Assessment of the infertile male

Authors

  • Stamatios Karavolos BSc MBBS MRCOG,

    Specialty Registrar, Corresponding author
    • Obstetrics and Gynaecology, The Gateshead Fertility Unit, Queen Elizabeth Hospital, Gateshead, UK
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  • Jane Stewart MD BSc MBChB FRCOG,

    Consultant Gynaecologist, Subspecialist in Reproductive Medicine
    1. Newcastle Fertility Centre at Life, International Centre for Life, Times Square, Newcastle upon Tyne, UK
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  • Isaac Evbuomwan MD MRCOG,

    Consultant Obstetrician and Gynaecologist
    1. The Gateshead Fertility Unit, Queen Elizabeth Hospital, Gateshead, UK
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  • Kevin McEleny BM BSc PhD FRCS (Urol),

    Consultant Andrologist
    1. Newcastle Fertility Centre at Life, International Centre for Life, Times Square, Newcastle upon Tyne, UK
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  • Ian Aird MBChB FRCOG

    Consultant Obstetrician and Gynaecologist
    1. The Gateshead Fertility Unit, Queen Elizabeth Hospital, Gateshead, UK
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Correspondence: Stamatios Karavolos. Email: s.karavolos@doctors.org.uk

Abstract

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?

Ancillary