Clinical andrology: The missing jigsaw pieces

The introduction of intracytoplasmic sperm injection (ICSI) in 1992 has revolutionized the management of infertile couples.[1] The workup of female partner remains important in the era of ICSI since she has to go through the procedure and pregnancy. Attention has been drawn to assisted reproduction technologies (ARTs) in improving embryo quality and pregnancy outcome. In contrast, the evolution of ART has had an adverse impact on the enthusiasm of researchers and clinicians in clinical andrology. Research into the clinical management of infertile men slowed to a grind in the last three decades because ICSI technology promises the couple a baby without exploring the cause of the underlying male infertility. However, the live birth rate utilizing ICSI as the treatment of male factor infertility has stagnated at 30% despite the advancement in ART over the years.[2] The limitation is linked to abnormalities in male gamete, including high sperm DNA fragmentation. The male gamete contributes half of the DNA content, and the importance of paternal DNA on pregnancy outcome is being increasingly recognized.[3] In view of the high prevalence of male factor-associated infertility among infertile couples, it is essential to improve the outcome by a comprehensive evaluation and correction of male infertility.[4] In this issue of the Indian Journal of Urology, four important topics in the field of male infertility are discussed in the reviews. These articles cover several areas of advances in the evaluation and management of infertile men.