Asian Basic and Applied Research Journal

Infertility is now recognised as a common reproductive disorder rather than a marginal concern of affluent health systems, yet the laboratory infrastructure required to characterise it remains weakest in the settings where its social consequences are most severe. This critical narrative review examines the contribution of medical laboratory science to the recognition, causal attribution and management of infertility in low- and middle-income countries, with sustained attention to Nigeria. Peer-reviewed literature was identified through PubMed and MEDLINE and Crossref Metadata Search, supplemented by targeted retrieval of institutional documents, and appraised for methodological adequacy, consistency and relevance rather than citation frequency. The synthesis is organised around five analytical problems: the measurement of infertility burden, the diagnostic evaluation of male factor infertility, the microbiological attribution of tubal and genital tract disease, the analytical performance of endocrine and genetic testing, and the systems conditions under which laboratory results acquire clinical meaning. The available evidence indicates that basic semen examination remains the single most consequential laboratory investigation in this context, that its reliability is undermined by measurement variability that external quality assessment can reduce but has rarely been applied to in African andrology laboratories, and that serological diagnosis of chlamydial tubal disease, which dominates the Nigerian literature, rests on assays of uncertain specificity and cannot support the causal claims frequently made from it. Evidence on regional laboratory quality systems demonstrates that accreditation has expanded substantially but remains geographically concentrated and largely confined to vertically funded disease programmes, from which reproductive diagnostics have been excluded. Confidence in most published aetiological fractions is limited by single-centre designs, reliance on convenience samples and inconsistent adherence to standardised laboratory methods. Priorities for research include the establishment of andrology proficiency testing schemes, prospective evaluation of nucleic acid amplification testing against serology for tubal disease attribution, and analytical verification of reproductive hormone assays in African populations.