Diagnostic evaluation of the infertile male A committee opinion

Authors:
Practice Committee of the American Society for Reproductive Medicine

Volume 103, Issue 3, Page e18

Abstract:

The purpose of this ASRM Practice Committee report is to provide clinicians with principles and strategies for the evaluation of couples with male infertility problems. This revised document replaces the document of the same name, last published in 2012 (Fertil Steril 2012;98:294–301).

  • “At a minimum, the initial screening evaluation of the male partner of an infertile couple should include a reproductive history and analysis of at least one semen sample. If the initial evaluation is abnormal, then referral to someone experienced in male reproduction is recommended.”

    The importance of the male factor evaluation cannot be emphasized. Male infertility can be a contributor in 20% solely and up to 60% combined. Proceeding directly to IVF/ICSI because of an abnormal SA without a male evaluation is a dis-service to the couple when a simple solution may have solved the underlying problem for the infertility. The other thing that a male evaluation includes is the evaluation for a serious underlying medical condition or cancer.

    The male infertility community sees the male evaluation as a complementary part of the evaluation and workup of the couple, not a means to keep the female partner from undergoing IVF/ICSI. The couple deserves evaluation from experts in both fields concurrently to allow for an efficient and thorough work up.

    • Good point Ed- the other issue about proceeding with IVF/ICSI without further workup in males with severely abnormal SAs is the genetic aspect: chromosomal abnormalities and y chromosome microdeletions may go unrecognized if no testing is performed, and proper genetic counseling of the couple is not possible. Do you have recommendations for what tests REI should send at a minimum when abnormal SAs are encountered (prior to referral to a male specialist)?

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