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Epididymal Surgery. (PDF, 8 MB) Chapter 8 from textbook, Infertility, 1992. When anatomic variance or obstruction is suspected, referral for surgical evaluation and treatment is appropriate.

Microscopic Technique for Reversal of Vasectomy. (PDF, 3 MB) Surgery, gynecology & obstetrics, 1976. Varicocele: Surgically removing a varicose vein in the scrotum may help. 29 When the semen analysis is abnormal, referral to a male fertility specialist or reproductive endocrinologist is warranted. Laparoscopy is an operation performed in the abdomen or pelvis through small incisions, generally no more than a centimeter, with the assistance of a laparoscope attached to a camera which projects to a screen. In men who have the necessary reproductive organs to procreate, infertility can be caused by low sperm count due to endocrine problems, drugs, radiation, or infection. Physical examination reveals gynecomastia, small testis, and eunuchoid body habitus due to delayed puberty.

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Hypogonadotropic Hypopituitarism: Low pituitary gland output of LH and FSH.  This condition arrests sperm development and causes the progressive loss of germ cells from the testes and causes the seminiferous tubules and Leydig (testosterone producing) cells to deteriorate.  May be treated with the drug Serophene.  However, if all germ cells are destroyed before treatment commences, the male may be permanently infertile. They may benefit from referral to a physician comfortable with prescribing pulsatile administration of gonadotropin-releasing hormone or gonadotropins with luteinizing hormone activity to induce ovulation.

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World Health Organization reference values for human semen characteristics. Issues with ejaculation Similarly, an inability to ejaculate is a sign that it might be time to visit a doctor. Intra-uterine insemination for male subfertility. Small, firm testicles The testes house a man’s sperm, so testicle health is paramount to male fertility.

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Birth after Preimplantation Diagnosis of the Cystic Fibrosis F508 Mutation by Polymerase Chain Reaction in Human Embryos Resulting from Intracytoplasmic Sperm Injection with Epididymal Sperm. (PDF, 2 MB) The Journal of the American Medical Association, 1994. Anti-Müllerian hormone of less than or equal to 5. Sermondade N, Faure C, Fezeu L, Lévy R, Czernichow S; Obesity-Fertility Collaborative Group. 8,33,35,36 Lastly, in vitro fertilization, with or without intracytoplasmic sperm injection, is the mainstay of assisted reproductive technology for male factor infertility. Ovarian Transplantation in a Series of Monozygotic Twins Discordant for Ovarian Failure. (PDF, 188 KB) The New England Journal of Medicine, 2007. Especially in men, psychological explanations should be considered as they are frequently the cause of sexual dysfunctions.