Evaluation of Sperm Function Additional studies may be selectively used to further evalu ate sperm transport in the female reproductive tract, sperm capacitation and acrosome reaction, zona pellucida bind ing, sperm-egg fusion and penetration, and sperm decondensation within the oocyte cytoplasm. Sperm trans port is initially assessed by the postcoital test, with addi tional in vitro tests of sperm-mucus interaction to further characterize the abnormality detected on the postcoital test. The treatment of any infertile male ulti mately depends both on an accurate determination of the underlying pathophysiologic process leading to disordered sperm production, delivery, or function and a thorough evaluation of the female partner. The role of cervical factors in infertility remains a contro versial one. However, most practitioners believe that cervi cal mucus abnormalities, in combination with other factors, may contribute to subfertility and should be evaluated.
Structural problems are often iatrogenic and result from surgical procedures, such as conization.
In such cases, destruction of the endocervical epithelium or stenosis leads to inadequate mucus production and sperm transport and, thus, disturbance of the function of cervical crypts for sperm storage. A variety of uterine conditions have been implicated in infertility. These include chronic endometritis, leiomyomata, intrauterine synechiae, congenital malformations, and polyps. Foreign bodies can also affect implantation. Most of these abnormalities can also cause recurrent abor tion.