Studies show that the improvement in semen quality after varicocele repair doesn't always translate to increased pregnancy rates and can use up precious time, especially when a woman's biological clock is ticking.
The remainder of infertility is unexplained.
Men, unlike women, produce new sperm throughout their reproductive lives.
So while a 40-year-old woman is dealing with a 40-year-old egg, sperm is never older than 3 months old regardless of the age of the man.
However, that sperm becomes lower in quality as a man ages.
Aging men have declining levels of sex hormones, and it appears that these declining levels of testosterone have a significant impact on sperm production.
This well-publicized fact is certainly part of the reason that a number of men taking supplemental testosterone have increased 210 percent since 1999.
Supplemental testosterone is no magic pill, however. While higher testosterone levels potentially, but not definitively, result in improved sperm number and quality, supplemental testosterone may also be responsible for a number of health problems such as an increased risk of prostate hyperplasia, and possibly cancer.
What is a man to do if doctors find his sperm isn't up to donor quality?
Testosterone supplementation is rarely the cure. Urologists who specialize in male fertility can sometimes come up with specific causes and treatment recommendations for a less than terrific semen analysis after an evaluation of the man in question.
If there are quality sperm -- but not a lot of them -- assisted reproductive techniques such as in vitro fertilization and intracytoplasmic sperm Injection (in which a sperm is actually injected into the egg) can solve the problems of many infertile couples in which a male factor is the dominant problem, but the techniques are complicated and expensive.
If sperm is being produced but is not transported properly, it can be retrieved from the testis prior to ejaculation.
Certain conditions result in an inability to make sperm and are not treatable. If that is the case, pregnancy can be achieved only with donor sperm.
Men can eat right, not smoke, and exercise regularly -- the standard and very effective health advice that applies to so many situations -- to help keep sperm as healthy as their biology allows.
Contrary to popular opinion, it is not necessary to replace those tight jockey shorts with baggy boxers.
It really doesn't make a difference and clearly does nothing to enhance a man's desirability.
Dr. Lauren Streicher is an assistant professor of obstetrics and gynecology at Northwestern University and a practicing OB-GYN at Northwestern Memorial Hospital in Chicago.