• in vitro fertilisation;
  • infertility;
  • intracytoplasmic sperm injection;
  • male;
  • semen analysis

Key content

  • Male factors alone account for up to 30% of subfertile couples undergoing in vitro fertilisation.
  • Male infertility may be due to problems with sperm production or transport and also sexual dysfunction. The underlying cause in most cases is idiopathic.
  • Modifiable lifestyle factors can have an impact on male fertility, but medical treatments have a limited value in enhancing semen quality. Most treatments are based on assisted fertilisation techniques, rather than treatment of the underlying cause.
  • The number and quality of sperm that can be recovered, either from the ejaculate or surgically, determines the available options for assisted conception.
  • Intracytoplasmic sperm injection (ICSI) is considered relatively safe; however, because of the ability to bypass natural barriers to conception, there are concerns regarding its potential to transmit genetic defects.

Learning objectives

  • To review appropriate practice in the assessment and investigation of the infertile male.
  • To critically appraise the currently available investigations for male fertility.
  • To summarise the treatment options for subfertile men.

Ethical issues

  • Does ICSI propagate genetic causes of male infertility?
  • Could there ever be a role for the use of artificial sperm in assisted reproduction?