Strategies for the Infertile Man

Sergio Oehninger, M.D.

Disclosures

Semin Reprod Med. 2001;19(3) 

In This Article

Semen Analysis

The cornerstone of the andrological evaluation in all cases is an exhaustive history and a physical examination followed by repeated semen analyses. A urological, endocrine, and/or imaging workup should be implemented as appropriate.

A comprehensive semen analysis following the World Health Organization (WHO) guidelines [11] is fundamental at the primary care level to make a rational initial diagnosis and to select the appropriate clinical management. The collection and analysis of the semen must be undertaken by properly standardized procedures in appropriately qualified and accredited laboratories. [12]

The "basic" semen evaluation should include: (1) assessment of physical semen characteristics (volume, liquefaction, appearance, consistency, pH, and agglutination); (2) evaluation of sperm concentration, grading of motility, and analysis of morphological characteristics (using strict criteria) [13] ; (3) determination of sperm vitality (viability) by dye exclusion, testing for sperm autoantibodies (using the mixed antiglobulin reaction and/or the direct immunobead tests), presence of leukospermia and immature sperm cells; and (4) bacteriological studies. The identification and separation of the motile sperm fraction is also an integral part of the initial semen evaluation.[14,15]

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