Sperm selection is a crucial step in any assisted reproduction treatment and will facilitate optimal results if the correct protocol is chosen as per the specifics of the case.

Although standard laboratory processes like classic swim-up or density gradients are suitable in a significant number of cases, special preparation methods are required for specific situations such as elevated sperm DNA fragmentation, infectious samples to avoid viral transmissions to partner or progeny, retrograde ejaculation, high viscosity semen, immotile spermatozoa, or testicular sperm.

The objective of this chapter is to supplement the information provided in the sixth edition of the WHO laboratory manual for the examination and processing of human semen by providing a clinical explanation of the various sperm preparation protocols and discussing the selection of the most appropriate technique for a given semen sample.

There is a complex interplay between male sexual dysfunction and male factor infertility, including ejaculatory dysfunctions which are the most common male sexual dysfunction. It is divided into four categories: premature ejaculation (PE), delayed ejaculation (DE), retrograde ejaculation (RE), and anejaculation/anorgasmia (AE). Unfortunately, some of these ejaculatory dysfunctions are less studied and not as well understood. Various pharmacologic treatments and surgical procedures can be offered for patients with ejaculatory dysfunctions seeking fertility. These include the off-label use of SSRIs (selective serotonin reuptake inhibitors) for PE, surgical (testicular sperm aspiration, testicular sperm extraction, and microsurgical epididymal sperm aspiration) and nonsurgical methods (medications, positive predictive value, and electroejaculation) for patients with RE and AE. The interaction between chemical impulses and the modulation of the ejaculation process in an individual patient is necessary to conclude the clinical status of the patient and feasibility of the available treatment techniques. Ultimately, this can help in deciding the best sperm retrieval technique to increase pregnancy outcomes.