Frontiers in clinical andrology

Ashok Agarwal, Chak- Lam Cho, Ahmad Majzoub, Sandro C. Esteves


Since the introduction of intracytoplasmic sperm injection (ICSI) in 1992 (1) the research into the clinical management of infertile men slowed to a grind in the last three decades (2). Attention has been drawn to assisted reproductive technology (ART) in improving embryo quality and pregnancy outcome. The enthusiasm in sperm function tests, including post coital and sperm penetration tests, in 1990s disappeared and none of these tests have been widely studied clinically. Despite all the pitfalls, conventional semen analysis has remained as one-and-only cornerstone in the evaluation of infertile men over the years (3). The increasing use of ICSI in bypassing severe male factors renders semen analysis a screening tool merely for the presence or absence of sperm. Despite its widespread use, the live birth rate utilizing ICSI as the treatment of male factor infertility is around 30% only (4). This clearly illustrates the pivotal role of paternal contribution to fertilization and development of healthy offspring. A comprehensive evaluation of infertile men and correction of male factors represent the way to improve both natural pregnancy and ART outcomes.