Examining Male Infertility

Susanne Quallich

Disclosures

Urol Nurs. 2006;26(4):277-288. 

In This Article

Abstract and Introduction

Problems of male infertility can seem like minor issues within the larger realm of urology. But many male infertility diagnoses can be successfully treated, allowing the couple to conceive naturally or with minimal medical assistance. Some patients presenting with male infertility can have more significant disease. Treatments for male infertility will continue to progress, and as an increasing number of couples seek infertility services, the need to provide basic information grows as well.

An increasing number of couples seek evaluation and treatment for infertility, especially as more couples delay childbearing in order to establish their careers. A male factor alone is the cause of infertility in up to 20% of infertile couples and a contributing factor in another 30% to 40% of all couples presenting for infertility evaluations (American Urological Association [AUA] & American Society for Reproductive Medicine (ASRM), 2001a; ASRM, 2004). Problems with infertility affect approximately 6.1 million people in the United States, or roughly 10% of the reproductive-age population. For these couples, a lack of success with conception is not just an inconvenience but rather a disease of their reproductive system(s). Understanding the basics of male infertility is an important part of providing complete urologic care to male patients.

There are causes of male infertility that are treatable, either through medical or surgical management, and causes that can be corrected, or improved, to the point where the couple is able to conceive naturally or to take advantage of less-costly assisted reproductive technologies.

It is common to recommend an infertility evaluation in couples with a history of unprotected intercourse for at least 12 months without a pregnancy and with attempts to time intercourse with ovulation, although this length of time can be shortened as the female partner's age increases to over age 35 or if the couple is worried about their fertility status. This guideline is relevant even if the couple has previously had children together. A couple can present with a history of little difficulty achieving a first pregnancy, and yet be unsuccessful in establishing a second pregnancy (secondary infertility). There are other reasons to consider an evaluation, such as female infertility issues, including age greater than 35, or a history of male risk factors for infertility, such as cryptorchidism or a history of cancer treatment. A screening evaluation for the couple should include a reproductive history and at least two semen analyses at a laboratory that is qualified to perform the testing.

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