The role of the laboratory in the evaluation of male factor in couple infertility

The evaluation of male factor in couple infertility aims at identifying risk factors and treatable causes of male infertility to offer an adequate counselling and to choose the best treatment options to improve fertility outcomes, including either the chance of a spontaneous conception or the outcome of assisted reproduction. The first approach to the infertile man requires an accurate assessment of medical history as well as a general and andrological anamnesis and physical examination. The evaluation is based on a series of laboratory procedures, comprising semen analysis, the assessment of hormone profile, the eventual microbiological tests for the investigation of urogenital tract infections and genetic testing. These laboratory procedures are associated with scrotal ultrasound, aimed at investigating the structure of testis, funiculus, epididymis, vasa and pampiniform plexus, and transrectal ultrasound, aimed at providing information on prostate and seminal vesicles. Semen analysis, performed according to WHO 2010 guidelines, is fundamental to assess the male fertility potential. Hormone profile assessment evaluates the function of the hypothalamic-pituitary-gonadal axis and is useful to establish a diagnosis of primary or secondary testis failure and to choose the most appropriate therapeutic approach. Microbiological assessment can be useful in case of clinical suspicion of urogenital tract infections, which might exert a detrimental effect on male fertility. Genetic testing, in particular karyotype analysis, and the assessment of Y chromosome microdeletions should be performed in case of clinical suspicion or in case of a severe reduction of sperm count.