Do we treat the male or his gamete?

The history of the male infertility patient is of utmost value. A physical examination is mandatory when psychosexual and ejaculatory dysfunction and male accessory gland infection are suspected, and even in the presence of azoospermia. It is also advisable to perform a physical examination to exclude the presence of testicular tumours. The diagnostic assessment includes sperm analysis, history, physical examination, the Valsalva manoeuvre, Doppler, ultrasonography, hormonal serum measurements, evaluation of testicular volume by orchidometry and evaluation of testicular consistency by palpation. The diagnosis of male infertility is descriptive and determination of true causality is almost non-existent. For decades, various therapies have been proposed to improve sperm parameters in cases of male factor infertility. Administration of anti-oestrogens and androgens is ineffective. No peer-review data are available to demonstrate the benefit of the use of intrauterine insemination or the correction of varicocele. Classic in-vitro fertilization is to some extent a solution for male factor infertility; however, the two-pronuclear fertilization rate for patients with impaired semen samples is significantly lower than that for patients with non-male indications. Conventional treatment for male factor infertility has little value and has been revised and abandoned. Intracytoplasmic sperm injection is an effective treatment, even for cases of extreme oligoasthenoteratozoospermia. It has to be considered the method of choice and should replace ineffective conventional therapies.