Who cares about oligozoospermia when we have ICSI.

The value of assessing subfertile males with oligozoospermia is controversial due to prevailing notions that therapies are limited and ICSI may provide the couple with a baby without the need to explain the nature or cause of underlying male infertility. This article highlights that indiscriminately offering ICSI to oligozoospermic men is not free of potential adverse effects and does not grant subfertile men the best fertility pathway. Recent data support associations between oligozoospermia and poor male reproductive health, DNA and epigenetic damage in spermatozoa, and possible adverse health consequences to offspring. Many conditions affecting the testicles are capable of causing oligozoospermia (varicocele, genital infections, congenital and genetic defects testicular torsion/trauma, chronic diseases, inadequate lifestyle, occupational/environmental exposure to toxicants, drugs, cancer and related treatments, acute febrile illness, endocrine disorders, and iatrogenic damage to the genitourinary system). If oligozoospermia is detected, therapeutic interventions can improve sperm quantity/quality and the overall male health, ultimately resulting in better pregnancy outcomes even when ICSI is used. Fertility clinics are urged to engage male infertility specialists in diagnosing and treating oligozoospermia as a matter of best clinical practice. A well-conducted male infertility evaluation represents a unique opportunity to identify relevant medical and infertility conditions, many of which may be treated or alleviated. The andrological assessment may also help guide the optimal application of ICSI. The final goals are to positively impact the overall patient health, the couple's pregnancy prospects, and the offspring's well-being.