Semen analysis results demonstrate considerable variation from sample to sample, which complicates research efforts to identify specific dietary or lifestyle change that might potentially improve sperm quality. Although the presence of a varicocele has been suggested to play a role in male infertility, the benefit of varicocelectomy remains controversial. Some studies have suggested that wearing boxers instead of briefs can improve a man’s sperm count. The avoidance of extremely high temperature may also improve sperm counts, so care should be taken to avoid prolonged exposure to extremely high temperatures, such as within a sauna or a hot tub. In one case, a pizzeria owner stopped working 18 hours a day in front of the pizza ovens and moved to the cash register and away from the heat. His sperm count normalized and his partner, a Dominion Fertility patient, conceived spontaneously. The effects of a variety of nutritional supplements on semen have been studied with some researchers suggesting that antioxidants may improve sperm quality, thereby leading to improved pregnancy rates (the desired outcome). Although the data on nutritional supplements with antioxidant properties are somewhat limited, a commercially available product based on this research is available (Proxeed, Sigma-Tau Pharmaceuticals). This nutritional supplement is available for purchase only over the Internet. Although it has been frequently prescribed by some urologists, additional studies are required to confirm its benefits. Surgical treatments for male factor infertility are very limited. Historically, varicocelectomy has been the surgical procedure most commonly used to improve sperm quality. In this procedure, dilated veins in the scrotum (varicocele) are cut or occluded. One theory is that these dilated veins may increase the scrotal-testicular temperature, thereby diminishing the sperm quality. By cutting the veins, the scrotal temperature is restored to normal and fecundity may be improved. Unfortunately, well-designed controlled studies have not shown any statistical increase in pregnancy rates following varicocelectomy. Furthermore, many fertile men have varicoceles. Today, this procedure is rarely, if ever, indicated. In most cases of male factor infertility, the best treatment involves intrauterine insemination (IUI) or, more often, proceeding directly with in vitro fertilization (IVF) and possibly intracytoplasmic sperm injection (ICSI). Have a semen analysis conducted to see which direction to go from here.