[Frontiers in Bioscience E5, 289-304, January 1, 2013]

What does the clinician need from an andrology laboratory?

Devon C. Snow-Lisy1, Edmund Sabanegh1

1Glickman Urological and Kidney Institute, Cleveland, Cleveland Clinic Foundation, Cleveland, OH, USA

TABLE OF CONTENTS

1. Abstract
2. Introduction
3. Logistics of a good diagnostic andrology laboratory
3.1. Certifications and accreditations
3.2. Quality control
3.3. Testing offered
4. Algorithm for evaluation of the infertile patient
5. Interpreting andrology laboratory tests
5.1. Semen analysis
5.1.1. Sperm count
5.1.2. Morphology
5.1.3. Volume, pH, liquefaction, and viscosity
5.2. Sperm motion and vitality
5.3. Assessment of seminal leukocytes
5.4. Reactive oxygen species
5.5. Total antioxidant capacity
5.6. Sperm DNA damage
5.7. Antisperm antibodies
5.8. Post ejaculate urine analysis
5.9. Other functional testing
5.9.1. Sperm-cervical mucus/post coital test
5.9.2. Capacitation
5.9.3. Acrosome reaction testing
5.9.4. Sperm binding tests
6. Assisted reproductive technologies and intrauterine insemination
7. Clinical vignettes
7.1. Introduction
7.1.1. Clinical vignette A: Retrograde ejaculation
7.1.2. Clinical vignette B: Klinefelter's syndrome
7.1.3. Clinical vignette C: Kallmann syndrome
7.1.4. Clinical vignette D: Inflammation
7.1.5. Clinical vignette E: Varicocele
7.1.6. Clinical vignette F: Y microdeletion
7.1.7. Clinical vignette G: Testicular tumor
8. Summary
9. References

1. ABSTRACT

What does the clinician need from an andrology laboratory? The andrology laboratory is vital for the accurate diagnosis and treatment of male factor infertility, which is contributory in 50% of infertile couples. While there are some diagnostic tests of limited clinical utility, many tests can be useful in specific clinical settings. In this chapter, we will review the basic interpretation of the semen analysis, testing for sperm vitality and motion, inflammation, semen antioxidant capacity, sperm DNA damage, antisperm antibodies, post ejaculate urine analysis as well as other functional testing. Several clinical vignettes are presented for real-life examples of interpretation of the role of the andrology laboratory in clinical infertility.