Infertility means not being able to become pregnant after a year of trying. If a woman keeps having miscarriages, it is also called infertility. Lots of couples have infertility problems. About a third of the time, infertility can be traced to the woman. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause is found.

If you think you might be infertile, tell your doctor. For a man, a first step is often a sperm test. For women, doctors run tests to see if their ovaries work properly. Women in their 30s who have been trying to get pregnant for six months should consider seeking help. A woman’s chances of having a baby drop rapidly every year after age 30.

Infertility is typically defined as failure to conceive within a certain period of time. For the male, this definition is particularly problematic, as it relies on an outcome for his female partner, who may have reproductive issues of her own. Fecundability is the term used for the probability of a woman in a sexually active couple becoming pregnant per menstrual cycle without contraception.

It is customary to define infertility clinically as the inability of a couple trying to conceive to do so within one year. This may make the usual definitions of prevalence and incidence somewhat confusing in this context. In this chapter, we use incidence as it is classically defined—a proportion per unit time. However, many authors use prevalence to describe the percentage of couples failing to conceive after one year.

The treatment of male infertility includes therapies targeted to specific medical and surgical diagnoses, empiric pharmacologic agents intended to improve spermatogenesis, and artificial reproductive techniques employed to bypass reproductive barriers in the female genital tract. Often, two or all three types of therapy are implemented simultaneously. Male reproductive medicine and surgery remains one of the most actively evolving areas in urology, with a variety of therapeutic modalities under investigation.

Drugs or surgery are common treatments. Happily, two-thirds of couples treated for infertility go on to have babies.