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Evaluation of the Infertile Couple

Eric K. Seaman, MD; Edward D. Kim, MD; Larry I. Lipshultz, MD
JAMA. 1996;275(3):185. doi:10.1001/jama.1996.03530270025019.
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To the Editor.  —Even though the recent Clinical Crossroads article by Dr Collins was entitled "A Couple With Infertility,"1 the article ignores the evaluation of an essential part of that couple, namely, the male partner. Although the clinical scenario includes a normal semen analysis (which is never defined) and postcoital test as proof of a normal male factor, this limited evaluation of the male partner is inadequate; unfortunately, more and more couples encounter this type of approach.Medical students are taught that 90% of diagnoses are made from the history and physical examination. Did the male in this couple have history of orchitis, epididymitis, previous inguinal surgery, or other risk factors for development of antisperm antibodies? It is possible to have a normal semen analysis and yet have antisperm antibodies interfere with fertilization at the site of sperm-zona pellucida interaction. It is also possible that the male in this


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