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10. Medical and Surgical Management of Male Factor Infertility


Male factor infertility is a common illness affecting 10% of the population. Furthermore male factor infertility is involved in at least 50% of cases of couple infertility.

Management of this clinical problem involves microsurgical techniques as well as a clear understanding of the use of assisted reproductive technologies. This module will be the current status of medical and surgical treatments of male factor infertility.


10.1 Medical Expert

Cognitive Skills

Required reading

  • Campbell’s Urology Volume II, male factor infertility. Infertility in the Male, 3rd addition, Author Larry Lipshultz, Stewart Howards Mosby, Canada, 1997
  • American Urologic Association; Guidelines Committee report on the Optimal Evaluation of the Infertile Male;
  • Management of Obstructive Vasospermia and Management of Varicoceles

Optional Reading

  • Updates on Male Factor Infertility, Fertility and Sterility Journal, Human Reproduction Journal, The Journal of Urology

Our residents will participate in elective surgeries and will cover the following topics:

  • The physiology of male reproduction
  • Clinical evaluation of male factor infertility
  • Clinical evaluation of female infertility
  • Microsurgical management of male factor infertility to include discussion of varicocele surgery and obstructive azoospermia
  • Medical management of male factor infertility to include discussion of management of endocrinologic causes of male factor infertility
  • Management of infertility with assisted reproduction to include discussion on techniques available, indications and contraindications to use of assisted reproduction in male factor infertility

Technical Skills

Core program rotations

The residents should focus on the following areas:

  • Develop a working knowledge of the operating microscope and microsurgical instruments used in completing microsurgical procedures.
  • Understand the differences in sutures, characteristics of these sutures used in microsurgery of male infertility.
  • Develop a working knowledge of the anatomy of the male genitourinary tract.

Urology PGY3, PGY4, PGY5

Residents will learn to:

  • Access the testicle via approaches both transscrotal and subinguinal.
  • Perform testicular biopsy both open and percutaneous as well as how to access the vas deferens and epididymis.
  • Perform lymphatic arterial sparing, subinguinal microsurgical varicocelectomy.
  • Senior residents will learn the indications for testicular biopsy, percutaneous epididymal sperm retrieval , microscopic epididymal sperm retrieval, microsurgical subinguinal varicocelectomy, electroejaculation of vibration of ejaculation.

Faculty for Cognitive Surgical Skills

  • Dr. Marc Anthony Fischer, Diagnosis, Surgical Management and Medical Management of Factor Infertility
  • Dr. John Booth, Endocrinological Management of Male Factor Infertility
  • Dr. Ed. Hughes, Reproductive Technologies

10.2 Communicator

General Objectives

  • The resident would help the therapeutic relationship with patients and their partners and entertain information in an effective and caring manner

Specific Objectives

  • Many of these patients will have significant social and psychological pressures - the residents should be able to assess and properly address these issues with the patients.
  • The resident should be able to record data from history and physical examination, laboratory work in an effective manor and communicate to others in order to develop an effective management plan.
  • The resident will learn to communicate the management plan to the patient and their family in manner that facilitates the patient’s appropriate management.

10.3 Collaborator

General Objectives

  • The resident will consult and work with physicians and other health team members to treat the infertile couple.

Specific Objectives

  • The resident will interact with gynecologists, nurses and geneticists and endocrinologists to deal with the issues related to male factor infertility.

10.4 Manager

General Objectives

  • The resident will utilize information technology and meetings to facilitate life long learning in the area of male factor infertility and will learn to organize their practice and work effectively within the health care organization.

Specific Objectives

  • The resident will develop a system of prioritizing patients for surgery and will be able to assess the appropriateness of assisted reproductive technologies for treatment of male factor infertility.

10.5 Health Advocate

General Objectives

The resident will identify factors predisposing to male factor infertility in their patients and will contribute to the prevention of male factor infertility and advocate for better treatment options.

Specific Objectives

The resident will understand the risk factors for male factor infertility and how they may be impacted in individuals in their community as well as understand the cost implications of reproductive technology for patients.

10.6 Scholar

General Objectives

  • The resident will develop a continued personal learning strategy in the field of male factor infertility and the resident will quickly appraise the information to facilitate the education of others including house staff, patient staff and the health care professionals.

Specific Objectives

  • The resident will evaluate their own capabilities and limitations in the fields of microsurgical and the general evaluation of male factor infertility and will develop a course to improve and refine their skills.
  • They will demonstrate a research a topic using available database and to critically evaluate the studies that they find. They will maintain an inquisitive attitude and may pursue to the development of research protocols. They will also need to be aware of the ethics of assisted reproductive technologies.

10.7 Professional

General Objectives

  • The resident will learn to develop the highest quality of care with integrity, honesty and compassion.
  • They will practice ethically and demonstrate appropriate behavior for a urologic consultant.

Specific Objectives

  • The resident will demonstrate personal responsibility by maintaining confidentiality, being available and being sensitive to the patients at a level of emotional and social discomfort.
  • The resident will be aware of the best practice and where appropriate refer patients to Centres of Excellence.
  • The resident will understand the process of informed consent and informed decision making as it applies to male factor infertility.

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