Evaluation of men with unexplained infertility

Abstract

Infertility affects approximately 15 % of couples desiring conception and male infertility underlies nearly half of the cases. However, despite the diagnostic advances in male infertility field, approximately 30 % of patients still have no apparent cause for their infertility problem. Although it is anticipated that future developments will allow identification of the etiology for subfertility in these patients, at present they are considered unexplained disorders that challenge specific treatment recommendations. The use of assisted reproductive techniques (ART) to overcome male infertility is increasing, and due to its effectiveness, this treatment modality has been suggested by some to be used as the treatment of choice in the majority of the cases of male factor infertility regardless of etiology. Although the use of ART may allow infertile couples to achieve pregnancy rapidly, the fear of transferring the unnecessary burden of invasive treatment on healthy female partners weigh down this treatment option heavily. The true litmus test for male fertility remains the ability to generate pregnancy in vivo. Although seminal parameters are used as a surrogate measure of a man’s fertility potential, it is definitely not a direct measure by any means. Seminal parameters between the reference ranges not reflect defects in sperm function. Thus, the assessment of sperm structure and function has gained interest and resulted in the development of the new techniques that are presented in this chapter.