Fertility workups: the times they are a-changin’

The recent improvements in infertility treatments and the broadening of its indications have modified the types of patients seeking care, including those who are not per se infertile.
Fertility workups: the times they are a-changin’

VOLUME 118, ISSUE 1, P5-7


Dominique de Ziegler, M.D., James P. Toner, M.D., Ph.D.


The workup of patients seeking assisted reproductive technology (ART) treatments has been modified by the tremendous improvements in ART efficacy accomplished recently. Moreover, the fact that ART is nowadays also offered to women who are not necessarily infertile—seeking genetic testing of their embryos—lead to important changes in how we investigate ART candidates. All the facets of these changes have been reviewed in the present introduction to this View-and-Review series on modern-day infertility workups.


Go to the profile of Pandiyan  Natarajan
about 1 month ago

Infertility work up- Times have indeed changed.

I enjoyed reading the excellent article. Times have indeed changed.  Infertility evaluation has become simpler, but treatment has got unnecessarily complicated by the addition of, ‘Add ons.’ When I started as Resident in this field, in 1977,  Laparoscopy was the gold standard for Tubal evaluation. To day it is no longer the Gold standard & it is not even indicated in routine Infertility practice, unless HSG indicates an abnormality. Many other Gold standards have also been given up.

Semen Analysis  still remains the Gold standard. Attempts to replace Semen Analysis with Spermatozoa Function Tests have turned futile.  The Spermatozoa Function Tests are, ‘ Road to Nowhere.’ DNA Fragmentation tests remain a Research tool,  1 ) with no useful clinical role. 

Endometriosis as a cause of Infertility is under serious debate. Endometriosis and Infertility are associated conditions with no clear causal relationship established.  Endometriosis  is more likely to be the consequence of Infertility, than the cause of it. ( 2 )  Besides, the treatment of Infertility is unrelated to the presence or absence of Pelvic Endometriosis. Endometrioma impairs Ovarian Reserve,  and surgical treatment of Endometrioma,  even more so.

Stand alone Testes Biopsy, another Gold standard is no longer indicated except when combined with Spermatozoa Retrieval and  Cryo preservation. Spermatozoa Retrieval Techniques have made fatherhood possible for 40 to 50 % of  men with Non Obstructive Azoospermia, but still other 50% would remain childless, with currently available techniques.  In Vitro Spermatogenesis may soon become a reality, and may help these desperate men longing for Biological Fatherhood. 

Reproduction is a Fundamental right of every individual. ( 3 ) All adult person,  regardless of their gender, sex, sexual orientation, sexual cohabitation should be offered, all Assisted Reproductive Technologies,  if and when possible without bias or prejudice. ( 4 )


1. A perspective on sperm DNA fragmentation 

Natarajan Pandiyan, Radha Pandiyan, D. Ramesh Raja


2. Infertility (Non Conception) with Regular Menstruation Predisposes to
Endometriosis – A Hypothesis
Pandiyan N, Surya P,  Radha Pandiyan


3. Is Reproduction a Fundamental Right? A Clinical, Ethical and Personal
Pandiyan N, Puvithra.


4. Embryo sex selection: a social comment on the article by Malpani and Malpani. 


Professor Dr Pandiyan Natarajan,

Chief Consultant in Andrology and Reproductive Sciences,


Chettinad Super Speciality Hospital ( Retired ).

Los Angeles, Cary, USA, Chennai, India.