The diagnostic of male infertility - an important part of reproductive medicine

Male infertility is frequently involved in the couples infertility and therefore the diagnostic work up of the couple should always involve gynaecologists and andrologists. The main task of the interdisciplinary diagnostic work up is the direction of the couple to potential treatments, bearing in mind that spontaneous pregnancies occur frequently in infertile couples. Well established pathways for the male diagnostic work up in infertility exist only marginally. A minimal andrological evaluation should be performed at least in all infertile men after one year of unsuccessful unprotected intercourse or earlier if established male or female risk factors are present. Components of the minimal evaluation of the male partner couple should include at least a reproductive history and two semen analyses according to WHO standards. An evaluation by an andrologist should be done as routine procedure. However, a full andrological evaluation is especially important if the initial evaluation demonstrates an abnormal male reproductive history or an abnormal semen analysis. Further evaluation of the male partner should also be considered in couples with unexplained infertility and in couples in whom there is a treated female factor and persistent infertility. In addition to the requirements of a minimal evaluation, a full evaluation for male infertility should include in addition at least a physical and genital examination. Based on the results of the andrological evaluation, the physician may recommend additional evaluations. These additional evaluations may include an endocrine evaluation, ultrasonography of the scrotal content and/or prostate and seminal vesicles, genetic screening and the conductance of a diagnostic/therapeutic testicular biopsy. Finally the diagnostic work up of the male infertile patient will lead to a solid dia-gnosis on which the subsequent therapeutic procedures must be based.