Male factor has been frequently considered to be a minor issue as opposed to female factor considering the strong relevance of the oocyte although this is a mistaken approach if we understand that male pathology is responsible for a high percentage of cases of sterility. If we carry out a correct diagnosis of the male and his semen sample we will be able to find the best way to tackle this pathology and, therefore, improve the condition of the couple when facing their sterility problem.

Over the years we are witnessing an enthralling emergence of new approaches for the diagnosis of the male factor including its genetic study.

I hope this handbook can be very useful in your daily practice and I encourage Nova IVI Fertility to go on with this way of continuous training for professionals working in the exciting area of human reproduction.

In the past, it was because the male himself was usually reluctant to come for evaluation, and the burden of infertility fell upon the woman. Later, even when semen analysis became common, evaluation and management of the male remained secondary due to the lack of therapeutic options. Then, when ICSI became the ultimate answer to male subfertility, ironically it shifted the spotlight away from the male because the infertility specialist used whatever sperm were available without being concerned about how to improve their number or quality.

However, recently the focus has finally shifted to the male due to the realization that merely having sperm is not enough, and that subnormal sperm will compromise pregnancy outcomes after ICSI. Hence, men are now being assessed thoroughly to assess their fertility potential, and are being treated when this is found to be suboptimal. Further, an increasing number of genetic causes of male infertility are being identified, with clinical and therapeutic implications and finally, advances in microsurgical techniques for reconstruction in obstructive azoospermia and for retrieving sperm in non-obstructive azoospermia have brought new hope to previously hopelessly infertile couples, making it imperative that men with azoospermia be evaluated and managed correctly.

This practical handbook seeks to update the clinician with clinically relevant advances in this field. The first two chapters discuss the new WHO guidelines for semen analysis and the use of special tests to assess sperm function, especially DNA integrity. Subsequent chapters address the uncommon but frustrating practical problem of ejaculatory failure, the treatment of OATS through medical and surgical therapy, and the clinical approach to the evaluation and management for azoospermia—a subject of increasing importance.

It is hoped that this handbook will serve as a handy update and reference volume to the gynecologist dealing with infertile couples.