A Critical Method of Evaluating Tests for Male Infertility

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Abstract
Considerable uncertainty surrounds the selection of test values that separate infertile from fertile men in the evaluation of male infertility. An objective method of determining these values, referred to as threshold values, for diffferent infertility tests is described. Using test results from fertile men threshold values were chosen such that 96% of the semen samples from the fertile men were scored as fertile. These threshold values then were used to evaluate 100 semen samples from 74 men presenting for evaluation of infertility. Using this method infertility profiles were constructed on each of the 100 semen samples presented for infertility evaluation; the zona pellucida-free hamster egg penetration test (a measure of a spermatozoon''s ability to undergo capacitation and penetrate an egg) identified 66% of these samples as infertile, while multiple exposure photomicrography (a quantitative measure of sperm motility) identified 54% of these samples as infertile. This compares with results from routine semen analyses using the same method which identified none of the samples as infertile by sperm motility grade, 1% semen pH, 4% by the percentage of motile sperm, 7% by the total count of motile sperm, 10% by the total sperm count, 11% by the semen leukocyte concentration, 12% by the concentration of motile sperm, 13% by ejaculate volume, 16% by sperm concentration and 27% by serpm morphology. This method of analyzing infertility test results provides insight into the potential causes of male infertility and offers a critical approach towards understanding the complex problem of male fertility dysfunction.