ABSTRACT
INTRODUCTION@#Advancement in male infertility were evident during the past several decades where ashift to evidence-based management is becoming apparent. However, there is still a knowledge gapamong training urologists in the said field where the Philippines is no exception. This is the first studythat would determine the current trend of practice in male infertility among Filipino urologists andrecommend solutions to this problem.@*MATERIALS AND METHODS@#A 42-item self-administered survey questionnaire was carried out using theSurvey Monkey. This Institutional Review Board (IRB)-approved online survey consisted of 3 parts:demographics, adherenceto the guidelines andclinical practice.The authors contacted thePhilippineUrological Association (PUA) via email and requested for confidential distribution of an online survey.The participants were given 4 weeks from the date of initial mailing until end of the survey process.STATA 15.0 was used for data analysis.@*RESULTS@#A total of 131 respondents participated in the survey. Only 13% responded that they are “veryinterested” in the specialty of male infertility. About 84% of respondents see less than 5 male infertilitycases per month with 67% of them reporting that male infertility constitutes less than 10% of theirpractice. For the treatment, 36% of them prescribe testosterone for empiric medical therapy of maleinfertility which is contraindicated in the treatment of male infertility and only 5% of respondents offerthe gold standard microsurgical varicocoelectomy in patients with varicocoele. Only 8% of respondentsare affiliated with IVF centers, which is troubling with regards to how men with poor reproductivepotential are treated especially in azoospermic men. Two percent of the respondents rated their exposureto male infertility during residency as “excellent” while only 3% of them rated their knowledge asexcellent. With this, responders suggest more exposure to the specialty, more postgraduate courses,lectures, and webinars, more training opportunities, a local guideline for Filipino urologists to follow,and more exposure to professional networks.@*CONCLUSION@#Practice of male infertility in the Philippines is inadequate in terms of knowledge andtreatment for these patients. Most respondents follow the male infertility guidelines available, but itdoes not translate into practice, highlighting their own preferences in diagnosis and treatment. Eventhough they consider it as a necessary part of Urology, lack of exposure to cases, surgical loads, andresearch makes it a challenge when faced with these cases in their clinics. A change in the residency,postgraduate, and national level are recommended to have the best clinical outcome and well-beingfor these patients.
ABSTRACT
Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.