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TheContemporary Evaluation Fertility


Infertility is a complexmedical, emotional and social condition that afflictsmore than fourmillion reproductive-age couples in the United States. Successful fertility treatment includes not only achieving pregnancy, but also achieving it in themost efficient and cost effectivemanner possible. The frequently ignored psychological toll of repeated treatment failuresmust also be considered. To achieve success, it is imperative that a timely and complete evaluation of both partners be performed. As our knowledge of reproductive physiology has expanded, the fertility workup has evolved as well. In this article, the contemporary fertility workup will be discussed. Attention will also be given to organizing the evaluation to prevent unnecessary testing.


Evaluation of theMale It is natural for the attention of the gynecologist and family practitioner to initially turn toward the female in cases of infertility. Although infertility is generally viewed as a 'female problem', fully 45%of infertile couples havemale factor as a contributing cause. It makes sense then to begin the fertility evaluation with a basic evaluation of themale partner. Because significantmale factor is generally treated with in vitro fertilization, needless hysterosalpingograms,


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BY DANIEL POTTER, MD, FACOG


laparoscopies and clomiphene cycles can be avoided by early detection of significant dysfunction in the male partner. The savings of time andmoney can be tremendous. In vitro fertilization with intracystoplasmic sperminjection (IVF/ICSI) hasmade it possible to successfully treat virtually all cases of male factor infertility, even with only a fewmoving spermin the entire ejaculate.


The evaluation of themale partner starts with a competent semen analysis. Non- specialized laboratories, such as LabCorp and Unilab, performa World Health Organization (WHO) semen analysis. This is a crude screening test and should be replaced by the strict semen analysis (Kruger) that is done bymost fertility centers. The difference between theWHO and the Kruger test is that, with the Kruger test, sperm morphology is evaluated in a very stringentmanner. The results of the Kruger test predict fertilization rates in vitro and presumably in vivo as well. TheWHO does not predict outcome and will frequentlymiss subtle but clinically significant spermabnormalities. The cost of the Kruger test is the same or less than aWHO analysis at our center. When themale has abnormal semen parameters, the couple should be referred to a reproductive endocrinologist and/or urologist for


THE RESOURCES LISTED IN THIS DIRECTORY ARE UNSCREENED AND SHOULD NOT BE VIEWED AS RECOMMENDATIONS OR ENDORSEMENTS, EITHER EXPRESS OR IMPLIED, BY THE AFA. 14


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