Male Infertility

Infertility is failure to achieve pregnancy after 12 months of regular unprotected intercourse. Evaluation should begin at 6 months when the female partner is 35 or older, when either partner has risk factors for infertility, or when a non-heterosexual partnership requires donor gametes. A male factor contributes to roughly 40–50% of couple infertility and is the sole identifiable cause in a substantial minority of couples. The reproductive evaluation therefore belongs to both partners from the beginning; a normal female assessment does not justify postponing assessment of the male partner. Male infertility can result from impaired sperm production, abnormal sperm transport or ejaculation, or endocrine and sexual disorders that prevent effective sperm delivery. The distinction matters because the same finding—such as a low sperm count—can lead to very different treatment. A person with high FSH and small testes has a production problem; a person with normal-sized testes, low-volume acidic semen, and absent vasa may have an obstructive or congenital outflow problem. Infertility is also a health signal: testicular masses, severe testicular atrophy, and absent vasa deferentia may reveal disease requiring evaluation...