Evaluation of male infertility.

Infertility is an emotionally charged problem affecting an estimated 15% of all couples. The man should be evaluated concurrently with the woman, since a male factor is the primary or contributing cause in 40% to 60% of cases. In addition to detecting treatable abnormalities, evaluation of the infertile man is critical to uncover life-threatening problems associated with the symptom of infertility, as well as genetic conditions associated with male infertility that could be transmitted to offspring with assisted reproduction. New diagnostic tests have been developed and surgical techniques refined resulting in improved treatment results and patient care. Dramatic advancements in, and widespread use of, assisted reproductive techniques such as intracytoplasmic sperm injection have created alternatives for couples who previously had little hope of reproductive success. The infertility practitioner should have a thorough understanding of the advantages and limitations of various laboratory tests as well as the indications, costs and success rates of all treatment options. The first step in evaluation is a thorough history and physical examination with initiation of basic laboratory studies.