Introduction

Male infertility affects one man in 20 and contributes with equal frequency to infertile unions. In many men it is not yet possible to improve the quality of ejaculated sperm, which has led to the widespread use of assisted reproductive techniques to resolve infertility. These techniques are now widely discussed in the lay press and as a result the population is far more knowledgeable and willing to discuss male infertility. Accordingly, it is essential that all clinicians involved in reproductive medicine be able to discuss the options for fertility using ART.

It is important to recognize that ART does not represent a true treatment for male infertility as it does not provide for an increase in sperm quality and improved prospects for natural conception. However, it does provide a powerful means of bypassing the infertility associated with poor sperm quality and provides pregnancy rates similar to those of normal couples having unprotected intercourse (approximately 20–25% pregnancy per cycle). Despite severely reduced sperm number, motility and quality, ART permits fertilization by providing a high concentration of sperm to come into close proximity with the egg and even to be injected into the egg cytoplasm if the need arises.

The prospects for pregnancy in severe male infertility have improved markedly since the advent of ICSI as the number and quality of sperm no longer limit the chance of success.