Instructional Course - Requires Course Pass or Individual Course Ticket, Additional Registration Required
Marc Goldstein, MD
Weill Cornell Medicine/New York Presbyterian Hospital
Mark Sigman, MD
Chief of Urology
Brown University
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Peter Chan, MD
McGill University Health Center
This course will focus on what general urologists who have not had fellowship or specialty training in male infertility can do to evaluate and treat male reproductive disorders. Basic science presented will be limited to that which is absolutely essential to understand the basic evaluation and treatment. In 90% of male infertility cases, a good history and careful physical examination, along with a basic semen analysis, which can often be performed by the doctor himself, will allow the general urologist to come up with a tentative diagnosis and treatment plan. More advanced testing is primarily designed to confirm the diagnosis. Key points of history, including inheritance issues, will be discussed. The finer points of physical examination, which in male infertility, due to the ready accessibility of the male reproductive organs to physical examination of a relaxed scrotum, allows the diagnosis to be made without the necessity for imaging studies in the majority of men. Interpretation of semen analysis will be discussed. When and what endocrine evaluations should be performed, including indications for genetic testing such as microY deletion assays and karyotype. When more advanced sperm testing, such as DNA fragmentation and anti-sperm antibody assays, are indicated as well as indications for imaging such scrotal and, transrectal ultrasonography and testis biopsy. The performance of basic office ultrasound, done by the general urologist, will be explained and the images obtained will be interpreted.
The most likely diagnoses resulting from the evaluation will be discussed and treatments that can be employed by general urologists without fellowship training will be discussed in great detail. This will include medical treatments, basic surgical treatments that can be performed by general urologists with minimal microsurgical training and lifestyle recommendations, including supplements that may be of value.
A limited presentation of advanced evaluation and treatment methods employed by fellowship trained specialists will be described and the indications for referral to such specialists presented.
Fully one half of the course will consist of case presentations, preferably employing interactive technology, allowing the audience to choose the cases they most want to discuss among several offered by the faculty and/or allowing the audience to submit cases ahead of time. Various diagnostic algorithms and management protocols, including those recommended in the AUA clinical practice guidelines, will be presented and discussed in this course to allow general urologists to adopt them into their daily practice in the management of a growing number of couples experiencing fertility issues.
In summary, male factor infertility is now known to be either the primary cause or contribute to at least half of all cases of couple infertility. The basic evaluation and often a majority of treatments can be performed by a general urologist without specialty training. This course will focus on the evaluation and the treatments that can be performed by the true general urologist.