Epidemiologic Considerations in Male Infertility

Abstract

The diagnosis of male infertility implies an impairment of the male reproductive potential. Unfortunately, there is no gold standard for the assessment of the male reproductive potential. The diagnostic accuracy of semen analysis is compromised by substantial overlap between the distributions of semen parameters in empirically fertile and infertile men. Novel assays, including seminal reactive oxygen species levels, sperm DNA fragmentation, and sperm epigenetic testing, may prove to be of greater clinical utility for identifying men with below-average reproductive potential. Efforts to identify and treat modifiable risk factors should ideally be targeted toward these individuals. Although economic analyses have demonstrated that pathology-directed treatment for male infertility is often more cost-effective than immediate use of assisted reproductive technology, there is a declining trend in surgical treatment of male infertility.