Which of the following statements are true concerning male infertility?

b. A varicocele can be associated with diminished sperm motility and abnormal sperm morphology

d. Anti-sperm antibodies are an important cause of infertility which may be treated successfully with corticosteroid administration

Infertility is defined as the inability to conceive a pregnancy within one year of unprotected intercourse. About 15% of couples in the United States are affected, and in about 25%-50% of infertility cases, the male contributes to the problem. The cornerstone of male fertility evaluation is the semen analysis. Oligospermia, or a low sperm count, is an incomplete form of testicular failure due to a number of causes. A varicocele is found in about 15% of the general male population, but 40% of infertile men have this finding. Men with a varicocele can exhibit low sperm counts but more often have diminished sperm motility and abnormal morphology. Surgical ligation or angiographic embolization of the internal spermatic vein improves the semen parameters in 50%-70% of these men and gives subsequent pregnancy rates of 25%-50%. Complete testicular failure is diagnosed by a testis biopsy showing no sperm production or by a markedly elevated serum FSH level, indicating the absence of negative feedback inhibition induced by spermatogenesis. Complete testicular failure is not remedial by treatment. Anti-sperm antibodies are found frequently in infertile men and represent an important cause of infertility. Corticosteroid administration may be helpful if antibodies are present, but the toxicity of these medications cannot be ignored.