Male fertility and infertility

TD Glover, CLR Barratt (eds). (285 pages, £45.) Cambridge University Press, 1999. ISBN 0-521-62375-8. This interesting book is composed of two parts, the first discussing biological perspectives and the second the implications of new technologies. Although not terribly relevant to practising clinicians, some of the discussions and topics covered in the first part provide fascinating reading. The human male it appears is vastly inferior to many other mammals. The male chimpanzee has on average 600 million sperm per ejaculate, while the human has less than 200 million. Rams can ejaculate 30 or 40 times a day compared with a maximum of six in a human male. In the second part, intracytoplamic sperm injection (ICSI) is discussed in detail and it is pointed out that, after years of disappointing attempts at treating male infertility, this has been the biggest breakthrough since IVF. The fact that only one spermatozoon is needed to fertilize an oocyte means that men with few or no sperm in their ejaculate can father a child, pregnancies being obtained with sperm retrieved from the ejaculate, epididymis or seminiferous tubules. This is irrespective of whether spermatogenesis is normal or deficient and whether the underlying pathophysiology is understood or not. The chapter on the genetic basis of male infertility discusses some of the causes, together with the importance of counselling and screening as many known defects may be passed to the offspring. Many candidates for ICSI have autosomal karyotype abnormalities; a number have Y chromosome microdeletion and men with absent vasa deferentia may have mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. This clearly has implications for the offspring but, as the first pregnancy achieved with ICSI was in 1993, there are still a number of years to wait before the full picture can be appreciated. Other gene abnormalities causing male infertility are discussed such as Kartagener's syndrome, Kallmann's syndrome, myotonic dystrophy and androgen insensitivity. The chapter concludes with a discussion of chromosomal abnormalities such as Klinefelter's, Noonan's and Prader–Willi's syndromes. The next chapter compares surgery versus ICSI as a treatment for male infertility, and this is followed by a chapter which attempts to define asthenospermia and to discuss methods of semen assessment. The use of molecular techniques for the diagnosis of inherited disorders is then discussed, with the final chapter gazing into the crystal ball for the future in andrology. As with many multi-author volumes, this book suffers from lack of flow and some repetitions, but this is counteracted by the fact that it has the benefit of the expertise of 20 individual specialists. Most of part two is relevant to practising clinicians in the field of infertility; part one provides an interesting background to the subject.