Infertility is defined as a couple's inability to achieve pregnancy following one year of appropriately timed and unprotected intercourse. By this criterion it has been estimated that approximately 15 to 20% of couples attempting to achieve pregnancy are unable to do so. A female factor is the primary etiology in approximately 50% of these couples, and another 20 to 30% are pure male factor. A combination of male and female factors accounts for the remaining 20 to 30% of cases. This suggests that in 50% of couples presenting for infertility evaluation, a male factor is contributory. Conservatively estimated, this means that 2.5 million American men would potentially benefit from a fertility evaluation.
Oftentimes, the approach to the infertile couple begins with an evaluation of the female, primarily because it is usually the female partner who has initiated a workup by consultation with her gynecologist. Because of this there is often a delay in male evaluation and treatment. Additionally, the mistaken notion that infertility is associated with "impotence" or decreased masculinity has also contributed to a delay in male evaluation and treatment. It makes sense, however, to start with the male partner, whose initial evaluation may be performed rapidly and non-invasively.
The most important part of the evaluation of the infertile male is the history and physical examination.
It is our experience that in 90% of cases an accurate impression is obtained from an initial visit after a thorough history, physical examination, and light microscopic examination of a semen specimen.
Further testing usually serves to confirm the diagnosis and help direct the course of therapy. Recent research advances in the area of male reproduction have brought about dramatic changes in the ability to not only diagnose, but also treat male infertility.
Currently, detection of the underlying problems causing male infertility and directed treatment is possible in most cases.
Furthermore, the specific treatment of the "male problem" is often more successful, less expensive and possibly less invasive than in vitro fertilization (IVF) or other assisted reproductive treatments. Additionally, about 1% of men who present with the symptom of "infertility" will actually have a serious medical problem causing the infertility that, if left untreated, may jeopardize a man's health or life.
The most important point is, the majority of couples suffering from infertility can be helped to conceive a child. Artificial techniques of reproduction have advanced to the point where a single sperm can be physically injected into an egg [intracytoplasmic sperm injection (ICSI)]. ICSI has dramatically changed the treatment available for even the most severe male factor infertility. Because of this technique, 90% of all infertile men, including half of all men with non-obstructive azoospermia, have the potential to conceive their own genetic child.