The evaluation of severe male infertility in the era of advanced in-vitro fertilization

Male infertility has been a subject for dynamic definition during the last decade since the introduction of intracytoplasmic sperm injection (ICSI) as an acceptable and routine technique in the IVF-ART procedure. Male sterility may be defined in cases in which no spermatozoa are located in a testicular biopsy using several specimens. The extreme case (absence of all gametes precursors) is termed Sertoli cell only. This evaluation may be reinforced by detailed genetic assessments of microdeletion in Y chromosome. Accordingly, once spermatozoa are isolated (even very few) they can fertilize an oocyte using ICSI, thereby the couple can achieve pregnancy. This shift in the definition of 'Sterility' brings about a shift in the consideration of male 'subfertility' or 'infertility'. This review explores the current 'state of the art' of male fertility evaluation with a focus on the role of an advanced andrology laboratory.