Assisted Reproductive Technology and Its Impact on Male Infertility Management

Abstract

Approximately 12-15% of sexually active couples are infertile. The etiology of infertility is likely multifactorial. Previous work has estimated that 50% of infertility is attributed to the female, 30% to the male, and 20% to both the male and female. Recent advances, mainly in the assisted reproductive technologies (ART), have allowed some couples with severe male factor infertility to establish a pregnancy. The most significant advance is in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). Previously, these couples had at best only a remote chance of establishing a pregnancy due to severely reduced sperm concentration, compromised sperm function, or uncorrectable obstruction. As a result of the high success of IVF/ICSI, and as a by-product of the fact that fertility visits are often initiated by the female partner, the practice of modern assisted reproductive technology (ART) can oftentimes proceed without a complete evaluation of the male partner. Instead, almost any couple, even those with a severe male factor, after being evaluated by only a reproductive endocrinologist, can theoretically become pregnant using IVF/ICSI. This, however, can miss significant medical pathology in the male, and this common practice needs to be reevaluated.