INTEGRATED DIAGNOSTIC VALUE OF SEMINAL FRUCTOSE, CITRATE, AND PH IN THE EVALUATION OF MALE INFERTILITY

This narrative review evaluates the diagnostic utility of key biochemical markers in semen analysis—fructose, citrate, and pH—in the assessment of male infertility. Seminal fructose reflects seminal vesicle function, citrate represents prostatic secretory activity, and pH integrates the relative contributions of accessory sex glands while remaining sensitive to inflammatory and preanalytical factors. Through a structured literature review and laboratory-oriented methodological synthesis, we demonstrate that absent or markedly reduced fructose strongly suggests ejaculatory duct obstruction or seminal vesicle agenesis; acidic seminal pH indicates diminished seminal vesicle contribution; and reduced citrate is consistent with prostatic inflammation or secretory hypofunction. Rather than addressing these parameters in isolation, this review highlights their combined diagnostic value in differentiating obstructive azoospermia, low-volume ejaculation, and inflammatory conditions. Analytical variability, preanalytical pitfalls, and the need for harmonization according to the World Health Organization (WHO) laboratory manual are discussed. We conclude that integrated interpretation of fructose, citrate, and pH alongside conventional semen parameters enhances diagnostic accuracy, clinical decision-making, and cost-effectiveness in the evaluation of male infertility.