Sperm banking, or male fertility preservation, is widely used prior to medical, surgical, and nonmedical procedures that might affect a male’s fertility. Both federal and state regulations have been instituted to regulate the sperm banking industry, requiring rigorous screening and testing of sperm donors and detailed records of the donors and clients that choose to store their own sperm. Cryopreservation consents are detailed and cover long-term storage, use of the specimens, and disposition of the specimens in case of incapacitation or death of the sperm banker or lack of need for the frozen specimens. Sperm cryopreservation is relatively simple in the laboratory, but does require trained staff working with cryopreservatives and liquid nitrogen. With the increased use of ART, cryopreservation of even the poorest specimens with only a few sperm has become routine. Sperm can be retrieved with testicular biopsy or epididymal aspiration even in the case of purported azoospermia. Use of fresh or frozen specimens have been shown to yield comparable results. The future of sperm cryopreservation is promising as we look to storage of testicular tissue for future autotransplantation as well as prepubertal spermatogonial stem cell storage for future in vitro maturation, or transplantation and growth of testicular tissue and sperm production.

History of andrology

According to Taber's Cyclopedic Medical Dictionary, ‘andrology’ is defined as the study of diseases of men, especially of the male genital organs (Thomas, 1989). Introduction of the term ‘andrology’ is credited to a gynecologist, Harald Siebke, a Professor of Gynecology in Bonn, Germany (Schirren, 1984). Professor Siebke used this term first in 1951 with the intention of demonstrating that the male and female are equally important in reproduction. Truer words have never been spoken! Although andrology refers to a study of male infertility, in the broadest sense, andrologists not only study the clinical aspects of male fertility, but also study the biological mission of the sperm, from production in the testes, to interaction with, and penetration of the oocyte at the time of fertilization.

Andrology as a science has made tremendous developments in the past 40 to 50 years. There are now national and international membership organizations (The American Society of Andrology), as well as national and international peer-reviewed journals (Journal of Andrology, Andrologia) devoted specifically to the field of andrology.

Leeuwenhoek and the discovery of spermatozoa

For centures, the theories of generation presented by Aristotle (reviewed by Schierbeek, 1959) were universally accepted. Aristotle believed that the male principle contained the efficient cause of generation and the female the material of it. Aristotle, in discussing whether semen comes from all parts of the body, wrote that the nature of semen is to be distributed to the whole of the body. Furthermore, Aristotle pointed out that the potential parts of the whole organism were found in the semen, not in the female.

Introduction

The routine semen analysis is the most important source of information on the fertility status of the male partner. Although gradually being replaced by more sophisticated computer-aided semen analysis methods (CASA; see Chapter 4), most hospital and private laboratories rely on the traditional, manual light microscopic method of assessing semen. Although an important part of the couple-based fertility evaluation, the semen analysis is more an assessment of the potential for fertility, rather than a test of actual fertility. Although only a rough estimate of the functional capability of the spermatozoa, routine semen analysis is an accurate measure of sperm production and epididymal maturation. A definitive diagnosis of male fertility cannot be made as a result of the semen analysis, and thus more sophisticated tests have become useful to the fertility specialist (see Chapters 6 and 9).

Historically, there has been a lack of standardization of methodologies for the semen analysis, as well as difficulty with interpretation of results. This makes comparison of semen analysis results and patient diagnosis nearly impossible between centers. Recently, the World Health Organization has published a manual (now in its third edition) for the laboratory evaluation of semen which encourages the use of standardized procedures for semen analysis (WHO, 1992). This should result in greater comparability among laboratories, as well as improving the precision, reproducibility and interpretation of the results.

This chapter will describe the standard manual methods for performing a semen analysis. Most importantly, however, information useful for the clinical evaluation of infertile couples will be presented, such as when to request a semen analysis, instructions in preparation for the analysis, and the interpretation of results.