Evaluation and Treatment of a Male Factor Component to Unexplained Infertility

Abstract

The standard semen analysis frequently fails to identify subfertile males even when findings are normal and conversely often fails to identify fertile males with subnormal semen analyses. This has created the need to produce other tests of sperm physiology that will better distinguish a fertile from a subfertile specimen. Understanding more about the nature of the sperm defect should lead to the establishment of more specific and effective therapies. Until that time, it would still be reasonable to try some of the available empirical therapies even though they may work merely by a placebo mechanism.

The Role of Contemporary Andrology in Unraveling the Mystery of Unexplained Male Infertility

“…On the other hand, direct MAR test is an inexpensive, quick and sensitive screening test where sheep erythrocytes are used instead of immunobeads to detect and localize antibody-bound sperm [25,26]. Frequently, antibody-coated sperm may appear as a poor postcoital test [27]. Complement, which is normally found in higher amounts in the cervical mucus than in the seminal plasma, can immobilize antibody-coated spermatozoa.…”

“…The antibody complement reaction may take at least 6 hours to manifest. Physicians performing a postcoital test (PCT) within 2h after intercourse or using in vitro mucus penetration assays may miss the immobilizing antibodies [27]. Consequently, these patients may appear as having an absence of male factor infertility.…”

“…Consequently, these patients may appear as having an absence of male factor infertility. It is therefore advisable to perform a PCT after at least 6 h following intercourse [27]. ASA can cause infertility without obvious problems with cervical mucus penetration.…”

“…Some investigators have shown no correlation with an abnormal test [145], whereas others have claimed 100% predictability [146]. Taking an average from different studies, a normal SPA may have 70% predictability of fertilization in vitro [27]. Nonetheless, semen samples which fail to fertilize hamster ova usually are unable to fertilize human ova [47].…”

Role and Significance of Sperm Function in Men with Unexplained Infertility

“…Some investigators have shown no correlation with an abnormal test [91], whereas others have claimed 100 % predictability [92]. Taking an average from different studies, a normal SPA seems to have 70 % predictability of fertilization in in vitro conditions [93]. Nevertheless, semen samples that fail to fertilize the hamster ova are usually unable to fertilize human ova.…”