Godart Erica S, Shin Daniel H, Christensen Emily, Thompson Eli R, Turek Paul J
The Turek Clinic, Beverly Hills, CA, USA.
Southern California Permanente Medical Group, Los Angeles, CA, USA.
Transl Androl Urol. 2021 Feb;10(2):620-625. doi: 10.21037/tau-20-1240.
Among couples with male factor infertility, the natural pregnancy rates associated with classic male factor treatments are well described. In couples with unexplained infertility, the proportion due to occult male factor is unclear. We hypothesized that many men diagnosed with unexplained infertility are actually fertile. We describe the 1-year natural pregnancy rates among couples in whom the male partner has been "cleared" of infertility on urologic evaluation.
Consecutive infertile couples were recruited from a single practice (PJT) over a 3-year period. A thorough male factor evaluation was performed, including a history, physical examination and 2 semen analyses. Based on this assessment, male partners in whom bulk semen parameters were normal were "cleared" from further evaluation. Lifestyle modifications were allowed, but no medical or surgical treatments were offered. The presence or absence of a female factor evaluation was not required for study inclusion. Subjects were followed for 12 months or until a pregnancy was achieved. Subjects were contacted via telesurvery 1-year later and pregnancy status ascertained. Simple descriptive statistics were used to evaluate the significance of observations.
Fifty-four men were enrolled in the study. The mean duration of infertility was 1.5 years (range, 0.4 to 4.0 years) and the mean male and female partner ages were 38.6 and 35.1 years, respectively. On evaluation, 40% of men were noted to have significant fertility risks that included a clinical varicocele, exposures, and androgen altering medications. Among n=31 couples with known pregnancy outcomes, 20/31 (65%) conceived naturally at a mean of 9 months after evaluation (range, 3-30 mos). Another 1/31 (3%) couples conceived with intrauterine insemination (IUI) and 4/31 (13%) conceived with IVF-ICSI.
A significant proportion of men diagnosed with unexplained infertility have lifestyle risk factors on urologic evaluation. Care in the form of counseling at-risk patients regarding lifestyle issues, in the absence of formal treatment, may have value in improving the fertility potential in this population. Indeed, natural conception rates among men identified with unexplained infertility are substantial and suggest that many of these men are truly fertile.
在男性因素导致不孕的夫妇中，经典男性因素治疗后的自然妊娠率已有充分描述。在不明原因不孕的夫妇中，隐匿性男性因素所占比例尚不清楚。我们推测，许多被诊断为不明原因不孕的男性实际上具有生育能力。我们描述了男性伴侣经泌尿外科评估“排除”不孕因素的夫妇的1年自然妊娠率。
在3年时间里，从单一诊所（PJT）招募连续的不孕夫妇。对男性因素进行了全面评估，包括病史、体格检查和2次精液分析。根据这一评估，精液参数正常的男性伴侣无需进一步评估。允许进行生活方式调整，但不提供药物或手术治疗。纳入研究不需要考虑女性因素评估情况。对受试者随访12个月或直至怀孕。1年后通过电话调查联系受试者并确定妊娠状态。使用简单描述性统计评估观察结果的显著性。
54名男性纳入研究。不孕平均持续时间为1.5年（范围0.4至4.0年），男性和女性伴侣的平均年龄分别为38.6岁和35.1岁。评估发现，40%的男性存在显著的生育风险，包括临床精索静脉曲张、接触史和使用改变雄激素的药物。在已知妊娠结局的31对夫妇中，20/31（65%）在评估后平均9个月自然受孕（范围3 - 30个月）。另外1/31（3%）的夫妇通过宫内人工授精（IUI）受孕，4/31（13%）的夫妇通过体外受精 - 卵胞浆内单精子注射（IVF - ICSI）受孕。
很大一部分被诊断为不明原因不孕的男性在泌尿外科评估中有生活方式风险因素。在不进行正规治疗的情况下，以咨询高危患者生活方式问题的形式给予关注，可能有助于提高该人群的生育潜力。事实上，被诊断为不明原因不孕的男性自然受孕率很高，这表明这些男性中有许多人确实具有生育能力。
