DO WE TREAT THE MALE OR HIS GAMETE

The history of the male infertility patient is of utmost value. A phys ical examination is mandatory when psychosexual and ejaculatory dysfun ction and male accessory gland infection are suspected, and even in th e presence of azoospermia, It is also advisable to perform a physical examination to exclude the presence of testicular tumours, The diagnos tic assessment includes sperm analysis, history, physical examination, the Valsalva manoeuvre, Doppler, ultrasonography, hormonal serum meas urements, evaluation of testicular volume by orchidometry and evaluati on of testicular consistency by palpation. The diagnosis of male infer tility is descriptive and determination of true causality is almost no n-existent. For decades, various therapies have been proposed to impro ve sperm parameters in cases of male factor infertility. Administratio n of anti-oestrogens and androgens is ineffective. No peer-review data are available to demonstrate the benefit of the use of intrauterine i nsemination or the correction of varicocele, Classic in-vitro fertiliz ation is to some extent a solution for male factor infertility; howeve r the two-pronuclear fertilization rate for patients with impaired sem en samples is significantly lower than that for patients with non-male indications. Conventional treatment for male factor infertility has l ittle value and has been revised and abandoned. Intracytoplasmic sperm injection is an effective treatment, even for cases of extreme oligoa sthenoteratozoo-spermia. It has to be considered the method of choice and should replace ineffective conventional therapies.