In no phase of medicine is it more difficult to evaluate etiological factors and therapeutic results than in the problem of infertility. The numerous constitutional and local conditions that can affect fertility of both the husband and the wife are so diversified that in any critical analysis it is difficult to know where to start and when to stop. Results of therapy statistically, on paper, can look impressive, but it is often questionable whether medicine and the physician have triumphed, or whether Nature and coincidence have succeeded. Superficially, it would appear that evaluation of therapeutic results in the husband can be made more readily than in the wife, since the fluctuations in seminal values are easily observed and interpreted. However, even with the present fairly comprehensive standards of semen interpretation, it is quite possible that additional factors are involved that at present are unrecognized and that may greatly affect evaluation
Tyler ET. SEMEN STUDIES AND FERTILITY. JAMA. 1951;146(4):307–314. doi:10.1001/jama.1951.03670040007002
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