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  • Print publication year: 2009
  • Online publication date: February 2010

2 - Male causes of infertility: evaluation and treatment

Summary

Introduction

The male is solely responsible for the failure to conceive in about 20% of infertile couples, and contributory in another 30–40%. Reduced male fertility can derive from congenital or acquired urogenital abnormalities, infection of male accessory glands, increased scrotal temperature, endocrine disturbances, genetic abnormalities or immunological factors. However, no demonstrable etiology can be diagnosed in 48.5% of cases of male infertility. An abnormal semen analysis (SA) suggests the presence of a male factor; however, a normal SA does not preclude a male factor being present.

The goals of the evaluation of the infertile male are to identify:

potentially correctable conditions

irreversible conditions amenable to assisted reproductive technologies (ART) using male gametes or donor insemination if the male partner's sperm is not procurable

life- or health-threatening conditions that may underlie infertility and require medical attention

genetic abnormalities that may affect the health of off spring if passed on via advanced reproductive techniques.

Traditionally, evaluation of infertility is postponed until one year of unprotected intercourse. However, it is justified to initiate an evaluation earlier if one of the following conditions is present:

defined male infertility risk factors

female infertility risk factors, including advanced age (> 35 years)

the male or female partner requests an earlier evaluation.

Initial evaluation of the male usually consists of two semen analyses separated by at least a month, a medical and reproductive history, and a focused physical examination by a urologist/andrologist.