ABSTRACT
INTRODUCTION A couple’s fecundity is the result of an interaction between both partners. For infertile men who suffer from azoospermia, a “male factor” is a certain cause for the couple’s, however, in case of oligozoospermia, the couple’s inability to have children may be influenced by a “female factor” as well. Given the trend of postponing pregnancy to a later age, female age has become the most important prognostic factor for a couple’s fecundity. The consequence of this interaction is that it is difficult to evaluate treatments that try to alleviate the “male factor”. On top of this, semen parameters show huge intraindividual variations over time. Because of the phenomenon of “regression towards the mean”, studies evaluating treatment of male subfertility must include placebo (1) and must have pregnancy as the main outcome measure. Yet, very few randomized controlled trials with pregnancy as outcome measure have been published in our field. The Cochrane library includes only nine reviews on male subfertility or infertility, including one on IVF and ICSI, and most have not been updated because of the lack of new evidence (2).
CASE 1 A 45-year old man visits the andrology clinic. For two years he is trying to have a child. He has been referred because his sperm count is 10 million spermatozoa per mL (he produced 3 mL of semen). Progressive motility is 20% and morphology according to strict criteria is 7%.
