Abstract
Male reproductive dysfunction is the sole or contributory cause of infertility in half of couples making the systematic clinical and laboratory evaluation of the male, and the application of cost-effective management strategies tailored to the individual patient's need, vital parts of fertility practice.1, 2 Male infertility has a wide range of etiologies and effective approaches to initiate, restore or preserve natural fertility are available in some settings. But the most striking development in the past 20 years has been in the area of assisted reproductive technologies (ART), especially intracytoplasmic sperm injection (ICSI); the latter provides an extraordinarily effective bypass of the natural processes involved such that a single viable sperm, obtained from any part of the reproductive tract, will often successfully fertilize an oocyte and has allowed many previously sterile men to father healthy children. However, our understanding of the genetic and environmental factors causing male factor infertility has lagged behind these technological advances and still for a significant minority, no options exist other than adoption, donor sperm or abandonment of their aspirations for a family.
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