Male infertility is a multifactorial condition contributing to approximately 50% of all cases of couple infertility. In recent years, significant advances have been made in both diagnostics and treatment. This review summarizes key developments from 2019 to 2024 with direct relevance to routine clinical practice in Czech urology and andrology. Particular attention is paid to the updated semen analysis standards (World Health Organisation 6th edition, 2021), sperm DNA fragmentation testing, genetic evaluation (karyotyping, Y chromosome microdeletions, and exome sequencing), surgical management of varicocele, and sperm retrieval techniques for azoospermia, including microdissection testicular sperm extraction (micro-TESE). The article also discusses pharmacological options (gonadotropins, selective estrogen receptor modulators, antioxidants), the impact of lifestyle factors, and the importance of interdisciplinary collaboration with assisted reproduction centers. Future perspectives, including the role of preventive strategies in male reproductive health, are also addressed. The aim is to provide a comprehensive and clinically applicable overview of current recommendations and therapeutic approaches in andrology, with a focus on their implementation in the Czech urological setting.
- MeSH
- Semen Analysis methods MeSH
- Antioxidants pharmacology therapeutic use MeSH
- Reproductive Techniques, Assisted MeSH
- Genetic Testing methods MeSH
- Gonadotropins therapeutic use MeSH
- Humans MeSH
- Infertility, Male * diagnosis etiology therapy MeSH
- Sperm Retrieval MeSH
- Selective Estrogen Receptor Modulators pharmacology therapeutic use MeSH
- Varicocele surgery MeSH
- Life Style MeSH
- Check Tag
- Humans MeSH
- Publication type
- Systematic Review MeSH
The use of microfluidic sperm sorting (MFSS) systems in infertility treatment is increasing due to their practicality and ease of use. While often presented as highly effective, their efficacy in patients with varying sperm analysis results remains uncertain. In this study, we evaluated the effectiveness of MFSS compared with the swim-up (SU) technique in terms of oxygen radical levels and spermiogram parameters. Samples from each patient were processed using both methods, followed by assessments of sperm concentration, motility, morphology, DNA integrity, acrosomal status, and mitochondrial membrane potential. Participants were selected based on sperm analysis and categorized as normozoospermic (n = 40) or non-normozoospermic (n = 28). An analysis of separation techniques revealed no significant differences, except for a lower percentage of DNA-fragmented sperm in the MFSS group compared with SU within the non-normozoospermic cohort (SU: 10.0% vs. MFSS: 5.69%, p = 0.027). No differences were observed between SU and MFSS in normozoospermic men. The MFSS method is a simple technique, frequently used in laboratories, that yields good results but does not offer a substantial advantage over SU. The primary benefit of MFSS appears to be a significant reduction in the proportion of sperm with DNA fragmentation compared with SU in patients with abnormal sperm analysis results.
- MeSH
- Semen Analysis methods MeSH
- Adult MeSH
- DNA Fragmentation MeSH
- Sperm Injections, Intracytoplasmic * methods MeSH
- Humans MeSH
- Membrane Potential, Mitochondrial MeSH
- Microfluidics * methods MeSH
- Sperm Motility * MeSH
- Infertility, Male therapy MeSH
- Cell Separation * methods MeSH
- Spermatozoa * cytology metabolism MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
Mužská neplodnost je komplexní stav s mnoha etiologickými faktory, včetně hormonálních, anatomických, genetických a vlivů životního stylu. Přestože se mužský faktor podílí až na 40 % případů neplodnosti, přesná příčina zůstává často neznámá (tzv. idiopatická neplodnost). Současné diagnostické metody zahrnují detailní klinické vyšetření, analýzu ejakulátu, hormonální profil, genetické testování a zobrazovací techniky. Výrazný pokrok byl zaznamenán v oblasti testování fragmentace DNA spermií a měření oxidačního stresu, jež poskytují širší pohled na kvalitu spermií. Terapeutické postupy se liší podle příčiny neplodnosti – od farmakologické léčby a chirurgických intervencí až po asistovanou reprodukci. Rychle se rozvíjející výzkum v oblasti regenerativní a genové terapie slibuje nové možnosti léčby. Nedílnou součástí prevence i léčby je rovněž zdravý životní styl a management rizikových faktorů.
Male infertility is a multifactorial condition influenced by hormonal, anatomical, genetic, and lifestyle factors. Although the male factor contributes to up to 40% of infertility cases, the exact etiology often remains unknown (so-called idiopathic infertility). Current diagnostic approaches include detailed clinical evaluation, semen analysis, hormonal assessment, genetic testing, and imaging techniques. Significant progress has been achieved in sperm DNA fragmentation testing and oxidative stress evaluation, offering a broader insight into sperm quality. Treatment strategies vary depending on the underlying cause, ranging from pharmacological therapy and surgical interventions to assisted reproductive technologies. Rapid advances in regenerative medicine and gene therapy show promise for novel therapeutic options. A healthy lifestyle and risk factor management are integral to both prevention and treatment.
- MeSH
- Semen Analysis MeSH
- Andrology trends MeSH
- Reproductive Techniques, Assisted MeSH
- Diagnostic Techniques and Procedures classification MeSH
- DNA Fragmentation MeSH
- Humans MeSH
- Infertility, Male * diagnosis etiology therapy MeSH
- Oxidative Stress MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Review MeSH
Testicular cancer is the most common form of cancer in young men of reproductive age and its incidence is increasing globally. With the currently successful treatment and 95% survival rate, there is a need for deeper understanding of testicular cancer-related infertility. Most patients with testicular cancer experience semen abnormalities prior to cancer therapy. However, the exact mechanism of the effect of testicular cancer on sperm anomalies is not known. Mitochondria are organelles that play a crucial role in both tumorigenesis and spermatogenesis and their malfunction may be an important factor resulting in sperm abnormalities in testicular cancer patients. Within the scope of this review, we will discuss current knowledge of testicular cancer-related alterations in the ATP production pathway, a possible pathophysiological switch from oxidative phosphorylation (OXPHOS) to glycolysis, as well as the role of oxidative stress promoting sperm dysfunction. In this regard, the review provides a summary of the impact of testicular cancer on sperm quality as a possible consequence of impaired mitochondrial function including the energy metabolic pathways that are known to be altered in the sperm of testicular cancer patients.
- MeSH
- Semen Analysis MeSH
- Neoplasms, Germ Cell and Embryonal * MeSH
- Humans MeSH
- Mitochondrial Diseases * metabolism MeSH
- Semen metabolism MeSH
- Spermatozoa MeSH
- Testicular Neoplasms * metabolism MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Historicky spíše ignorovaná mužská neplodnost zapříčiňuje samostatně nebo v kombinaci neplodnost páru přibližně v 60 % případů. Nemožnost páru zplodit potomka vede k psychosociálnímu stresu. Úlohou systematické diagnostiky a terapie neplodnosti muže je rozpoznání příčiny, snaha o zlepšení tvorby spermií a zvýšení šance na úspěšné početí.
Historically rather ignored male infertility is alone or in combination the cause of approximately 60% infertile couples. Inability of couple to conceive leads to psychosocial stress. Role of systematic diagnostics and treatment of male infertility is to understand the cause, improve spermatogenesis and increase chances of successful fertilization.
- MeSH
- Semen Analysis methods MeSH
- Antioxidants therapeutic use MeSH
- Chorionic Gonadotropin administration & dosage therapeutic use MeSH
- Diagnostic Techniques, Endocrine MeSH
- Genetic Testing MeSH
- Aromatase Inhibitors therapeutic use MeSH
- Infertility, Male * diagnosis etiology drug therapy MeSH
- Selective Estrogen Receptor Modulators administration & dosage therapeutic use MeSH
- Check Tag
- Male MeSH
STUDY QUESTION: What is the impact of the EuroNet-PHL-C2 treatment for boys with classical Hodgkin lymphoma (cHL) on semen parameters? SUMMARY ANSWER: More than half of the patients (52%, n = 16/31) had oligozoospermia or azoospermia at 2 years from cHL diagnosis; particularly boys treated for advanced-stage cHL had low sperm counts and motility. WHAT IS KNOWN ALREADY: Chemotherapy and radiotherapy to the inguinal region or testes can impair spermatogenesis and result in reduced fertility. The EuroNet-PHL-C2 trial aims to minimize radiotherapy in standard childhood cHL treatment, by intensifying chemotherapy. The present study aims to assess the (gonadotoxic) impact of this treatment protocol on semen parameters and reproductive hormones in boys aged ≤18 years. STUDY DESIGN, SIZE, DURATION: This international, prospective, multi-centre cohort study was an add-on study to the randomized phase-3 EuroNet-PHL-C2 trial, where the efficacy of standard cHL treatment with OEPA-COPDAC-28 (OEPA: vincristine, etoposide, prednisone, and doxorubicin; COPDAC-28: cyclophosphamide, vincristine, prednisone, and dacarbazine) was compared to intensified OEPA-DECOPDAC-21 chemotherapy (DECOPDAC-21: COPDAC with additional doxorubicin and etoposide and 25% more cyclophosphamide). Patients were recruited between January 2017 and September 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: Eligibility criteria included male patients, diagnosed with classical HL before or at the age of 18 years, and treated according to the EuroNet-PHL-C2 protocol in any of the 18 participating sites in the Netherlands, Germany, Belgium, Czech Republic, and Austria. Sperm parameters (sperm concentration, progressive motility, sperm volume, and calculated total motile sperm count) were assessed at diagnosis and 2 years after diagnosis in (post)pubertal boys. Laboratory measurements (serum follicle-stimulating hormone (FSH) and inhibin B) were performed in samples drawn at diagnosis, during treatment (2-3 times), and at 2 years post-diagnosis, and (age-adjusted) analyses were conducted separately for pre-pubertal and (post)pubertal boys. Outcomes were compared between the treatment levels (TL1, TL2, and TL3) and consolidation treatment schemes (COPDAC-28 and DECOPDAC-21). MAIN RESULTS AND THE ROLE OF CHANCE: In total, 101 boys were included in the present analysis: 73 were (post)pubertal (median age 15.4 years, (IQR 14.4; 16.6), 10 TL1, 29 TL2, 34 TL3, 62% of TL2/3 patients received COPDAC-28) and 28 boys were pre-pubertal (median age 9.6 years (IQR 6.6; 11.4), 4 TL1, 7 TL2, 17 TL3, 38% of TL2/3 patients received COPDAC-28). The study included six boys who had received pelvic radiotherapy; none were irradiated in the inguinal or testicular area. At diagnosis, 48 (post)pubertal boys delivered semen for cryopreservation; 19 (40%) semen samples were oligospermic and 4 (8%) were azoospermic. Low sperm concentration (<15 mil/ml) appeared to be related to the HL disease itself, with a higher prevalence in boys who presented with B symptoms (76% vs 26%, aOR 2.3 (95% CI 1.0; 3.8), P = 0.001) compared to those without such symptoms. At 2 -years post-diagnosis, 31 boys provided semen samples for analysis, of whom 12 (39%) boys had oligozoospermia and 4 (13%) had azoospermia, while 22 boys (71%) had low total motile sperm counts (TMSC) (<20 mil). Specifically, the eight boys in the TL3 group treated with DECOPDAC-21 consolidation had low sperm counts and low progressive motility after 2 years (i.e. median sperm count 1.4 mil/ml (IQR <0.1; 5.3), n = 7 (88%), low sperm concentration, low median progressive motility 16.5% (IQR 0.0; 51.2), respectively). Age-adjusted serum FSH levels were significantly raised and inhibin B levels (and inhibin B:FSH ratios) were decreased during chemotherapy in (post)pubertal boys, with subsequent normalization in 80% (for FSH) and 60% (for inhibin B) of boys after 2 years. Only 4 out of the 14 (post)pubertal boys (29%) with low sperm concentrations after 2 years had elevated FSH (>7.6 IU/l), while 7 (50%) had low inhibin B levels (<100 ng/l). In pre-pubertal boys, reproductive hormones were low overall and remained relatively stable during chemotherapy. LIMITATIONS, REASONS FOR CAUTION: The present analyses included sperm and laboratory measurements up to 2 years post-diagnosis. Long-term reproductive outcomes and potential recovery of spermatogenesis remain unknown, while recovery was reported up to 5- or even 10-year post-chemotherapy in previous studies.Boys who were pre-pubertal at diagnosis were still too young and/or physically not able to deliver semen after 2 years and we could not assess a potential difference in gonadotoxicity according to pubertal state at the time of treatment. Overall, the statistical power of the analyses on sperm concentration and quality after 2 years was limited. WIDER IMPLICATIONS OF THE FINDINGS: Results of the semen analyses conducted among the 31 boys who had provided a semen sample at 2 years post-treatment were generally poor. However, additional long-term and adequately powered data are crucial to assess the potential recovery and clinical impact on fertility. The participating boys will be invited to deliver a semen sample after 5 years. Until these data become available, benefits of intensified chemotherapy in cHL treatment to reduce radiotherapy and lower risk for development of secondary tumours should be carefully weighed against potentially increased risk of other late effects, such as diminished fertility due to the increased chemotherapy burden. Boys with newly diagnosed cHL should be encouraged to deliver sperm for cryopreservation whenever possible. However, patients and clinicians should also realize that the overall state of disease and inflammatory milieu of cHL can negatively affect sperm quality and thereby reduce chance of successful fertility preservation. Furthermore, the measurement of FSH and inhibin B appears to be of low value in predicting low sperm quality at two years from cHL treatment. STUDY FUNDING/COMPETING INTEREST(S): This study was funded by the Dutch charity foundation KiKa (project 257) that funds research on all forms of childhood cancer. C.M.-K., D.K., W.H.W., D.H., MC, A.U., and A.B. were involved in the development of the EuroNet-PHL-C2 regimen. The other authors declare no potential conflict of interest. TRIAL REGISTRATION NUMBER: N/A.
- MeSH
- Semen Analysis MeSH
- Azoospermia drug therapy MeSH
- Cyclophosphamide * therapeutic use MeSH
- Dacarbazine therapeutic use MeSH
- Child MeSH
- Doxorubicin therapeutic use adverse effects MeSH
- Etoposide therapeutic use administration & dosage MeSH
- Follicle Stimulating Hormone blood MeSH
- Hodgkin Disease * drug therapy MeSH
- Inhibins blood MeSH
- Humans MeSH
- Adolescent MeSH
- Sperm Motility drug effects MeSH
- Oligospermia drug therapy MeSH
- Sperm Count MeSH
- Prednisone therapeutic use administration & dosage MeSH
- Child, Preschool MeSH
- Prospective Studies MeSH
- Antineoplastic Combined Chemotherapy Protocols * therapeutic use adverse effects MeSH
- Vincristine therapeutic use MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Child, Preschool MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
Obesity represents a growing problem due to its impacts on human health and reproduction. In this study, we analysed semen quality, sperm DNA integrity and gene-specific CpG methylation in 116 healthy men from normal population. The men were divided into three groups according to their body mass index (BMI), and their ejaculates were analysed using standard methods, sperm chromatin structure assay (SCSA), methylation next generation sequencing (NGS) and amplicon sequencing. The sperm methylation NGS revealed six significantly differentially methylated regions (DMRs). Using subsequent targeted amplicon sequencing in 116 men, two of the DMRs were proved as differentially methylated in sperm of men with normal BMI vs. BMI ≥ 25. The DMRs were located in the EPHA8 and ANKRD11 gene. Also, we detected a significant decline in the EPHA8, ANKRD11 and CFAP46 gene methylation in association with increasing BMI values. The genes EPHA8 and ANKRD11 are involved in the nervous system and brain development; the CFAP46 gene plays a role in a flagellar assembly and is associated with sperm motility. Significantly lower rates of motile and progressive motile sperm were observed in men with BMI ≥ 30. Our results show that excess body weight can modify CpG methylation of specific genes, affect sperm motility, and compromise sperm chromatin integrity. These factors can stand behind the observed reduced fertility in men with obesity. The methylation changes might be transmitted to their offspring through sperm, and become a basis for possible developmental and reproductive issues in the next generation.
- MeSH
- Semen Analysis * MeSH
- Chromatin * metabolism MeSH
- CpG Islands MeSH
- Adult MeSH
- Body Mass Index * MeSH
- Humans MeSH
- DNA Methylation * MeSH
- Young Adult MeSH
- Sperm Motility genetics MeSH
- Obesity genetics MeSH
- Spermatozoa * metabolism MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
Pacienti s testikulárními nádory ze zárodečných buněk (TGCT) mají výrazně vyšší riziko výskytu patospermie v důsledku odstranění jednoho z varlat a adjuvantní chemoterapie. Patologické nálezy ve spermiogramu jsou často přítomny již před nálezem tumoru varlete tzv. syndrom testikulární dysgeneze. Standardní vyšetření spermiogramu u pacientů s diagnózou TGCT je provedeno před kryokonzervací ejakulátu a zahrnuje viabilitu, motilitu, koncentraci, apoptózu, fragmentaci DNA a integritu akrozómu. Tento základní screening však není dostatečný k hlubšímu poznání kvality spermií u jednotlivých pacientů s TGCT. Pro detailnější pochopení fyziologie TGCT spermií a varlat se zaměříme na povrchové antigeny spermií, epigenom spermií a testikulární tkáně a s tím spojené molekulární mechanismy z klinického i experimentálního úhlu. Naším cílem je poskytnout nové diagnostické strategie pro hodnocení vzorků od pacientů s TGCT před operací a po zákroku, aby bylo možné sledovat a porovnávat kvalitu parametrů plodnosti a doporučit, který ejakulát z kryoprezervace by měl být použit při asistované reprodukci.; Patients with testicular germ cell tumours (TGCT) have a significantly higher risk of occurrence of sperm pathologies due to a testis removal and adjuvant chemotherapy. Sperm pathologies are present prior to cancer occurrence and attributed to the testicular dysgenesis syndrome. Standard semen testing of TGCT patients is conducted prior to sperm cryopreservation and includes viability, motility, concentration, apoptosis, DNA fragmentation and acrosome integrity. However, this screening does not suffice to provide deeper knowledge of sperm quality of individual TGCT patients. To encompass the major areas of testicular and sperm physiology, we will focus on sperm surface antigens, testicular and sperm epigenome and sperm motility, with underlying molecular mechanisms from both clinical and experimental angle. We aim to deliver novel diagnostic strategies for TGCT sample evaluation prior to surgery and after the therapeutic intervention, in order to monitor and compare the quality of fertility parameters and recommend which cryopreserved semen should be used for assisted reproduction.
- Keywords
- spermie, sperm, chemoterapie, chemotherapy, asistovaná reprodukce, cryopreservation, assisted reproduction, kryoprezervace, tumor varlete, testicular tumor,
- NML Publication type
- závěrečné zprávy o řešení grantu AZV MZ ČR
Cíl: Cílem studie bylo zhodnotit vliv konkrétní diagnózy neplodných žen a mužů na jejich kvalitu života a psychosexuální fungování pomocí mezinárodně validovaných dotazníků. Soubor a metodika: Dotazníkovou baterii pro pacienty vyplnilo celkem 853 párů, které vyhledaly lékařskou pomoc z důvodu neplodnosti. Oba partneři vyplnili dotazník Fertility Quality of Life tool (FertiQoL), ženy dále Female Sexual Function Index (FSFI) a muži Brief Sexual Function Inventory (BSFI). Ženy byly sledovány ve skupině primární a sekundární sterility, dále s konkrétními diagnózami – syndrom polycystických ovarií, tubární faktor, endometrióza a idiopatická sterilita. Muži byli zařazeni dle výsledku spermiogramu do kategorií normozoospermie, sloučené kategorie mírnějších poruch spermiogramu (teratozoospermie, astenozoospermie, oligozoospermie a oligoastenoteratozoospermie), oligoastenoteratozoospermie (OAT) gravis, azoospermie a kategorie, kdy muž nebyl dosud vyšetřen. Výsledky: Při hodnocení kvality života jsme u žen nalezli statisticky významné rozdíly zejména mezi primární a sekundární sterilitou. Primárně neplodné ženy skórovaly hůře především v sociální oblasti. Horší hodnocení se objevilo i v tzv. mind-body (oblast hodnotící zasažení tělesné stránky). V emocionální a vztahové doméně měly primárně a sekundárně neplodné ženy výsledky podobné. U konkrétních diagnóz se nám statisticky významné rozdíly nepodařilo prokázat. Při použití orientačního cut off skóre FertiQoL můžeme konstatovat, že přibližně 10 % žen vnímalo svou kvalitu života ve vztahu k fertilitě jako špatnou. V oblasti sexuálního fungování vykazovalo 30 % žen klinicky významné dysfunkce. Muži v kategorii normozoospermie a nevyšetření skórovali na obou nástrojích (FertiQoL, BSFI) celkově výše než muži ve sloučené kategorii a OAT gravis. Jako špatnou kvalitu života ve spojitosti s fertilitou označila pouze 2 % mužů, klinicky významné sexuální dysfunkce pouze 3 % mužů. Závěr: U žen jsme při hodnocení kvality života prokázali vliv zejména primární sterility, kde je postižena nejsilněji sociální doména. Vliv ostatních konkrétních diagnóz se jeví jako velmi malý. U žen byla nalezena vysoká úroveň sexuálních dysfunkcí. U mužů sledujeme vazbu hodnocené kvality života a sexuálního fungování ve spojitosti s výsledkem spermiogramu. Při zhoršeném spermiogramu mohou být postiženy obě oblasti fungování.
Aim: The aim of the study was to evaluate the influence of a specific diagnosis of infertile women and men on their life quality and psychosexual functioning based on internationally validated questionnaires. Materials and methods: A total of 853 couples seeking treatment for infertility completed the gender-specific batteries comprised of Fertility Quality of Life tool (FertiQoL), Female Sexual Function Index (FSFI) in women, and Brief Sexual Function Inventory (BSFI) in men. Women were followed in the group of primary and secondary infertility and then with specific diagnoses – polycystic ovary syndrome, tubal factor, endometriosis, and idiopathic sterility. Men’s categories reflected spermiogram results, i.e., normozoospermia, merged categories of milder disorders of a spermiogram (teratozoospermia, asthenozoospermia, oligozoospermia, and oligoasthenoteratospermia), oligoasthenoteratospermia (OAT) gravis, azoospermia, and when the man was not examined. Results: When evaluating the quality of life in women, we found statistically significant differences between primary and secondary sterility. Primary infertile women scored worse especially in the social area. Worse assessment appeared also in mind-body (area evaluating affliction of the body). Emotional and relational domains included similar results in primary and secondary infertile women. With a specific diagnosis, statistically significant differences were not proved. Using the orientational cut-off score, FertiQoL stated that approximately 10% of women experienced adverse quality of life in relation to fertility. In the domain of sexual functioning, 30% of women demonstrated clinically significant dysfunctions. In men, respondents in the normozoospermic and non-diagnosed categories scored higher than those in the merged category and OAT gravis. Only 2% of men felt their quality of life was poor due to fertility, and clinically significant dysfunctions appeared only in 3% of them. Conclusion: In women, impaired fertility-related quality of life and psychosexual functioning are significantly linked to primary sterility, where specifically the social domain is affected. The impact of a specific diagnosis appears to be minimal. We found high levels of sexual dysfunctions in women. In men, we follow the link of evaluated quality of life in connection with their results of the spermiogram. With spermiogram defects, both areas of functioning can be affected.
Posouzení plodnosti muže je založeno na vyšetření spermatu. Neexistuje univerzální ukazatel, o plodnosti vypovídá až komplex kvantitativních a kvalitativních parametrů. Metody ke stanovení těchto parametrů se stále vyvíjejí a zpřesňují. Jsou standardizovány v Manuálu WHO, který je pravidelně aktualizován. Poslední, šesté vydání je z roku 2021. Cílem přehledového článku je stručně shrnout současné možnosti vyšetření plodnosti muže a současně poukázat na některé změny, které přineslo poslední vydání manuálu.
The assessment of fertility in a man is based on the semen examination. There isn't any single universal indicator, fertility is determined by a complex of quantitative and qualitative parameters. Methods for determining these parameters are evolving and becoming more precise. They are standardised in the WHO Manual, which is regularly updated. The latest is the sixth edition of 2021. The aim of this review article is to summarize the current options for male fertility testing and to highlight some of the changes brought by the latest edition of the manual.
