Male Infertility

Infertility is usually defined as the inability of a couple to conceive even after 1 year of unprotected, frequent sexual intercourse. Infertility affects about 15% of couples in the US and at least 180 million couples worldwide. Male infertility is defined by the World Health Organization (WHO) as the inability of a man to impregnate a fertile woman after at least 1 year of regular unprotected intercourse. The male partner is solely responsible for about 20% of cases and is a contributing factor in another 30% to 40% of infertility cases. Because male and female causes often coexist, both partners should be evaluated for infertility and treated together. Overall, the male factor substantially contributes to about 50% of infertility cases. Causes of male infertility include reversible and irreversible conditions. Additional factors may affect either partner, including age, medications, surgical history, exposure to environmental toxins, genetic problems, and systemic diseases. The primary goals of evaluating a man for infertility are to identify contributing factors, offer treatment for reversible causes, determine if he is a candidate for assisted reproductive techniques, and provide counseling for irreversible and untreatable conditions. Up to 6% of men evaluated for male infertility will be found to have more serious underlying pathology, such as cancer. The possibility of serious underlying disease provides an additional reason to perform a comprehensive evaluation of the male partners of couples with infertility so that clinically significant underlying medical conditions can be identified and treated.