Unexplained Male Infertility – Looking Beyond Routine Semen Analysis

Unexplained infertility is a diagnosis reserved for couples in whom routine semen analysis is within normal values and female infertility factors have been ruled out. Its reported prevalence ranges from 6–27 % depending on how exhaustive the patient work-up is. Despite differing according to urological societies, recommendation for male infertility evaluation usually considers routine semen analysis results as surrogates for fertility potential. Male infertility evaluation, however, must go far beyond counting spermatozoa and assessing motility and morphology. It has to be complemented with comprehensive history taking, proper clinical examination and relevant endocrine, genetic and/or other investigations. There is a broad spectrum of potential aetiologies of unexplained male infertility (UMI), ranging from the simple couple’s miscomprehension of the concept of the female fertile window to complex molecular and functional defects involving either the male or the female, or both. Novel contemporary technologies added to the current knowledge on this subject highlight a case for careful reconsideration before clinicians make treatment decisions for patients with unexplained infertility.