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Lancet Diabetes Endocrinol. 2017 Jul;5(7):544-553. doi: 10.1016/S2213-8587(16)30040-7. Epub 2016 Jul 7.

Novel concepts in the aetiology of male reproductive impairment.

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Centre for Reproductive Medicine, University Hospital of the Free University Brussels, Brussels, Belgium. Electronic address:
Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
Department of Urology, Boston University School of Medicine, Boston, MA, USA.


Infertility is a widespread problem and a male contribution is involved in 20-70% of affected couples. As a man's fertility relies on the quantity and quality of his sperm, semen analysis is generally used as the proxy to estimate fertility or gain insight into the underlying reasons for infertility. Male reproductive impairment might result from factors that affect sperm production, quality, function, or transport. Although in most men the origin of infertility remains unexplained, genetic causes are increasingly being discovered. In this first of two papers in The Lancet Diabetes and Endocrinology Series on male reproductive impairment, we propose a novel, clinically based aetiological construct with a genetic focus, and consider how this might serve as a helpful way to conceptualise a diagnostic algorithm.

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