Department of Andrology and IVF, San Carlo Clinic, Paderno-Dugnano/Milano, Italy.
Department of Life, Health and Environmental Sciences, University of L' Aquila, L' Aquila, Italy.
Andrology. 2018 Jul;6(4):513-524. doi: 10.1111/andr.12502.
Oligo-astheno-teratozoospermia is frequently reported in men from infertile couples. Its etiology remains, in the majority of cases, unknown with a variety of factors to contribute to its pathogenesis. The aim of this European Academy of Andrology guideline was to provide an overview of these factors and to discuss available management options.
PubMed was searched for papers in English for articles with search terms: male infertility and oligo-astheno-teratozoospermia. For evidence-based recommendations, the GRADE system was applied. Issues related to urogenital infections/inflammations have not been included in this document as they will be covered by separate guidelines.
For men with oligo-astheno-teratozoospermia, the European Academy of Andrology recommends: A general physical examination to assess signs of hypogonadism. A scrotal physical examination to assess (i) the testes and epididymes for volume and consistency, (ii) deferent ducts for total or partial absence, and (iii) occurrence of varicocoele. Performing two semen analyses, according to World Health Organization guidelines to define an oligo-astheno-teratozoospermia. An endocrine evaluation. A scrotal ultrasound as part of routine investigation. Karyotype analysis and assessment of Yq microdeletions in infertile men with a sperm concentration ≤5 × 10 /mL. Cystic fibrosis transmembrane conductance regulator gene evaluation in case of suspicion for incomplete congenital obstruction of the genital tract. Against quitting physical activity to improve the chance of achieving pregnancy. Against androgen replacement therapy to improve the chance of achieving pregnancy. Assisted reproduction techniques to improve the chance of achieving pregnancy, in case other treatment options are not available or not efficient. Androgen replacement therapy in patients with biochemical/clinical signs of hypogonadism, after completion of the fertility treatment.
These guidelines can be applied in clinical work and indicate future research needs.
在不育夫妇的男性中，常报告出现少精症、弱精症和畸形精子症。其病因在大多数情况下仍然未知，多种因素促成其发病机制。本欧洲男科学会指南的目的是概述这些因素，并讨论现有的治疗选择。
在 PubMed 上搜索英文文献，使用以下搜索词：男性不育和少精症、弱精症和畸形精子症。对于循证推荐，应用了 GRADE 系统。与泌尿生殖系统感染/炎症相关的问题未包含在本文件中，因为它们将由单独的指南涵盖。
对于患有少精症、弱精症和畸形精子症的男性，欧洲男科学会建议：进行全面的体格检查以评估是否存在性腺功能减退的迹象。进行阴囊体格检查以评估（i）睾丸和附睾的体积和质地，（ii）输精管道是否完全或部分缺失，以及（iii）精索静脉曲张的发生。根据世界卫生组织的指南进行两次精液分析，以定义少精症、弱精症和畸形精子症。进行内分泌评估。作为常规检查的一部分进行阴囊超声检查。对于精子浓度≤5×10 /mL 的不育男性，进行染色体核型分析和 Yq 微缺失评估。在怀疑存在不完全性生殖道梗阻的情况下，进行囊性纤维化跨膜电导调节基因评估。反对停止体育活动以提高妊娠机会。反对雄激素替代疗法以提高妊娠机会。在其他治疗方法不可用或无效的情况下，采用辅助生殖技术以提高妊娠机会。在完成生育治疗后，对于存在生化/临床性腺功能减退迹象的患者，进行雄激素替代疗法。
这些指南可应用于临床工作，并指出未来的研究需求。
