Management of Male Fertility

Module details

Title

Management of Male Fertility

Type

Specialist

Module code

SLS330

Credits

10

Requirement

Compulsory

Aim of this module

This module will explore the broad area of male fertility to provide the underpinning knowledge and experience to underpin future clinical practice. Beginning with the clinical presentation and lifestyle and public health issues it will include treatment options and laboratory methods of diagnosis. This module will provide trainees with the knowledge and understanding of lifestyle and treatment approaches to management of male fertility. They will understand the role of regulation in patient treatment and become familiar with legislative and quality management aspects of licensed treatments. Trainees should gain insight into patient perspectives and information sharing with patients and how well this is understood.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1,3,4	Competency Review case notes to link the cause of potential male subfertility with potential and suggested treatment plans and produce an interpretive report of the investigations.	Action View
# 2	Learning outcome 1,3,4	Competency Review case notes to link the cause of infertility with the suggested treatment plan and produce an interpretive report of the investigations.	Action View
# 3	Learning outcome 1	Competency Using specific case studies (likely to be from previously published investigations/incidents) critically review the case studies identifying the risks and strategies to reduce risk.	Action View
# 4	Learning outcome 1	Competency Present the findings of the critical review with colleagues to use the learning to minimise risk in your work place	Action View
# 5	Learning outcome 2,5	Competency Perform witness checks during a procedure to meet Human Fertilisation and Embryology Authority (HFEA) requirements.	Action View
# 6	Learning outcome 2	Competency Perform quality assurance and quality control tasks within the diagnostic laboratory.	Action View
# 7	Learning outcome 2,5	Competency Review the required consents appropriate for an insemination treatment cycles, including those involving donated gametes.	Action View
# 8	Learning outcome 2	Competency Minimise risks and hazards in compliance with health and safety policies.	Action View
# 9	Learning outcome 3	Competency Perform and report a risk assessment for one key therapeutic procedure performed in the laboratory.	Action View
# 10	Learning outcome 5	Competency Discuss insemination methods used in treatment based on semen quality with patients communicating sensitively and empathically.	Action View
# 11	Learning outcome 5	Competency Keep accurate, legible records in accordance with applicable legislation, protocols and guidelines	Action View
# 12	Learning outcome 5	Competency Handle records and all other clinical information in accordance with all applicable legislation, guidance and protocols	Action View

Assessments

You must complete:

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

Observe initial consultation for a couple with subfertility, particularly try to attend where there is likely male factor.	OCE
Take a lifestyle history from a male patient	OCE
Discuss procurement of a semen sample with a patient, including factors such as abstinence and hygiene and how they may affect the same	OCE
From case based data correctly identify patients that require referral for further testing / medical input	OCE
Discuss results of a semen sample with a patient	OCE
Perform a post-vasectomy semen analysis	DOPS
Perform QC assessment of environmental control in the laboratory, including but not limited to temperature and pH.	DOPS
Perform toxicity testing for a new batch of laboratory consumables	DOPS
Analyse results of, and correctly interpret laboratory Quality Indicators	DOPS

Learning outcomes

1. Review a series of case notes to link the cause of potential male subfertility and infertility with the suggested treatment plan and produce  an interpretive report of the investigations.
2. Perform diagnostic procedures within the statutory and regulatory framework following appropriate quality assurance processes handling gametes correctly to maintain viability.
3. Review a series of case notes and recommend a patient’s pathway, including treatment options based upon clinical presentation.
4. Identify patients who, based on clinical parameters, require a referral to the department of sexual medicine or urology, Intervention for retrograde ejaculation (RE); Intra-Uterine Insemination (IUI) vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).
5. Communicate sensitively and empathically with a diverse range of patients and associated people according to best practice.

Learning outcomes

1. Explain the range of clinical presentations of males requesting fertility support and critically review the range of treatment options.
2. Discuss the potential impact of lifestyle on male fertility and evaluate public health strategies to support lifestyle change and the impact of culture, equality and diversity on practice.
3. Explain the range of male fertility options for contraception and critically review the range of treatment options available.
4. Describe and evaluate the range of laboratory procedures used in the diagnosis and treatment of male infertility.
5. Discuss how supplements to media can affect sperm parameters.

Indicative content

Clinical Presentation/Treatment Options

• Signs and Symptoms including
  • Azoospermia
  • Leucocytes in semen
  • Oligoasthenoteratozoospermia
  • Hypogonadotrophic hypogonadism
• Effect of different pathologies on sperm
• Effect of therapeutic treatments on sperm
• Treatment options (Pharmacological and Non-Pharmacological)
• Pharmacology

Lifestyle/Public Health

• Alcohol
• Drugs
• Smoking
• Obesity and weight management issues
• Occupation
• Current Public Health Strategies which may assist with these

 Male Fertility Options

• Correct support and management options for: o transgender individuals
• single men
• male-male partners
• Psychosocial aspects of male fertility
• Contraception
• Sexually transmitted infections
• pathology
• history and presentation
• clinical examination
• investigations
• treatment options
• preventive strategies
• psychosocial aspects

 Scientific Laboratory Practice/Culture systems

• Laboratory design and regulatory requirements
• Culture systems used in Andrology
• The importance of the culture environment and the implications for sperm viability, e.g. physical and biochemical
• Types of media and their applications
• Control of the culture environment for gametes in the Assisted Reproductive Technology laboratory, the role of buffers and the implications of pH and temperature on cellular processes
• Regulatory issues
• Laboratory quality indicators

 Sperm Parameters

• Chemicals that may improve sperm parameters and associated potential adverse effects

Activities

• Attend clinical appointments to gain experience of the clinical presentation of male infertility (with the permission of patients). Evaluate your experience in terms of both the clinical presentation and patient experience/needs and discuss with your supervisor.
• Attend clinical appointments to gain experience and review the range of treatment options for the sub fertile patient (with the permission of patients). This may include attendance at initial medical consultation, nurse consultation or follow-up consultation within the clinical setting of an HFEA licensed treatment centre.
• Shadow at least one patient infertility pathway to gain awareness of the clinical situations in which treatments including Intrauterine Insemination, In-vitro Fertilisation and Intracytoplasmic Sperm injection the monitoring undertaken and the importance of maintaining the safety of both service users and those involved in their care.
• Attend clinical appointments and procedures to gain experience of the range of male fertility options for contraception (visit urology outpatients or contact a local GP vasectomy provider), including but not restricted to vasectomy (with the permission of patients). Evaluate your experience in terms of both the clinical presentation and patient experience/needs and discuss with your supervisor.
• Attend clinical appointments to gain awareness of the issues and treatment faced by a patient considering gender reassignment (with the permission of patients). Evaluate your experience in terms of both the clinical presentation and patient experience/needs with particular reference to requirements the patient may have for gamete storage and future use and how proposed treatment will affect these. Discuss with your supervisor and the local clinical team(s) managing the case(s).
• Attend multidisciplinary team meetings to participate in case discussion to review a wide range of clinical cases.
• 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.
• Attend multidisciplinary team meetings to gain experience and describe the partnership between the reproductive science laboratory and other clinical specialisms in the investigation of infertility, for example Clinical Genetics.

   

• Become familiar with the laboratory quality management system and perform examination and other audits as part of the treatment accreditation process (applies as appropriate to all specialist modules).