Diagnosing male infertility

### What you need to know Around 1 in 7 couples in the UK1 seek treatment for infertility when they are unable to conceive, despite regular unprotected intercourse. Male infertility describes any factor in men that may prevent a couple from becoming pregnant. In nearly half of infertility cases, the male partner has suboptimal sperm parameters.23 Some cases of idiopathic infertility may have underlying male aetiology. Both partners need to be assessed for infertility, so the couple should ideally be seen together. In this practice pointer, we discuss a practical approach for non-specialists to diagnose male factor infertility in primary care. In about a third of patients, no cause is identified.2 The infographic outlines common causes such as hormonal, testicular, or obstructive factors. In a prospective cohort study of 1737 men with infertility, undescended testes (10.7%), genetic abnormalities (7.8%), and obstruction (5.9%) were the most common causes.4 Sixty percent of participants in that study were overweight or obese, which may cause sperm DNA damage and suppress reproductive hormone secretion.5 Genitourinary infection, urological surgery during childhood, and illicit drugs are common and under-recognised causes of male infertility. Varicoceles increase scrotal temperature and reduce testicular perfusion.6 A meta-analysis of observational studies noted that varicoceles were associated with reduced sperm quality.7 Forty percent of men with primary infertility …