Diagnosis of Male Infertility: Diagnostic Work-up of the Infertile Man

The diagnostic workflow to evaluate male infertility follows a systematic approach to elucidate previous factors influencing fertility and the present status. The medical history should be taken, preferably in the presence of the female partner, and a clinical examination focusing on testicular morphology and function is done, followed by laboratory tests of gonadotropins and androgens as well as semen analysis according to the World Health Organization criteria. Depending on the results, more elaborate investigations may be necessary, such as the genetic background of male infertility or analysis of testicular spermatogenesis. To better characterize the functional capability of spermatozoa, modern analytical instruments such as DNA fragmentation and methylation analysis or Raman spectroscopy of spermatozoa are used for scientific evaluation. Finally, the differential diagnosis of hypothalamic–pituitary or testicular malfunction will determine the treatment options. Endocrine, surgical, or empirical treatment options such as assisted reproductive techniques can be applied after interdisciplinary diagnosis of both partners, male and female, by the andrologist and a specialized gynecologist to obtain optimal treatment options for the couple.