An In-Depth Bibliometric Analysis and Current Perspective on Male Infertility Research

Contributors: Dr. Keerti Singh (Barbados), Dr. Kavindra Kesari, (Finland), and Dr. Ranjit Vishwakarma (India)

*Commentary:

Baskaran S. et al., in their comprehensive bibliometric analysis of male infertility, employed a novel Funnel Model and reported a 265% increase in male infertility research from 1998 to 2017. The study highlighted a significant focus on testicular cancer, obesity, metabolic syndrome, and azoospermia, with relatively less attention given to erectile dysfunction and unexplained male infertility. An increasing trend in assisted reproductive technology (ART) research was also noted. The study projected a future trend towards integrated omics and ART research, emphasizing the need for improved diagnostic and treatment strategies in male infertility.

Key takeaways from this research:

• Research interest: Over the past two decades, there has been significant research interest in testicular cancer, obesity, Metabolic Syndrome (MetS), and azoospermia.

• Testicular cancer: The incidence of testicular cancer has doubled in the last three decades, especially in industrialized countries. This rise correlates negatively with semen parameters and fertility, particularly alarming among younger males.

• Obesity and MetS: These conditions have public health implications and negatively impact male fertility. Mechanisms and treatment options remain poorly understood.

• Erectile dysfunction (ED): Publication trends indicate a growing concern about ED and its importance in male infertility over the past decade.

• Unexplained male infertility (UMI): Despite fewer publications, there has been a significant increase in articles on UMI in the past two decades. This condition is poorly understood and clinically challenging, but research interest is growing.

• Genomics and advanced techniques: There has been a significant increase in genomics publications in the past two decades, along with a growing interest in proteomics, transcriptomics, and metabolomics. However, there are limitations due to the shortage of advanced techniques and sophisticated instruments, as well as limited accessibility and applied knowledge.

The Reviewer's (Keerti, Kavindra, and Ranjit) Viewpoint on Current Literature on Male Infertility:

The exponential growth in research publications on male infertility underscores the need for bibliometrics as a comprehensive tool for analyzing publication trends. This approach offers succinct analyses, uncovers the latest trends, and provides vital statistics for future research. Scientometrics mainly uses the Scopus database and includes literature from regional journals, thereby it can present diverse viewpoints on specific topics.

Key Topics in Male Infertility Research:

• Testicular Cancer, Obesity & Metabolic Syndrome (MetS), and Unexplained Male Infertility (UMI): These remain major clinical concerns with significant research focus.

• Erectile Dysfunction (ED): Fewer publications focus on ED, possibly because many EDrelated studies address sexual dysfunction. However, there has been a recent surge in ED research, likely due to increased awareness and acceptance of male sexual health issues.

Trends and Challenges:

• The global education of male infertility scientists and clinicians, along with the dissemination of scientific literature, has improved perceptions and highlighted the equal contributions of male and female factors to infertility.

• Idiopathic Male Infertility (IMI): Treating IMI is challenging, with many cases showing no improvement and often receiving empirical treatments. Understanding its multifactorial etiology has engaged more researchers, leading to in-depth studies on gene mutations and molecular defects. Significant progress is being made with genome-wide proteomics and transcriptomics technologies.

Current Gaps and Future Directions:

• Up to 40% of infertile males fall under the category of IMI, with idiopathic oligospermia accounting for 20% of cases. A critical unanswered question is, "Why is there a lack of new drugs for treating idiopathic oligospermia?" The role of the FDA and pharmaceutical agencies is crucial in approving and introducing new treatments with proven efficacy for IMI.

Global Collaboration and Policy Implications:

• There is a growing trend of collaborative global publications from international research consortia and intraregional collaborations. This addresses research capacity building and disparities in publication rates among regional indigenous universities, and lower-middle- and high-income countries.

• Future priorities should include investment in R&D, policy development, and insurance coverage for male infertility. This comprehensive approach will ensure continued progress in understanding and treating male infertility, ultimately benefiting patients worldwide.

*The commentary has been lightly edited for clarity and conciseness by Ashok Agarwal.

Take Home Message: Contributing author - Ashok Agarwal

Reproductive clinicians should prioritize screening for testicular cancer, obesity, MetS, and azoospermia due to their significant impact on male infertility. They should be aware of emerging omics technologies for comprehensive diagnostics and stay informed on advances in ART. Address ED and UMI with the latest research insights, emphasizing evidence-based and collaborative care.