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The forefront of andrological research at EAU18

Does the environment contribute to male infertility? What are the conception risks in correlation to advancing paternal age? Chaired by Dr. Maarten Albersen (BE) and Prof. Jens Sønksen (DK), Plenary Session 1: Hot topics, evidence quality and advances in andrology examined these topics and more today.

As paternal age increases, it presents no absolute barrier to conception, but it does present greater risks and complications, stated Prof. Andrea Salonia (IT) in his lecture Are European men delaying fatherhood? Epidemiology and the effects of advancing paternal age in fertility potential and the offspring. “The older the male patient, the higher the probability of comorbid conditions,” said Salonia.

With advancing paternal age, published data support a decrease in fertility, a decline in semen quality, and a lower success rate for ART (Assisted Reproductive Technology). There is an upsurge in male germline ageing, an increased risk of neurodevelopmental outcomes such as autism spectrum disorders and schizophrenia/psychosis, as well as an increased risk of childhood cancers.

According to Dr. Marij Dinkelman-Smit (NL), who presented on behalf of Prof. Gert Dohle (NL), Endocrine Disrupting Chemicals (EDCs) may be linked to testicular dysgenesis syndrome and decreased fecundity. In Western society, sperm count has declined and incidence of testicular cancer has increased. He highlighted the importance of pre-conceptional health in all genders with regard to EDCs.

EDCs mimic the female hormone oestrogen (pseudo-oestrogens) or antagonise androgens (anti-androgens). They can pass through the placenta and influence testicular development during early pregnancy (the ‘window of vulnerability’). EDCs can be found in plastic bottles, metal food cans, detergents, flame retardants, food, toys, cosmetics and pesticides.

In her lecture Is the environment responsible for male infertility: What is the evidence?, Dinkelman-Smit also stated that there are epidemiological studies that confirm the association between mothers’ exposure to EDCs and cryptorchidism in sons.

EAU Guidelines snapshot
In her lecture Surgical therapy for male infertility: Techniques and indications, Prof. Dr. Sabine Kliesch (DE) stated that when the diagnosis is varicocele of the testis, the therapeutic options are varicocelectomy / embolisation, and the recommendation is microsurgical varicocele surgery in idiopathic oligozoospermic men to improve natural conception.

Kliesch added that when the diagnosis is OA (obstructive azoospermia), microsurgical reconstruction or (micro-)surgical retrieval are two of the therapeutic options. As first-line therapy, refertilisation via vasovasostomy or tubulovasostomy is recommended. For second-line therapy, the recommendation is testicular or epididymal sperm retrieval such as Testicular Sperm Extraction (TESE) or Microsurgical Epididymal Sperm Aspiration (MESA).

For Non-obstructive azoospermia (NOA), TESE after genetic testing and counselling is the recommended therapeutic option. Other recommendations include microsurgical TESE for severe NOA; superior multifocal TESE rather than conventional TESE; and the inclusion of histological analysis to detect germ cell neoplasia in situ (GCNIS).