Key content
Male factors alone account for up to 30% of subfertile couples undergoing in vitro fertilisation.
Male infertility may be due to problems with sperm production or transport and also sexual dysfunction. The underlying cause in most cases is idiopathic.
Modifiable lifestyle factors can have an impact on male fertility, but medical treatments have a limited value in enhancing semen quality. Most treatments are based on assisted fertilisation techniques, rather than treatment of the underlying cause.
The number and quality of sperm that can be recovered, either from the ejaculate or surgically, determines the available options for assisted conception.
Intracytoplasmic sperm injection (ICSI) is considered relatively safe; however, because of the ability to bypass natural barriers to conception, there are concerns regarding its potential to transmit genetic defects.
Learning objectives
To review appropriate practice in the assessment and investigation of the infertile male.
To critically appraise the currently available investigations for male fertility.
To summarise the treatment options for subfertile men.
Ethical issues
Does ICSI propagate genetic causes of male infertility?
Could there ever be a role for the use of artificial sperm in assisted reproduction?