Year : 2022  |  Volume : 24  |  Issue : 2  |  Page : 125-134

Severe male factor in in vitro fertilization: definition, prevalence, and treatment. An update

1 Clinica Valle Giulia, GeneraLife IVF Centers, Via G. De Notaris, Rome 2B 00197, Italy Department of Clinical and Molecular Medicine, University of Rome "Sapienza", Via di Grottarossa 1035, Rome 00189, Italy Catholic University of the Sacred Heart, Via della Pineta Sacchetti 217, Rome 00168, Italy Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, Rome 00161, Italy Centre for Reproductive Medicine, Free University Brussels (UZ Brussel), Brussels 1090, Belgium

Correspondence Address:
Filippo Maria Ubaldi
Clinica Valle Giulia, GeneraLife IVF Centers, Via G. De Notaris, Rome 2B 00197
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aja.aja_53_21

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Infertility affects 10%–15% of couples worldwide. Of all infertility cases, 20%–70% are due to male factors. In the past, men with severe male factor (SMF) were considered sterile. Nevertheless, the development of intracytoplasmic sperm injection (ICSI) drastically modified this scenario. The advances in assisted reproductive technology (ART), specifically regarding surgical sperm retrieval procedures, allowed the efficacious treatment of these conditions. Yet, before undergoing ICSI, male factor infertility requires careful evaluation of clinical and lifestyle behavior together with medical treatment. Epidemiologically speaking, women whose male partner is azoospermic tend to be younger and with a better ovarian reserve. These couples, in fact, are proposed ART earlier in their life, and for this reason, their ovarian response after stimulation is generally good. Furthermore, in younger couples, azoospermia can be partially compensated by the efficient ovarian response, resulting in an acceptable fertility rate following in vitro fertilization (IVF) techniques. Conversely, when azoospermia is associated with a reduced ovarian reserve and/or advanced maternal age, the treatment becomes more challenging, with a consequent reduction in IVF outcomes. Nonetheless, azoospermia seems to impair neither the euploidy rate at the blastocyst stage nor the implantation of euploid blastocysts. Based on the current knowledge, the assessment of male infertility factors should involve: (1) evaluation – to diagnose and quantify seminologic alterations; (2) potentiality – to determine the real possibilities to improve sperm parameters and/or retrieve spermatozoa; (3) time – to consider the available “treatment window”, based on maternal age and ovarian reserve. This review represents an update of the definition, prevalence, causes, and treatment of SMF in a modern ART clinic.

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