An update on the management of male infertility

Key contentMale infertility underlies or contributes to up to 50% of infertility cases; current therapeutic interventions rely on assisted reproductive technology (ART), as medical or surgical treatments have limited value in enhancing semen quality or parameters.Lifestyle factors that affect male fertility could offer a therapeutic opportunity; however, their modification seems to be of variable benefit.In the quest for sperm functional assessment and selection tests, there is controversy over which patients, if any, should be tested for sperm DNA fragmentation, as well as which test to perform. Sperm selection techniques for intracytoplasmic sperm injection do not appear to significantly improve treatment outcomes or live birth rates.Routinely performed genetic tests are effective in determining aetiology in approximately 20% of infertile men; however, newer genetic tests could enhance diagnosis and change the future management of male infertility.Learning objectivesTo summarise the key lifestyle factors that affect male fertility.To appraise the currently available investigations for sperm testing and selection.To describe the genetic tests currently available to identify the aetiology of male infertility, including emerging technologies in the field of genetics and personalised genomics.Ethical issuesHow to deal with couples’ requests for unproven medical interventions to manage male infertility