Men with persistently abnormal semen analyses may be evaluated by a urologist.The most common conditions associated with male factor infertility include varicocele, testicular failure, obstruction, and undescended testes. About 90 percent of male factor infertility is felt to be idiopathic, with or without varicoceles. Varicoceles are present in about 15 percent of normal men and in about 40 percent of men with male factor infertility. Some studies have shown increases in sperm counts and motility following surgical repair of varicocele, which is a simple outpatient procedure, with risk comparable to that of a herniorrhaphy.
On the other hand, in many infertility centers, for patients with moderate male factor, IUI is attempted first, followed by IVF or ICSI, with good success rates. For patients with severe male factor infertility (severe oligospermia or azoospermia), either ICSI or therapeutic donor insemination should be the initial treatment.
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