In a recent study published in the journal Nature Reviews Urology, researchers addressed the most pertinent questions concerning male infertility. They discussed the current understanding of the subject, as well as the areas and opportunities for improving male reproductive health.
Although the incidence of infertility among middle-aged men and women is almost equal, the dearth of understanding about aspects related to male gamete production and the impact of lifestyle and environmental factors has resulted in a lack of clarity about the etiology of male infertility. The health system also fails to understand the importance of male infertility as a biomarker for other systemic illnesses or the benefits of improved knowledge of male reproductive health in medically assisted reproduction (MAR) technology.
The tests to precisely diagnose male infertility are still rare, and infertility is mainly diagnosed using family histories, semen analyses, physical examinations, and surrogate markers in the form of hormone profiles. Furthermore, the categories used to group men who seek MAR are broad, such as azoospermia, asthenozoospermia, oligozoospermia, and teratozoospermia, which can have multiple underlying causes. The lack of clarity about male infertility makes it difficult to treat the condition and often results in the female partner being misassigned the burden of treatment in cases of infertile couples seeking MAR.
About the study
In the present study, the researchers emphasize the need for a better understanding of the underlying causes of male infertility, such as an interplay of epigenetic and genetic factors and the influence of lifestyle choices and environmental factors. Furthermore, they believe that the issue of male infertility extends beyond the conception of offspring and also impacts other aspects of health, with studies indicating that the disease burden is higher among infertile men than fertile men. The need to better understand male infertility is imperative also from the perspective of ensuring that children conceived through MAR do not inherit the genetic factors that cause male infertility.
The present review was a result of a request from the Male Reproductive Health Initiative (MRHI), which is part of the European Society of Human Reproduction and Embryology, for a recommendation document that could provide clarity on the current knowledge about male reproductive health and medicine, and identify research gap areas for further improvement. This document is intended for researchers in the field, as well as the governments and general public. The recommendations address some of the most pertinent questions related to male infertility and are a result of consultations with experts in the field of andrology research, public policy, and clinical practice from across the globe.
Results
The researchers identified 13 of the most vital questions regarding male infertility and addressed these questions with the aim of improving the understanding, diagnoses, and treatment options for male infertility. The first question addresses the global prevalence of male infertility, and surprisingly, there is a lack of clarity on the subject. An accurate estimation of the prevalence of male infertility has proven difficult because most of the information comes from data from infertility clinics or from studies examining populations that are at risk, such as those exposed to specific toxins.
Furthermore, assessments of male infertility are based on semen analysis from heterosexual couples seeking MAR. The prognostic ability of semen analysis is not accurate, and the ability to conceive is based on the combined fertility of the couple. Therefore, in many cases, men with impaired spermatogenesis and reduced fertility still manage to conceive if their female partner is healthy, and cases often come to light only if the female partner also suffers from reduced fertility.
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With regard to diagnostic techniques, the review discussed the combination of methods currently used to diagnose male infertility but highlighted the lack of clarity in determining the causality of the cellular or physiological deficits identified through these tests.
The other areas of concern discussed in the review included the current treatment options that exist for addressing male infertility and the need for improved options. The review also discussed the genetic factors, as well as the lifestyle choices and environmental factors that impact male fertility. Epigenetic factors and their influence on male fertility and the inter-generational consequences of these epigenetic factors were also discussed.
Some of the other aspects of male reproductive health addressed in this review were the economic burden, as well as the disease burden, of male infertility and the possibility of developing gamete storage or restoration protocols before the administration of medical interventions.
The study also addressed the long-term impact of compromised fertility on the health of children conceived naturally or through assisted reproduction to men with impaired fertility. Lastly, the researchers addressed the need for improved communication about andrology and male infertility with health professionals, policymakers, funding agencies, and the general public.
Conclusions
Overall, this comprehensive review on male reproductive health addressed the significant areas of research, including a better understanding of the prevalence of male infertility and improved diagnosis and treatment methods. The researchers also discussed the need to understand the underlying causes of male infertility and to improve the communication of information about andrology to various stakeholders and the general public.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
