The male partner can contribute to difficulty conceiving in 30-40% of couples. Infertility in men can be caused by hormone (endocrine) problems, enlarged testicular veins (varioceles) or other anatomic problems and genetic causes. Male factor infertility is usually first detected through a semen analysis. Results on a semen analysis that suggest the male partner should see a fertility specialist include having less than 39 Million sperm (total sperm count) per sample, less than 40% moving sperm (Motility) or less than 4% normally shaped sperm (strict morphology). Men with an abnormal semen analysis should undergo a hormone (endocrine) evaluation, and an exam by a urologist who specializes in infertility. In men with sperm counts less than 5 Million, genetic testing may be indicated to search for genetic causes of male factor infertility. Low sperm counts can often be reversed with medication or surgery depending on the cause. In men with male factor infertility that cannot be reversed with medication or surgery, In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injections (ICSI) can be performed to achieve pregnancy. Performing ICSI with IVF increases the percentage of eggs that are successfully fertilized and may allow a woman to achieve pregnancy with as few as 5-10 normal sperm, as opposed to the 10-20 Million usually required for intercourse or insemination to be successful. In men with no or very few visible sperm on the semen analysis, urologic procedures such as Testicular Sperm Aspiration (TESA), Testicular Sperm Extraction (TESE) and Microsurgical Epididymal Sperm Aspiration (MESA) can be used to locate and obtain sperm for fertility treatments.