ABSTRACT
A thorough history of the infertile couple at the time of the initial consultation will frequently reveal conditions that could affect semen quality. Some of the important factors to consider are as follows:
1. Reproductive history, including previous pregnancies with this and other partners
2. Sexual interaction of the couple, including frequency and timing of intercourse as well as the duration of their infertility
3. Past medical and surgical history: Specifi c attention should be paid to sexually transmitted diseases, prostatitis, or epididymitis, as well as scrotal trauma or surgery-including varicocele repair, vasectomy, inguinal herniorrhaphy, and vasovasostomy
4. Exposure to medication, drugs, toxins, and adverse environmental conditions such as temperature extremes in occupational and leisure activities, either in the past or in the present
The hallmark of the evaluation of the male remains the semen analysis. It is well known that the intrapatient variability of semen specimens from fertile men can vary signifi cantly over time (1). This variability decreases the diagnostic information that can be obtained from a single analysis, often necessitating additional analyses. What is also apparent from literature that analyzes samples from “infertile” patients is that the defi ciencies revealed may not be suffi cient to prevent pregnancy from occurring: rather, they may simply lower the probability of pregnancy, resulting in so-called “subfertility.” Clearly, the overall prognosis for a successful pregnancy is dependent on the complex combination of variables in semen quality coupled with the multiple factors inherent in the female reproductive system that must each function
fl awlessly to enable a pregnancy to occur. The commonly accepted standard for defi ning the normal semen analysis is the criteria defi ned by the World Health Organization (WHO). These parameters for both the fourth and the fi fth edition are listed in Table 4.1.
