Presence of abnormal semen parameters in the male partner of a couple unable to achieve conception after 1 year of unprotected intercourse.
Male factor alone contributes up to 30% of cases of infertile couples and to an additional 30% to 40% in combination with other factors.
Most cases are of unknown aetiology.
Diagnosed if abnormal semen parameters in 2 semen analyses separated by 1 month.
Sperm functional assays, endocrine tests, genetic testing, and imaging can be helpful.
Treatment should be targeted to the aetiological factors whenever possible.
Assisted reproductive techniques are often the fastest and most effective method to achieve pregnancy regardless of the aetiology.
The clinical definition of male factor infertility is the presence of abnormal semen parameters in the male partner of a couple unable to achieve conception after 1 year of unprotected intercourse. The World Health Organization defines male factor infertility as the presence of ≥1 abnormalities in the semen analysis or the presence of inadequate sexual or ejaculatory function.
History and exam
- presence of risk factors
- inability of a couple to conceive
- palpable and dilated testicular veins
- erectile dysfunction and decreased libido
- testis atrophy (testis smaller than 20 cm^3)
- body habitus, abnormal hair distribution, and gynaecomastia
- absent vasa or epididymis
- prior chemotherapy or radiotherapy
- current medications
- cystic fibrosis and congenital bilateral absence of vas deferens (CBAVD)
- Y chromosome abnormalities
- Klinefelter's syndrome (47,XXY)
- genital tract infection
- erectile dysfunction
- previous infertility
- retrograde ejaculation
- testicular torsion or trauma
- lifestyle including smoking and alcohol consumption
- exposure to androgen
- age >55 years
- environmental toxin exposure
- history of CAD or diabetes
- history of STD
- hot tub use
- sperm viability
- sperm membrane function
- hormonal assays
- MRI of the pituitary and hypothalamus
- colour flow Doppler imaging
- urine testing for retrograde ejaculation
- genetic analysis
- sperm DNA assays
- antisperm antibody serology
- acrosome reaction test
- sperm penetration assay (hamster egg penetration test)
- sperm longevity test
- electron microscopy
- testicular biopsy
Ali A. Dabaja, MD
Director of Male Reproductive Medicine and Sexual Medicine
Henry Ford Health System
K9 Urology Clinic
AAD declares that he has no competing interests.
Ahmad O. Hammoud, MD, MPH
IVF Michigan Fertility Center
AOH declares that he has no competing interests.
Dr Ali A. Dabaja and Dr Ahmad O. Hammoud would like to gratefully acknowledge Dr Benjamin Emery, the previous contributor to this monograph. BE declares that he has no competing interests.
Peter N. Kolettis, MD
Division of Urology
University of Alabama at Birmingham
PNK declares that he has no competing interests.
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