Infertility is defined when a couple is unable to achieve pregnancy after a year of regular unprotected sexual intercourse. Male infertility can be defined as an inability of the male to initiate pregnancy in his female partner due to inability to produce or deliver quality fully functioning sperms. It can also mean that the infertility in a couple is solely due to a problem in the man.

Infertility is a condition of global interest, found in about 10-15% of couple in western world and 20 -25% of couples in Africa. 50% of cases are linked to or contributed to by male factor infertility; there is a gradual drop in semen parameters over the years.

The testes are a paired organ located in the scrotum, chiefly responsible for the production of sperm cells and male sex hormone, it functions under the control of hormones from hypothalamus and pituitary.

Epididymis and ductus deferens help with storage, transport and maturation of sperms. The accessory glands secret liquid portion of semen which makes up about 80-90% of ejaculate. Penis contains the urethra which functions as passage for ejaculation of semen and excretion of urine. Spermatogenesis involves differentiation of spermatogonia into spermatocytes, spermatids, and finally, spermatozoa. The process of differentiation from spermatogonia to spermatozoa takes place in the testes over 74 ± 5 days.

Male infertility can be due to Impaired production or function of sperm cells as seen with abnormal shape or movement of sperm, low sperm count/concentration, varicocele, undescended testicle, testosterone deficiency (male hypogonadism), genetic defects, infection of the reproductive tract eg clamydia, mumps and gonorrhea. Impaired delivery of sperm cells as seen in erectile dysfunction, retrograde ejaculation, blockage of the epididymis or ejaculatory duct, hypospadia, anti-sperm antibody and cystic fibrosis. General health and lifestyle issues identified as risk factor for male infertility include: emotional stress, malnutrition, obesity, alcohol and drugs, cancer and its treatment (radio/chemotherapy), advancing age of the man, other medical conditions like hypertension and diabetes.  Environmental hazards/ exposure with adverse effects include: pesticides and other chemicals, overheating the testicles, substance abuse, tobacco smoking, radiations.

Management of male infertility usually begins with evaluation of the couple, this involves history taking, examination and baseline investigations. For the man, background family history, medical or surgical history including that of testicular descent and development of male secondary sexual characteristics are important to note. Examinations involve inspection of testes and phallus, testicular scan, Seminal Fluid Analysis and sperm DNA Integrity testing where indicated.

Traditionally male infertility is treated with sperm boosters and/or surgery where indicated, this however do not always lead to fulfilling the hope of becoming a father, with lack of beneficial outcome after these treatments, the condition seems hopeless. Affected men are therefore advised on lifestyle modification focused on: stopping cigarettes and marijuana, stress relief therapy, prompt and adequate treatment of infections, avoidance of anabolic steroids and avoiding the use of sperm toxic lubricants

All variants of male factor infertility are now treatable with a good chance of becoming a father after applying assisted reproductive techniques. These involve treatment like intrauterine insemination and in-vitro fertilization. The option of treatment is decided based on the semen function derived from SFA result. Mildly low sperm count with optimal motility and morphology, can be treated with intrauterine insemination, success rate is comparable to natural monthly pregnancy rate, so it is advised that couple move on to IVF after 3-4 failed IUI.

IVF involves a myriad of highly skilled techniques done in the laboratory, which could be employed to target the specific deficit in sperm function based on SFA result. Sperm selection techniques include ICSI (intracytoplasmic sperm injection), PICSI (physiological ICSI) and IMSI (intracytoplasmic morphologically selected sperm injection). The selected sperm is microinjected into the egg during process of fertilization in the IVF laboratory. Sperm retrieval techniques like TESA (testicular sperm aspiration) is applied to obtain immature sperms from the testes in men with azoospermia (no sperm cells in semen). This is used to fertilize the egg with a good outcome. Donor sperm is used as a last option in azoospermic men when sperms are not retrieved from TESA.