Treatment options for male infertility

Introduction: the importance of assessment of the male partner Male reproductive dysfunction is the sole or contributory cause in half of infertile couples. Remarkable advances in ART, particularly intracytoplasmic sperm injection (ICSI), now provide fertility in previously sterile men. Such powerful technology does not remove the clinician's obligation to fully evaluate infertile men because, for example, natural fertility may be restorable, and, even when treatment is not possible, providing the man with a reason for his infertility will assist him in coming to terms with his disability. In addition, some health issues are more prevalent in infertile men and must be sought (e.g. androgen or gonadotropin deficiency, testicular cancer) and the opportunity taken to assess and improve general and sexual health. A diagnosis will allow consideration of medical and surgical therapies that permit natural pregnancy. Natural fertility should always be the prime goal so that basic discussions should occur with the couple about the physiology of conception and the timing of intercourse and include preconception counseling of both partners to optimize their health. (See also Chapters 2 and 3.) The effects of the stress of infertility on the couples' individual and relationship health must be considered and counseling offered as indicated: most fertility programs have specialist staff available for this purpose (Chapter 19). Fertility practices are often staffed by gynecologists yet a process must be in place that facilitates full evaluation of the man on site or through collaborative arrangements.