Male reproductive dysfunction is the sole or contributory cause in half of infertile couples. Some health issues are more prevalent in infertile men and must be sought and the opportunity taken to assess and improve general and sexual health. Spontaneous conception may occur in many couples with male factor subfertility. In counseling patients, the severity of the male's reproductive problem, the duration of unprotected intercourse, and its frequency and timing, and the female partner's age and reproductive status are all important variables. There is a substantial background rate of spontaneous conception in subfertile men such that about 30% of couples with sperm densities of 1-5 million/ml as the only apparent fertility issue, achieved pregnancy over a two- to three-year period. Depending on the couple's age and reproductive history, some couples are happy to delay treatment in the hope that they will conceive while others express a wish for immediate intervention.

The treatment options that face a couple prior to in vitro fertilisation (IVF) depend upon the cause of their infertility. To clarify the definition of male factor subfertility to produce a pragmatic approach to treatment, Van Voorhis published a study that correlates the effect of the total motile sperm count with the outcome of assisted reproduction. A diagnosis of unexplained infertility cannot be made without a laparoscopy to exclude the presence of pelvic adhesions or endometriosis. There is evidence that in couples with otherwise unexplained infertility, the fecundity of women with minimal and mild endometriosis is improved by laparoscopic ablation of the endometriotic deposits. The commonest cause of anovulatory infertility is polycystic ovarian syndrome (PCOS). Unexplained infertility is reported to occur in up to 60% of couples. The simplest, least invasive and cheapest regime for superovulation and intrauterine insemination (IUI) is the use of clomiphene citrate.