Infertility is defined as the failure to conceive despite one year of regular unprotected intercourse.  A couple should consider evaluation sooner if either partner has a known risk factor for infertility (e.g., advanced female age, male with a history of undescended testicles), or if the couple has concerns about their fertility potential.  In most cases, it is recommended that both partners be evaluated simultaneously to prevent any delays in successful treatment.

Approximately 15% of couples will experience infertility, and of these, 20% will have a male factor that is solely responsible; male factors will contribute in an additional 30% of cases.  Generally, male infertility is identified by abnormalities on a semen analysis; however, other issues can contribute to infertility despite normal semen.

The causes of male infertility are widely varied, and are best evaluated by a urologist who specializes in male reproductive health.  Some causes of male infertility can be identified and reversed (or improved) with specific surgery or medication while other causes can be identified but not reversed.  Occasionally the underlying cause of infertility or an abnormal semen analysis cannot be identified, in which case it is termed idiopathic.  These cases may be amenable to non-specific or empiric treatment to improve the chances of conception.

The purpose of the male infertility evaluation is to:  1) identify and correct the reversible causes of male infertility with the goal of allowing a couple to conceive through intercourse, or with the least amount of technology; 2) identify irreversible conditions that may be amenable to treatment with assisted reproductive technology (ART) using the male partner’s sperm; 3) identify irreversible conditions in which the man’s sperm are not obtainable, in which case the couple may consider donated sperm or adoption; 4) identify medical diseases that may be associated with infertility and require treatment; and 5) identify specific genetic causes of infertility that may be transmitted to and impact offspring.

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