In the evaluation of the infertile couple, male factors account for up to 50% of causes. These factors may occur alone or in combination with female causes. Transrectal ultrasound has allowed imaging of the urogenital tract to be less invasive. New assisted reproductive techniques (ART) have revolutionised management. Many previously "hopeless" cases now have a good chance of fathering a child. Such ART include microscopic epididymal sperm aspiration (MESA) and intracytoplasmic sperm injection (ICSI).