Tests of sperm DNA damage and sperm chromosome anomalies have also been developed. The advanced sperm tests yield information on the fertilizing capacity of human spermatozoa, as well as their ability to support normal embryonic development. The most common abnormalities involve the structure of the sperm tail, with defects in either the axoneme or outer dense fibers. Postcoital test (PCT) assesses the ability of sperm to traverse the cervical mucus, and is performed by examining the cervical mucus several hours after intercourse for the presence of sperm. The sperm penetration assay (SPA) utilizes hamster ova, which have had the zona pellucida enzymatically removed, allowing penetration by human spermatozoa. The hemizona assay uses zona pellucida from nonfertilizable, nonliving oocytes. Reactive oxygen species (ROS) are ubiquitous in aerobic biologic systems and are formed as a by-product of oxygen metabolism.

Female fertility begins to decline many years before menopause, despite continued regular ovulatory cycles. Decreased fecundity with increasing female age has long been recognized in demographic and epidemiological studies. Traditionally, the evaluation of the infertile female consists of: (i) ovulation assessment (ovulatory factors), (ii) evaluation of the uterine morphology (ovulation assessment) and tubal patency (tubal factors), (iii) assessment of the presence of pelvic pathology (by laparoscopy) (peritoneal factors), and (iv) postcoital test (cervical factors). Hysterosalpingography (HSG), laparoscopy are widely used in assessing infertility. Chlamydia antibody testing is a screening method for assessing tubal infertility. HSG, sonohysterography, hystero-salpingo contrast sonography (HyCoSy), magnetic resonance imaging (MRI) and hysteroscopy are used in assessment of uterine factors related to infertility. Currently, the best method to monitor ovulation is transvaginal ultrasound, which can be used to demonstrate the growth of a dominant follicle and provide presumptive evidence of ovulation and leutinization.