Infertility is defined as a couple's inability to achieve pregnancy following one year of appropriately timed and unprotected intercourse. By this criterion it has been estimated that approximately 15-20% of couples attempting to achieve pregnancy are unable to do so. A female factor is the primary etiology in approximately 40% of these couples and another 30 - 40% are pure male factor. A combination of male and female factors accounts for the remaining 20% to 30% of cases. This suggests that in more than 50% of couples presenting for infertility evaluation, a male factor is contributory. Conservatively estimated, this means that 2.5 million American men would potentially benefit from fertility evaluation. Historically, the approach to the infertile couple has started with an evaluation of the female, primarily because it is usually the female partner who has initiated a workup by consultation with her gynecologist. It makes more sense, however, to start with the male partner, whose initial evaluation may be performed rapidly and noninvasively.
Despite the availability of advanced reproductive technologies, detection of the problem causing male infertility and institution of directed treatment is possible in most cases. This specific treatment of the "male problem" is often more successful, less expensive and possibly less invasive than ICSI or other assisted reproductive treatments. In addition, about 1% of men who present with the symptom of "infertility" will actually have a serious medical problem causing the infertility that, if left untreated, may jeopardize a man's health or life. The most important part of the evaluation of the infertile male is the history and physical examination. Even in this era of "high-tech" medicine it has been our experience that in 90 % of cases an accurate impression is obtained from an initial visit after a thorough history, physical examination, and light microscopic examination of a semen specimen. Further testing usually serves to confirm the diagnosis and help direct the course of therapy.