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Approach to the male with infertility

Bradley D Anawalt, MD
Stephanie T Page, MD, PhD
Section Editors
Peter J Snyder, MD
Alvin M Matsumoto, MD
Deputy Editor
Kathryn A Martin, MD


In the United States, infertility in a couple is defined as the inability to achieve conception despite one year of frequent, unprotected intercourse. However, up to 50 percent of young, healthy couples that fail to conceive in the first 12 months will conceive in the subsequent 12 months with no specific treatment [1]. Therefore, in some circumstances, delay in extensive evaluation and treatment is reasonable. In approximately 35 percent of couples with infertility, a male factor is identified along with a female factor; in approximately 10 percent, a male factor is the only identifiable cause.

While many men with male infertility have oligozoospermia (a low number of sperm cells in the ejaculate compared with reference ranges) or azoospermia (no sperm cells in the ejaculate), some infertile men have normal sperm counts. Over 80 percent of infertile men have low sperm concentrations associated with a decrease in sperm motility (asthenozoospermia) and/or an increase in spermatozoa with abnormal morphology (teratozoospermia). A small percentage of infertile men have normal sperm concentrations but poor sperm quality, reflected by a decrease in sperm motility and/or abnormal sperm morphology, and another small percentage of infertile men have normal sperm concentrations and normal motility and morphology.

This topic will review the evaluation of male infertility. The causes and management of male infertility and an overview of infertility are reviewed separately. (See "Causes of male infertility" and "Treatments for male infertility" and "Overview of infertility".)


The causes of male infertility can be divided into four main areas (table 1):

Endocrine and systemic disorders (usually related to secondary [hypogonadotropic] hypogonadism) – 2 to 5 percent.

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Literature review current through: Nov 2017. | This topic last updated: Oct 31, 2017.
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