The Role of Urologist in the Era of Assisted Reproductive Technology (ART)

Kim, Jong Hyun

Abstract

Because of the success of assisted reproductive technology (ART), many men who have uncorrectable causes of infertility can become biological fathers. However, this robust technology can result in bypassing the evaluation and management of infertile men, and unknowingly transmit genetic disorders into the next generation. In the era of ART, the goals of the evaluation of infertile men are to identify (1) reversible conditions, (2) irreversible causes that may be managed by ART using the male partner's sperm, (3) irreversible conditions that may not be managed by the above techniques and for which the couple should be advised to pursue donor insemination or adoption, (4) significant underlying medical pathology, and (5) genetic and/or chromosomal abnormalities that may affect either the patient or his offspring. After a proper evaluation, the urologist should attempt to upgrade the infertile man through various medical and/or surgical management. Before ART is performed, genetic counseling is also needed to ascertain the probability of transmission of genetic problems to the next generation by ART. In addition, to improve the success rate of natural conception and ART, the urologist should never cease attempting to get more healthy sperm with a well- preserved nucleus DNA integrity.