Chapter 5 - Assessment of the male partner

Summary

A complete history and physical exam is the cornerstone of the evaluation of the infertile male. The semen analysis is critical in the initial evaluation of the infertile man and to a large extent guides further work-up. Karyotype analysis and microdeletion analysis of the Y chromosome are indicated for men with severe oligospermia or azoospermia because of the common detection of genetic anomalies in men with low sperm production. Computer-assisted semen analysis (CASA) has been developed to overcome the highly subjective nature of conventional analysis of sperm morphology and quality. The post-coital test evaluates the interaction between sperm and the cervical mucus environment in the woman. In light of an abnormal post-coital test or in cases of idiopathic infertility, antisperm antibody testing may be obtained. With a thorough understanding of the proper work-up algorithm, there is less unnecessary testing, which will benefit patients both financially and emotionally.