All-round approach in diagnosis
Dr. Veeramachaneni (1) in response to the practice recommendations by Agarwal et al. (2) reminded the importance of interacting multiple factors on reproductive system. Indeed, it is of paramount importance to rule out reversible factors (such as genital tract infection and exposure to environmental toxicants) during the assessment and management of infertile patients. In contrary to the notion of one-man one-disease in traditional teaching, multiple intercalating factors are often present in a couple investigated for infertility (3). This is one of the reasons for the standardization of semen sample collection before any test in order to minimize the impact of confounding factors (4). These include possible exposure to heat stress, drugs and environmental toxins which should be ruled out in the history taking before clinical tests. Symptoms or microscopic features (e.g., leukocytospermia) suggestive of genitourinary tract infection warrants further investigation and correction (5).