Male infertility-evaluation and management at a glance

Abstract

Poor semen quality contributes to the sub-fertility in 30%–50% of couples undergoing IVF. Ever-changing societal values and its stress, professional pressures, delayed parenthood and rampant obesity are fuelling an exponent increase in male infertility. Traditionally evaluation and management of male infertility relied heavily on semen analysis. The need for standardization of procedures for semen analysis leads to conception of WHO laboratory manual for the examination of human semen in 1980. It has been since revised and updated four times in light of emerging evidence. But time and again these reference values have been shown to be ineffective in reliably predicting the fertility status of men and has highlighted the fact that semen analysis needs to be complemented by a comprehensive history taking, physical examination, and relevant endocrine, genetic, and other investigations. In present scenario, role of IUI with husband/partner’s sperm for male infertility is limited except in couples with physical, ethical or moral objection to IVF/ICSI. ICSI has revolutionised the treatment of male infertility. Surgical sperm retrieval in the form of PESA, TESA and open testicular biopsy has allowed azoospermic patients the opportunity of biological paternity.