Goal and Indications for Evaluation of the Infertile Male

Male infertility can be attributed to a variety of conditions; however, most of the time an exact cause is not found, but if found, not all can be trnated and/or corrected. An abnormal semen picture may be the only finding; in these cases, the cause of infertility is termed idiopathic.

The aim of male infertility evaluation is to identify and treat potentially correctable causes. The identification of genetic disorder during male infertility workup would help in counseling the couple about the potential risks involved to the offspring and also help guide the couple to alternate treatment strategies. Potential serious conditions like testicular cancer and pituitary tumors may also present with infertility and/or sexual dysfunction as the only primary symptom during an assessment (Honig et al. 1994).

In a large WHO study involving over 8500 couples from 25 countries, a standardized classification system for categorizing the various causes of male infertility was published. This study clearly showed that the single most common etiology of male infertility belonged to the idiopathic abnormalities of the semen category (25%), followed by varicocele (Cornhaire 1987).

Nevertheless, with our recent understanding of genetic causes, this study is in need of a review. The various causes of male infertility are summarized in Table 4.1. Varicocele is however a debatable cause of male infertility.

Reference

Male Infertility - A Clinical Approach Editors: Gunasekaran, Karthik, Pandiyan, N (Eds.)