Clinic and Polyclinic for Dermatology, Venereology and Allergology, University Hospital Leipzig AöR and Leipzig Medical School of the University of Leipzig, Germany.
J Dtsch Dermatol Ges. 2013 Sep;11(9):799-814; quiz 815. doi: 10.1111/ddg.12177.
Basic andrological diagnosis consists of taking the patient's medical history and the couple's history as well as performing a physical examination including genital ultrasound, spermiogram, and hormonal analysis. If needed, a testicular biopsy and genetic testing may also be performed. Recent studies have shown the effect of lifestyle factors on male fertility. Thus, the patient history and clinical/andrological examinations have been broadened to include information on metabolic disorders like obesity and diabetes mellitus. The biggest changes occurred with the publication of the fifth edition of the WHO laboratory manual in 2010 and the introduction of a section on semen analysis in the German Medical Association guidelines (RiliBÄK). The reference values for almost all spermiogram parameters were adapted in an evidence-based approach using worldwide prospective population studies. For central parameters such as sperm motility and morphology, the assessment criteria were changed. New independent markers such as sperm DNA fragmentation rate are now routinely used in clinical diagnosis. For German andrological laboratories, there are now mandatory quality assurance measures for semen analysis (in the German "Rili-BÄK" guidelines). These include duplicate testing of all standard semen parameters and inter-laboratory comparison at regular intervals.
基础男科诊断包括采集患者病史和夫妇病史，以及进行体格检查，包括生殖器超声、精液分析和激素分析。如果需要，还可以进行睾丸活检和基因检测。最近的研究表明，生活方式因素对男性生育能力有影响。因此，患者病史和临床/男科检查已经扩大，包括肥胖和糖尿病等代谢紊乱的信息。最大的变化发生在 2010 年发布第五版世界卫生组织实验室手册和德国医学协会指南（RiliBÄK）中引入精液分析部分之后。几乎所有精液参数的参考值都通过使用全球前瞻性人群研究进行了基于证据的调整。对于精子活力和形态等中心参数，评估标准发生了变化。现在，精子 DNA 碎片率等新的独立标志物已常规用于临床诊断。对于德国男科实验室，现在精液分析有强制性的质量保证措施（在德国的“Rili-BÄK”指南中）。这些措施包括对所有标准精液参数进行重复测试，并定期进行实验室间比较。
