Spermatogenesis is a complex process by which primitive, totipotent stem cells divide to either renew themselves or produce daughter cells that become spermatozoa. These processes occur within the seminiferous tubules of the…

Introduction
Infertility is defined as the inability to conceive after 1 year of unprotected sexual intercourse. Infertility affects approximately 15% of couples. Roughly 40% of cases involve a male contribution or factor, 40% involve…

If neither surgery nor medical therapy is appropriate for male infertility treatment, assisted reproductive techniques can be used to achieve a pregnancy.

In at least 25% of infertile men, no identifiable cause can be attributed to the problem. Because the pathophysiology is ill-defined, this is termed idiopathic infertility. There is a second group…

Specific Therapy

Specific therapy seeks to reverse known pathophysiologic effects to improve fertility. For the most part, they are cost-effective treatments.

A. Pyospermia
The presence of elevated numbers of leukocytes in…

An undescended testis occurs in 0.8% of male infants at 1 year of age. Spontaneous descent into the scrotum is unlikely after 1 year. Although the most important reason for…

A complete failure of emission and ejaculation occurs most commonly from spinal cord injury (10,000 cases/ year in the United States) and as a result of deep pelvic or retroperitoneal…

For over 20 years, transurethral resection of the ejaculatory ducts (TURED) has been used to relieve pain due to ejaculatory duct obstruction. More recently, it has become obvious…

About 35,000 men per year undergo vasectomy reversal in the United States. The most common reason is remarriage and the desire for more children. Occasionally, an unfortunate individual will have…

A. Impotence
Sexual dysfunction stemming from low libido or impotence is a frequent cause of infertility. The male hormonal evaluation can detect organic reasons for such problems. Most…

A. Immotile Cilia Syndromes
Immotile cilia syndromes are a heterogeneous group of disorders (1:20,000 males) in which sperm motility is reduced or absent. The sperm defects are due to abnormalities…

POSTTESTICULAR

A. Orchitis
Inflammation of testis tissue is most commonly due to bacterial infection, termed epididymo-orchitis. Viral infections also occur in the testis in the form of mumps orchitis. Orchitis…

Peripheral resistance to androgens occurs with 2 basic defects: (1) a deficiency of androgen production through the absence of 5α-reductase or (2) a deficiency in the androgen receptor. In…

The undescended testis is a very common urologic problem, observed in 0.8% of boys at 1 year of age. It is considered a developmental defect and places the affected testis at…

A. Radiation
The effects of radiotherapy on sperm production are well described. They are derived mainly from a series of remarkable experiments performed during the “atomic age” but only recently…

A. Renal Failure
Uremia is associated with infertility, decreased libido, erectile dysfunction, and gynecomastia. The cause of hypogonadism is controversial and probably multifactorial. Testosterone levels are decreased, and FSH…

A. Noonan Syndrome
Also called male Turner syndrome, Noonan syndrome is associated with clinical features similar to Turner syndrome (45,X). However, the karyotype is either normal (46,XY) or mosaic…

A. Pituitary Insufficiency
Pituitary insufficiency may result from tumors, infarcts, surgery, radiation, or infiltrative and granulomatous processes. In sickle cell anemia, pituitary and testicular microinfarcts from sickling of red…

The causes underlying male infertility are numerous but are conveniently grouped by effects at one or more of the following levels: pretesticular, testicular, and posttesticular.