Introduction

Though this chapter will deal in detail with the clinical assessment of the male partner in an infertile couple, it is necessary to emphasize (as described in Chapter 2) the importance of treating the couple rather than just the individual. There is no doubt that subfertility frequently occurs in both partners and the effects tend, on the basis of a number of studies, to be synergistic rather than additive. Therefore both partners in any couple with subfertility must be assessed fully and a strategy of investigation and management planned that takes account of them both. Thus the assessment of the male should occur in parallel with the assessment outlined in Chapter 3 for the female partner.

With the recent exciting developments in assisted reproductive technologies, particularly as applied to male subfertility (as outlined in Chapter 10), there is a temptation to take a minimalistic approach to the assessment of the male partner and to rely simply on the semen analysis followed by a decision as to whether to proceed to in-vitro fertilization, perhaps with sperm microinjection. It is important to recognize that there are uncommon but potentially treatable and/or preventable causes of male subfertility which should be identified before proceeding to more invasive and expensive technologies. The couple must be made fully aware of the options available to them, including the likely success rates, complications and expenses involved.