Male Infertility: The Clinical Aspects of Evaluation and Management

Introduction At a time when limiting family size has become of national interest, increasing numbers of married couples are moving in a different direction-to overcome infertility and conceive children. Reasonably reliable statistics indicate that approximately 3 .5 million couples, or nearly 15% of those of childrearing age, are subfertile. If one adds the cases of secondary infertility, in which a pregnancy or a miscarriage has already occurred in the marriage but is followed by years of difficulty conceiving another child, the magnitude of the infertility problem is indeed impressive. At the personal level, involuntary childless couples may suffer doubts about their own sexuality and are often caught in intense emotional, family, and societal pressures emanating from their inability to conceive. Furthermore, the incidence of infertility seems to be slowly increasing due to a number of factors including the increased risk of prolonged anovulation following the use of birth control pills and to adnexal infections associated with the use of intrauterine devices. Additionally, there is a definite trend by women to delay having children until later in life and thus to bypass the time of their optimal fertility potential between 22 and 26 years of age. Whether or not the true incidence of infertility is increasing, there is a definite and substantial increase in the demand for treatment. This reflects a growing awareness by childless couples that treatment for infertility in many instances can be effective and that