Male Reproductive Medicine

What is male infertility?

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 15-20% 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 20-30% are pure male factor. A combination of male and female factors accounts for the remaining 20-30% 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.

The approach to the infertile couple often begins with an evaluation of the female; this is primarily because it is usually the female partner who has initiated a workup by consultation with her gynecologist. As a result, there is often a delay in male evaluation and treatment. The mistaken notion that infertility is associated with "impotence" or decreased masculinity has also contributed to a delay in male evaluation and treatment. It often 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.

The specific treatment of male infertility 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 health or life.

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.

Postmortem Sperm Retrieval (PMSR)

To learn more about PMSR and Weill Cornell Medicine's policies & guidelines surrounding this procedure, please click here.

Male Infertility Research - Additional Reading

If you are interested in learning more about Weill Cornell Medicine's current research on new treatments for severe male infertility, please click here. 

Additional resources related to male infertility research can be found on the Center for Male Reproductive Medicine and Microsurgery page as well as the Male Infertility Genetics Laboratory page.

Testosterone Replacement Therapy

James J. Colt Professor of Urology and Reproductive Medicine, Dr. Peter N. Schlegel, provides expert commentary regarding new guidelines on Testosterone Replacement Therapy for aging men. Read more here.

Male Infertility and the Risk of Prostate Cancer

Are men with infertility prone to develop clinically significant prostate cancer? Dr. Peter N. Schlegel provides expert commentary on the connection between male infertility and the risk of prostate cancer. Read more here.