluorescence-activated cell sorting are alternative and promising technologies. Further research is needed to optimally identify and isolate sperm to help couples achieve the goal of biologic children.
The internet constantly evolves and facilitates the development of new avenues for users to interact and communicate internationally. Social media and search engines represent the forefront of internet technologies that enable users to produce content, develop digital participatory networks, and share information across various topics. These internet tools are reshaping the continuum of care by enabling patients to acquire medical information, consult peers and healthcare practitioners, and even make treatment decisions without leaving their connected device. The consequences of circumventing traditional pathways to care are amplified in men’s health due to the fact that men frequently do not engage with the healthcare system and that erectile dysfunction and male infertility are stigmatized. The focus of this chapter is to evaluate the emerging online landscape for common men’s health conditions including male infertility, erectile dysfunction, hypogonadism, and Peyronie’s disease.
Over the last few decades, cancer incidence has increased in the United States. Many patients diagnosed with cancer are young, with nearly 10 percent below the age of 45 years and 1 percent below the age of 20 years [1]. Specifically for males aged between 15 and 19 years, cancer incidence has increased annually by 0.67 percent, resulting in >25 percent increase over 40 years [2]. Despite, the rise in cancer incidence, cancer survival has also dramatically improved, largely due to earlier detection and better treatments. With a growing number of chronic cancer survivors, there is focus on a concept termed cancer survivorship. Cancer survivorship focuses on maintaining and enhancing wellness in cancer survivors and on optimizing management of long-term side effects of their cancer and cancer treatments [3, 4].
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