Approximately 15% of couples are involuntarily infertile. In the United Kingdom it has been estimated that 24% of women will consult a doctor about infertility at some stage during their lives (Greenhall and Vessey, 1990). Surveys produce variable frequencies for male disorders causing infertility, probably because of the use of different definitions of male and female infertility and variations in the thoroughness of investigation but the lowest estimates are about 25% (Comhaire et al., 1987). Commonly, both partners have defects which contribute to the infertility. In this chapter we outline a method of management of male infertility and emphasize the effectiveness or otherwise of treatments.

Usually, clinical evaluation, semen analyses and other investigations (as indicated below) allow each man's problem to be assigned to one of three therapeutic groups: untreatable sterility, treatable conditions, or subfertility. Subfertility is most common, and treatable conditions are rare (Baker, 1995).

Conditions causing untreatable sterility

Conditions causing severe primary seminiferous tubule failure with persistent azoospermia are untreatable (Table 5.1). The azoospermia must be shown to be persistent otherwise natural pregnancies may occur, albeit at a very low rate. In addition, if any live sperm can be obtained, these can be cryopreserved for intracytoplasmic sperm injection (ICSI) (Tournaye et al., 1995). The men may have a history of events causing the testicular failure such as torsion of the testes or cytotoxic drug therapy, or an association such as orchidopexies for bilateral undescended testes.