Investigation and management of male infertility.

Infertility is rarely due only to the male or female partner. Usually each partner's fertility is in some way diminished. Male infertility may be related to deficiencies in spermatogenesis or sperm transport. Accurate diagnosis can be achieved only by a careful evaluation including precise semen analyses and, where indicated, gonadotropin and other assays. Treatment may be specific for physical or endocrine deficits, but is often empirical. Factors other than the sperm count, such as emission of sperm mainly at the beginning of ejaculation, low seminal volume with good quality sperm, excessive seminal viscosity, pyospermia, and idiopathic oligospermia, may be responsible for infertility. These may respond to simple measures. Understanding and empathy for the infertile couple is of the utmost importance.