Consensus workshop on advanced diagnostic andrology techniques

Abstract

The Workshop reviewed four areas of advanced diagnostic andrology identified in the World Health Organization's 1992 Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction as 'research tests'. These were computer-assisted sperm analysis (CASA), acrosome reaction tests, the zona-free hamster egg penetration test and sperm-zona pellucida binding tests. For each topic, the Workshop Report comprises an overview of the particular field, a chronicle of the discussion that followed and a statement of the specific consensus points that were established. Free discussion allowed the elaboration of several general concepts that are presented here as the Workshop participants' perceived framework for future work in this area. While it was recognized that large-scale screening of male partners using advanced sperm function tests is almost certainly totally impractical on grounds of cost and lack of adequate services, urgent consideration was recommended for the development of a sperm function testing strategy capable of providing the likelihood of pregnancy for given diagnostic situations within certain timeframes. Establishing a clear definition of the role of diagnostic andrology in male infertility should be a primary focus of the Special Interest Group's activities. Further initiatives, including training courses, workshops, symposia and multicentre research studies, will be accorded high priority. Similar consideration will also be given to protocols for facilitating rational management decisions to ensure cost-effective therapeutic strategies, including consideration of the hierarchy of complexity and cost versus predicted fecundity. In addition, it was recognized that we need a greater understanding of the genetic basis of male infertility and how this impacts on the achievement of a viable pregnancy, while also minimizing the burden of genetic defects on the next generation.