How to asses the male partner ???

How to assess of Male Infertility:-Ans: Male factor infertility is the only cause of infertility in approximately 30% of couples and a contributing factor in another 20% to 30%. Assessment of the infertile couple includes evaluation of the male partner by history, examination, and semen analysis.

 What tests for male subfertility?  Important elements of the history include prior paternity, a history of cryptorchidism, medical and surgical history, sexual dysfunction, and any use of medications, tobacco, alcohol, or illicit drugs. On the physical examination, testicular abnormalities such as a varicocele or absence of the vas deferens can be detected. If the semen analysis is abnormal, it should be repeated after at least 1 month by a laboratory that adheres to World Health  Organization.

Limitations of RSA:  Although semen analysis is routinely used to evaluate the male partner in infertile couples, the discriminatory ranges are not clearly defined. A study by Guzick and colleagues concluded “threshold values for sperm concentration, motility, and morphology can be used to classify men as subfertile, of indeterminate fertility, or fertile. None of the measures, however, are diagnostic of infertility.” The reference values for fertile, indeterminate, and subfertile ranges for semen analysis parameters as identified by regression analysis is mentioned below.. Despite its limitations, semen analysis remains the most important tool in the investigation of male factor infertility. If any abnormalities are repeatedly detected on a semen analysis, referral to a urologist may be warranted. The treatment of severe male factor infertility including azoospermia has been revolutionized with the combination of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

Health Organization Criteria for a Normal Semen Analysis(old standars)

Classifying the semen report as -àFertile, Indeterminate, and Subfertile Ranges as identified by Regression Analysis World Health Organization Criteria for a Normal Semen Analysis: Old standards “ Currently there have been  many changes

Criteria	Parameters
Volume	2.0–5.0 mL
pH	7.2–7.8
Sperm concentration	≥ 20 × 106/mL
Total sperm count	≥ 40 × 106 spermatozoa
Motility	≥ 50% with forward progression or ≥ 25% with rapid
	linear progression within 60 min after collection
Morphology	≥ 50% with normal morphology
Viability	≥ 75% live (ie, excluding dye)
White blood cells	≤ 1 × 106/mL
Fructose (total)	≥ 13 mol/ejaculate

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Adapted from Ann Ist Super Sanita. 2001;37:I–XII, 1–123 By such report the clinicians classifies semen report as

Previously, the postcoital test (PCT) assessing the sperm motility in a sample of postcoital cervical mucus was considered an integral part of the basic infertility evaluation. However, past investigations revealed a poor correlation between postcoital sperm motility and pregnancy outcome.In addition, a 1995 blinded, prospective study demonstrated poor reproducibility of the test among trained observers, further questioning the validity of the PCT as a diagnostic tool. Today, the PCT has been largely abandoned and we do not recommend it as a component of the standard infertility investigation