Recent Contributions from Dr. Schlegel

Dr. Schlegel routinely continues to identify new ways to help men with a variety of urologic conditions, especially severe male infertility. Several of his most recent medical publications are overviewed below.

Can sperm quality affect reproductive outcomes?

Published: August 10, 2023 | View Article

As an editor for the medical journal, Fertility & Sterility, Dr. Schlegel routinely asks experts to provide input into topics of interest to other reproductive experts. One set of these contributions was published in October, 2023 with articles on a variety of studies that analyze sperm quality, using structural analysis of the sperm structures called centrosomes, sperm DNA damage, and forms of Artificial Intelligence evaluation of sperm. Of note, sperm centrosomes provide the tubules that drive early embryo development. Sperm DNA fragmentation has been shown to affect the chance of achieving a pregnancy naturally, with IVF or with ICSI, as well as the risk of miscarriage – indicating that sperm can affect embryo development even after the embryo has implanted in the uterus and is a developing fetus.

Dr. Schlegel delivers The Patrick Steptoe Lecture at the British Fertility Society

Medical meetings are an opportunity for doctors and scientists to gather and present the latest information on treatments that are available for care of patients, including new breakthrough interventions and the most effective treatments available for specific medical conditions. One of the most important contributions at these meetings are “named” or “endowed” presentations, usually recognized by a historical contributor to the field of medicine/science. For the 2024 annual meeting of the British Fertility Society, the programme committee asked Dr. Schlegel to give a talk on the evolution of treatment of severe male infertility. On January 11 at this meeting at the Edinburgh International Convention Center in Scotland, Dr. Schlegel gave a 45 minute talk overviewing the work that he has done in identifying genetic, hormonal and surgical treatments that can be used for men with few or no sperm in the ejaculate. The invitation by the British Fertility Society to give this talk is a unique recognition of Dr. Schlegel’s contributions to the field of male infertility by his international colleagues.

Births after intracytoplasmic injection of sperm obtained by testicular extraction from men with nonmosaic Klinefelter's syndrome

Published: February 26, 1998 | View Article

Published January 11, 2024 | View Article

Men with Klinefelter syndrome (KS) routinely have severe male infertility. These men were previously thought to be sterile, incapable of having children. Dr. Schlegel was an integral part of the first team to be able to allow men with KS to have children (https://pubmed.ncbi.nlm.nih.gov) published in the New England Journal of Medicine. Some men with KS are identified in childhood or early adolescence, so there has been a debate as to whether early efforts should be taken to preserve fertility for these young men, possibly before they lose that fertility potential. In one of the most extensive experiences with surgical sperm retrieval in KS, Dr. Schlegel and co-authors reported in The Journal of Urology that early sperm retrieval (during adolescence) is not necessary – men can wait until they are married and have treatment with their future wife or female partner (published 2024 in the Journal of Urology ).

Treatment of male infertility: Is ICSI the only successful approach?

Published: February 20, 2025 | View Article

For male infertility, there is often a rush to proceed directly to ICSI, a very effective treatment using single sperm injection into each egg during an IVF cycle. Although ICSI has revolutionized our ability to treat many men with fertility problems, there is also data to suggest that enhancing men’s heath and sperm quality may benefit couples, even if IVF is eventually required.

In the above-referenced article, Dr. Schlegel brought together experts in male and female infertility to discuss the viewpoitnes of treating just with ICSI, versus trying to treat the man directly.

Authors in that article note that IVF success rates can be greatly enhanced, according to a series of published studies, if male factors affecting fertility (like varicoceles) are treated before a couple goes to IVF treatment. Even though ICSI is very successful as a treatment for male factor, evaluating and treating causes of male infertility can improve the results of ICSI.

What’s the take home message? For an infertile couple, having the male evaluated is important for his health as well as the overall treatment results for a couple. Analyzing a man by looking at sperm analyses alone is an inadequate approach to caring for couples with male infertility. Not only can infertility reflect medical problems for a man, but intervention may improve his sperm as well as his overall health. Male fertility experts can be found at professional societies like SSMR.org or SMRU.org, or by calling Dr. Schlegel’s office for a recommendation. The article will be published in the journal, Fertility & Sterility this spring (with an overview by Dr. Schlegel: https://authors.elsevier.com/a/1keJ23Qi80qMd.

Does hormone treatment or varicocele repair improve sperm retrieval rates in men with non-obstructive azoospermia? Probably not!!!

Published: August 20, 2024 | View Article

High quality evidence, summarized in the American Urological Association & American Society for Reproductive Medicine Guidelines (chaired by Dr. Schlegel) did not find evidence in dozens of manuscripts to recommend hormone treatment or varicocele repair routinely before microTESE in men with NOA (non-obstructive azoospermia.). A recent article from Brazil suggested that men did better with medical treatment and/or those who had varicocele repair before microTESE. What conclusion is correct? In the commentary (article referenced above), Dr. Schlegel points out the many methodological flaws in this Brazilian study, that make their conclusions inaccurate to apply for most men with NOA. Although Esteves et al. suggested 2.5-fold improvements in sperm retrieval rates, these data are not “high quality” evidence and may not be accurate representations of the benefit, if any, of such treatments. Of course, men with low testosterone should be treated with medications to normalize their production of testosterone before microTESE, but routine treatment is not necesarily beneficial if testosterone is borderline or normal (many of the men in the Esteves study had what would be considered normal testosterone levels without treatment.). Don’t be confused by the term, “Real World Evidence”; it is not usually high quality data that we get from randomized, controlled, carefully done scientific studies because of biases in how patients are treated.

Published: November 18, 2024 | View First Segment on Isotretinoin, View Second Segment on Isotretinoin

Dr. Schlegel provides input in medical journals to explain studies published by other authors

One of the roles for an established leader in male infertility is to provide input when other doctors submit a manuscript to be published in medical journals. In a recent editorial (https://www.sciencedirect.com/science/article/pii/S0090429524009580?dgcid=author), Dr. Schlegel provided key input on the limitations of a published medical journal article. In a series of YouTube videos published online, he also provided the background for potential medical treatment of severe male infertility presenting with maturation arrest (https://www.youtube.com/watch?v=13T5-YSWQ_M; https://www.youtube.com/watch?v=n51Rqv3YnGI ) as well as to include caveats on these experimental interventions using the drug isotretinoin for male infertility.

Dr. Schlegel also presented a webinar. for the prestigious Europen Society for Human Reproduction and Embryology Socity on fertility preservation in young men. A recording of the webinar is available here: https://ecampus.eshre.eu/course/view.php?id=11964.

Further information on treatment options for severe male infertility and the opportunity for a virtual or in-person consultation are available by contacting us at PNS@NYMensHealth.org.

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