Limitation of ovulation induction to anovulatory women, limitations on the number of cycles of ART, moving more quickly to donor oocytes, and maximizing the male factor are all probable trends for the future. An evaluation for male factor infertility is called for when a couple presents with complaints of failure to conceive after one year of unprotected intercourse, or earlier when there are known risk factors for decreased fertility. Reasons for evaluation of male infertility include identifying a condition that may be treatable, identifying untreatable conditions, particularly those of genetic origin, so that couples may proceed with donor insemination or adoption, and excluding life-threatening causes of infertility. Evaluation of male infertility begins with a detailed history. Reproductive history, family history and history of surgery or medications are important.
Physical examination is also important.
Laboratory tests including semen analysis, hormone levels, and tests of sperm function should be performed, although not all tests are indicated in all patients. Often, the cause is undetermined. Causes of male infertility are listed in Table 1. The optimal goal of treatment of male infertility is to increase fertility enough to allow conception through normal intercourse. Specific treatments, such as repair of a varicocele or correction of hormone deficiency, may be curative.