Male Infertility

Infertility affects about 15% of all couples and a male factor is believed to play a role in about half the cases. Male infertility may be caused by dysfunctions in any component of normal fertility including hormonal homeostasis, spermatogenesis, sperm transport and storage, and the ability to deliver the sperm intravaginally. In addition, the condition is associated with developmental defects in the male reproductive system, and the development of testicular cancer and is believed to be a marker for overall health status. In the diagnosis of male infertility, both reproductive and general health should be assessed. A full evaluation includes at least two semen samples and an endocrinological and potentially genomic evaluation if semen quality is reduced. The evaluation helps the clinician determine if the cause of the infertility is pre-testicular, testicular, or post-testicular. Management includes counseling as well as attention to specific issues that reduces fertility. In pre-testicular cases, any treatable underlying conditions should be managed. If this is not possible, the mainstay of treatment is assisted reproductive techniques (ART) with ejaculated or retrieved semen. This is also the choice in most testicular cases of infertility except in the presence of a varicocele, which may be surgically corrected resulting in improved semen quality. In post-testicular obstruction, either transurethral desobstructive surgery or reconstructive surgery with microsurgical technique is the first choice to re-establish the presence of sperm in the semen. In cases of ejaculatory dysfunction, an antegrade ejaculate may be induced by vibratory stimulation or electroejaculation. In cases where this is not possible, surgical sperm retrieval for use in ART is indicated.