Andrological Dysfunction

Module details

Title

Andrological Dysfunction

Type

Specialist

Module code

SLS320

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with knowledge and understanding of the causes, diagnosis and treatment of both male and female infertility and wider aspects of andrological dysfunction. They will understand the psychosocial aspects of male and female infertility and how to support men and women referred for investigation. They will also understand the role of regulation and accreditation in diagnosing and treating infertility and the legislatory quality management aspects of licensed treatments. They will apply their understanding of the interrelationship of the different problems to potential outcomes; the diagnostic and therapeutic modalities available for conditions beyond the field of subfertility and the impact of infertility on the male, their partner, extended family and friends.

 

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Plan and optimally time andrological investigations exercising their own professional judgement.	Action View
# 2	Learning outcome 1	Competency Perform witness checks during a procedure to meet regulatory and good practice requirements.	Action View
# 3	Learning outcome 1	Competency Review the required consents appropriate for a variety of diagnostic testing and different treatments.	Action View
# 4	Learning outcome 1	Competency Follow the appropriate guidelines for incident reporting.	Action View
# 5	Learning outcome 2,3	Competency Review case notes to link the results from semen analysis to fertility prognosis and produce an interpretive report of the investigations.	Action View
# 6	Learning outcome 2,3	Competency Review case notes to link the cause of male sexual dysfunction with the suggested treatment plan and produce an interpretive report of the investigations.	Action View
# 7	Learning outcome 2,3	Competency Review case notes to link the cause of male endocrine dysfunction with the suggested treatment plan and produce an interpretive report of the investigations.	Action View
# 8	Learning outcome 2,3	Competency Review case notes to assist diagnosis of male genital tract pathologies and design/confirm a suggested treatment plan.	Action View
# 9	Learning outcome 4	Competency Perform a risk assessment for screening for sexually transmitted infections.	Action View
# 10	Learning outcome 4	Competency Perform an audit for an endocrine diagnostic laboratory procedure related to this module.	Action View
# 11	Learning outcome 4	Competency Analyse the data, present a report and discuss and implement recommendations.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform identity checks with a patient having a procedure meeting regulatory and good practice requirements	DOPS
Perform witness checks during a procedure meeting regulatory and good practice requirements	DOPS
Review the required consents and what is appropriate for a variety of diagnostic testing, including for endocrine and STI tests	DOPS
Perform a blood endocrine assay for a male patient	DOPS
Perform a witnessing audit	DOPS
Perform a risk assessment	DOPS
Discuss a male patient case where endocrine diagnosis has been indicated at an MDT, include discussion of endocrine markers beyond testosterone.	OCE
Discuss subsequent pathways for a patient with male sexual dysfunction / spinal cord injury / psychosexual issues in an appropriate MDT or specialist clinic team meeting.	OCE
Discuss male patient experience/needs either at a group or individual level within a service.	OCE
Present and evaluate to colleagues an array of treatment options for men beyond simple assisted conception (e.g. varicocele surgery / vibratory stimulation for anejaculation / etc).	OCE
Discuss the impact of STI diagnosis on the individual and the couple.	OCE

Learning outcomes

1. Plan and optimally time andrological investigations.
2. Review a series of case notes to link the cause of male sexual dysfunction, endocrine dysfunction and/or genital tract pathologies with the suggested treatment plan and produce an interpretive report of the investigations.
3. Review a series of case notes and recommend treatment pathways, including options based upon clinical presentation.
4. Perform a risk assessment and audit in a diagnostic setting, analysing the findings and presenting a report with recommendations.

Learning outcomes

1. Discuss the diagnosis and causes of male and female infertility and critically evaluate treatment options.
2. Discuss and appraise the causes, pathological changes, diagnosis and treatment of male infertility and sexual dysfunction.
3. Discuss and critically evaluate medical and surgical treatment options and appropriate Assisted Reproductive Technology (ART) open to the male with andrological dysfunction.
4. Explain and critically evaluate the current accreditation requirements for laboratories performing semen analysis.
5. Examine the current statutory and regulatory requirements of fertility treatments and professional codes of practice.
6. Explain and critically analyse the principles and practice of quality management and validation.
7. Discuss the linkages between the reproductive science laboratory and other clinical specialisms in the investigation of male and female infertility and patient care.

Indicative content

Male and Female Infertility

• Investigation of the infertile male, including specialist andrology testing including endocrine and laboratory

 Causes of Male Infertility and Sexual Dysfunction

The need to be empathetic and sensitive when considering issues of male infertility and sexual dysfunction should be paramount to all learning in the academic and work-based setting and should be considered alongside all causes and cases listed below: 

• Endocrine deficiencies
• Obstructions
• Genetic and chromosomal disorders
• Autoimmunity
• Varicocele
• Spinal Cord Injury
• Psychosexual issues including:
  • disturbances of desire
  • arousal
  • erectile dysfunction
• Ejaculatory and orgasmic dysfunctions, including retrograde ejaculation
• Male sexual dysfunction including:
  • disorders of sexual development
  • hypogonadism
  • male ageing and other conditions from puberty to senescence
• Male genital tract pathologies including:
  • Infections and their consequences
  • inflammations
  • sexually and non-sexually transmitted
• Cancer and conditions, the treatment of which affect male fertility
• Genetic and chromosomal disorders
• Overview of the causes of female infertility including:
  • endocrine disorders
  • genetic and chromosomal disorders
  • tubal disorders
  • endometriosis

Medical and surgical treatment options

• Non-pharmacological, pharmacological and surgical treatment options for male infertility and sexual dysfunction including mode of action, evidence base and the reasons why they are used in different clinical situations
• Non-medical and non-surgical options (including expectant management and psychological interventions) and the evidence supporting these
• Treatment options for female infertility
• Patient involvement in treatment decisions
• Financial considerations in treatment choices

 Regulation and Accreditation requirements including quality management

• The Human Fertilisation and Embryology Act and Code of Practice
• Legislation and regulatory mechanisms in the UK compared with those both within and outside the EU
• Accrediting organisations, e.g. the United Kingdom Accreditation Service and the Royal College of Pathology
• Licensing for both treatment and research in the UK
• Social and ethical responsibilities of a Clinical Scientist working in Andrology
• The limits of the concept of confidentiality
• Quality management system within a diagnostic laboratory (e.g. ISO615189) and treatment centre (e.g ISO9001), including audit requirements.
• Quality control tests routinely employed in the andrology laboratory including internal and external quality control, CE-marking and bioassays
• Validation and verification of equipment and processes
• Statistical analysis, uncertainty and quality control charts for diagnostic Andrology.
• Principles of information governance and be aware of the safe and effective use of health and social care information

Activities

• Attend clinical appointments to gain experience of the clinical presentation of, and the range of treatment options for male sexual dysfunction (with the permission of patients) including erectile dysfunction, disturbances of desire, arousal, ejaculatory and orgasmic dysfunctions. Evaluate your experience in terms of both the clinical presentation and patient experience/needs, where possible talking to patients, and discuss with your supervisor.
• Attend clinical appointments (with the permission of patients) to gain experience of the clinical presentation of, and the range of treatment options for male endocrine dysfunctions (including disorders of sexual development; hypogonadism; male ageing and other conditions from puberty to senescence). Evaluate your experience in terms of both the clinical presentation and patient experience/needs, where possible talking to patients and discuss with your supervisor.
• With consent shadow at least one patient pathway to gain experience of the endocrine and physiological responses to different endocrine treatments and discuss the clinical situations in which each would be used, the monitoring undertaken and patient safety considerations.
• Attend clinical appointments to gain experience and review the range of treatment options for male genital tract pathologies (with the permission of the patient). This may include infections and inflammations or cancers relating specifically to the male. This may include attendance at initial medical consultation, nurse consultation or follow-up consultation within a clinical setting.
• Attend multidisciplinary team meetings to participate in case discussion to review a wide range of clinical cases and gain experience. Discuss the partnership between the reproductive science andrology laboratory and other clinical specialisms in the investigation of male problems for example the Endocrinology Clinic and laboratory performing Endocrinology assays with your supervisor.
• With a mentor discuss a series of more complex clinical scenarios and diagnoses that occur (these may be rarer and it is not expected that you will have seen them).
• Select one case discussion and review in more detail, following patient progress and actual/potential outcomes, to include the clinical presentation, options considered, treatment provided and patient engagement and experience in the process. Present  the case to colleagues responding to questions appropriately.

  

• This module is focused upon clinical experience and learning in related fields, however experience and comprehensive understanding should be obtained during the module in the running of male Endocrine assays.