Guidelines Summary

The following guidelines on male infertility are available:

European Association of Urology (EAU) Guideline: Male Infertility
American Urologic Association (AUA) Best Practice Statement: Optimal Evaluation of the Infertile Male
AUA Best Practice Statement: The Evaluation of the Azoospermic Male
AUA Best Practice Statement: The Management of Obstructive Azoospermia

Medication

Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet. 1992 Jul 4. 340(8810):17-8. [QxMD MEDLINE Link].
Matorras R, Diez J, Corcóstegui B, Gutiérrez de Terán G, García JM, Pijoan JI, et al. Spontaneous pregnancy in couples waiting for artificial insemination donor because of severe male infertility. Eur J Obstet Gynecol Reprod Biol. 1996 Dec 27. 70(2):175-8. [QxMD MEDLINE Link].
Carlsen E, Giwercman A, Keiding N, Skakkebaek NE. Evidence for decreasing quality of semen during past 50 years. BMJ. 1992 Sep 12. 305(6854):609-13. [QxMD MEDLINE Link].
Mulcahy N. Male infertility increases overall cancer risk. Medscape Medical News. June 21, 2013; Accessed July 30, 2013. Available at http://www.medscape.com/viewarticle/806619.
Eisenberg ML, Betts P, Herder D, Lamb DJ, Lipshultz LI. Increased risk of cancer among azoospermic men. Fertil Steril. 2013 Jun 12. [QxMD MEDLINE Link].
Ventimiglia E, Capogrosso P, Boeri L, Serino A, Colicchia M, Ippolito S, et al. Infertility as a proxy of general male health: results of a cross-sectional survey. Fertil Steril. 2015 Jul. 104 (1):48-55. [QxMD MEDLINE Link].
Baker HW. Reproductive effects of nontesticular illness. Endocrinol Metab Clin North Am. 1998 Dec. 27(4):831-50. [QxMD MEDLINE Link].
Alshahrani S, Ahmed AF, Gabr AH, Abalhassan M, Ahmad G. The impact of body mass index on semen parameters in infertile men. Andrologia. 2016 Feb 5. [QxMD MEDLINE Link].
Anguiano A, Oates RD, Amos JA, Dean M, Gerrard B, Stewart C, et al. Congenital bilateral absence of the vas deferens. A primarily genital form of cystic fibrosis. JAMA. 1992 Apr 1. 267 (13):1794-7. [QxMD MEDLINE Link].
Chillón M, Casals T, Mercier B, Bassas L, Lissens W, Silber S, et al. Mutations in the cystic fibrosis gene in patients with congenital absence of the vas deferens. N Engl J Med. 1995 Jun 1. 332 (22):1475-80. [QxMD MEDLINE Link].
Petersen PM, Skakkebaek NE, Vistisen K, Rørth M, Giwercman A. Semen quality and reproductive hormones before orchiectomy in men with testicular cancer. J Clin Oncol. 1999 Mar. 17 (3):941-7. [QxMD MEDLINE Link].
Jacobsen KD, Ous S, Waehre H, Trasti H, Stenwig AE, Lien HH, et al. Ejaculation in testicular cancer patients after post-chemotherapy retroperitoneal lymph node dissection. Br J Cancer. 1999 Apr. 80(1-2):249-55. [QxMD MEDLINE Link].
Gundersen TD, Jørgensen N, Andersson AM, Bang AK, Nordkap L, Skakkebæk NE, et al. Association Between Use of Marijuana and Male Reproductive Hormones and Semen Quality: A Study Among 1,215 Healthy Young Men. Am J Epidemiol. 2015 Sep 15. 182 (6):473-81. [QxMD MEDLINE Link].
El Osta R, Almont T, Diligent C, Hubert N, Eschwège P, Hubert J. Anabolic steroids abuse and male infertility. Basic Clin Androl. 2016. 26:2. [QxMD MEDLINE Link].
Wang C, McDonald V, Leung A, Superlano L, Berman N, Hull L, et al. Effect of increased scrotal temperature on sperm production in normal men. Fertil Steril. 1997 Aug. 68(2):334-9. [QxMD MEDLINE Link].
Pulkkinen MO, Mäenpää J. Decrease in serum testosterone concentration during treatment with tetracycline. Acta Endocrinol (Copenh). 1983 Jun. 103 (2):269-72. [QxMD MEDLINE Link].
Schatte EC, Orejuela FJ, Lipshultz LI, Kim ED, Lamb DJ. Treatment of infertility due to anejaculation in the male with electroejaculation and intracytoplasmic sperm injection. J Urol. 2000 Jun. 163(6):1717-20. [QxMD MEDLINE Link].
Brackett NL, Lynne CM, Aballa TC, Ferrell SM. Sperm motility from the vas deferens of spinal cord injured men is higher than from the ejaculate. J Urol. 2000 Sep. 164(3 Pt 1):712-5. [QxMD MEDLINE Link].
da Silva BF, Meng C, Helm D, Pachl F, Schiller J, Ibrahim E, et al. Towards understanding male infertility after spinal cord injury using quantitative proteomics. Mol Cell Proteomics. 2016 Jan 26. [QxMD MEDLINE Link].
Talebi AR, Khalili MA, Vahidi S, Ghasemzadeh J, Tabibnejad N. Sperm chromatin condensation, DNA integrity, and apoptosis in men with spinal cord injury. J Spinal Cord Med. 2013 Mar. 36 (2):140-6. [QxMD MEDLINE Link].
Takihara H, Sakatoku J, Fujii M, Nasu T, Cosentino MJ, Cockett AT. Significance of testicular size measurement in andrology. I. A new orchiometer and its clinical application. Fertil Steril. 1983 Jun. 39(6):836-40. [QxMD MEDLINE Link].
Bouloux P, Warne DW, Loumaye E; FSH Study Group in Men's Infertility. Efficacy and safety of recombinant human follicle-stimulating hormone in men with isolated hypogonadotropic hypogonadism. Fertil Steril. 2002 Feb. 77(2):270-3. [QxMD MEDLINE Link].
Whitten SJ, Nangia AK, Kolettis PN. Select patients with hypogonadotropic hypogonadism may respond to treatment with clomiphene citrate. Fertil Steril. 2006 Dec. 86(6):1664-8. [QxMD MEDLINE Link].
Rucker GB, Mielnik A, King P, Goldstein M, Schlegel PN. Preoperative screening for genetic abnormalities in men with nonobstructive azoospermia before testicular sperm extraction. J Urol. 1998 Dec. 160(6 Pt 1):2068-71. [QxMD MEDLINE Link].
[Guideline] Jarow J, Sigman M, Kolettis PN, Lipshultz LR, McClure RD, Nangia AK, et al. The Evaluation of the Azoospermic Male. American Urologic Association Best Practice Statements. Available at http://www.auanet.org/guidelines/male-infertility-azoospermic-male-(reviewed-and-amended-2011). 2011; Accessed: June 6, 2020.
[Guideline] Jarow J, Sigman M, Kolettis PN, Lipshultz LR, McClure RD, Nangia AK, et al. Optimal Evaluation of the Infertile Male. American Urologic Association Best Practice Statements. Available at http://www.auanet.org/guidelines/male-infertility-optimal-evaluation-(reviewed-and-validity-confirmed-2011). 2011; Accessed: June 6, 2020.
Yoshida A, Miura K, Nagao K, Hara H, Ishii N, Shirai M. Sexual function and clinical features of patients with Klinefelter's syndrome with the chief complaint of male infertility. Int J Androl. 1997 Apr. 20(2):80-5. [QxMD MEDLINE Link].
Groth KA, Skakkebæk A, Høst C, Gravholt CH, Bojesen A. Clinical review: Klinefelter syndrome--a clinical update. J Clin Endocrinol Metab. 2013 Jan. 98 (1):20-30. [QxMD MEDLINE Link].
[Guideline] Jungwirth A, Diemer T, Kopa Z, Krausz C, Minhas S, Tournaye H. Male Infertility. European Association of Urology. Available at http://uroweb.org/guideline/male-infertility/. 2017; Accessed: June 6, 2020.
Aiman J, Griffin JE, Gazak JM, Wilson JD, MacDonald PC. Androgen insensitivity as a cause of infertility in otherwise normal men. N Engl J Med. 1979 Feb 1. 300 (5):223-7. [QxMD MEDLINE Link].
Davis-Dao CA, Tuazon ED, Sokol RZ, Cortessis VK. Male infertility and variation in CAG repeat length in the androgen receptor gene: a meta-analysis. J Clin Endocrinol Metab. 2007 Nov. 92 (11):4319-26. [QxMD MEDLINE Link].
Vicdan A, Vicdan K, Günalp S, Kence A, Akarsu C, Isik AZ, et al. Genetic aspects of human male infertility: the frequency of chromosomal abnormalities and Y chromosome microdeletions in severe male factor infertility. Eur J Obstet Gynecol Reprod Biol. 2004 Nov 10. 117(1):49-54. [QxMD MEDLINE Link].
[Guideline] Krausz C, Hoefsloot L, Simoni M, Tüttelmann F, European Academy of Andrology., European Molecular Genetics Quality Network. EAA/EMQN best practice guidelines for molecular diagnosis of Y-chromosomal microdeletions: state-of-the-art 2013. Andrology. 2014 Jan. 2 (1):5-19. [QxMD MEDLINE Link].
Patsalis PC, Sismani C, Quintana-Murci L, Taleb-Bekkouche F, Krausz C, McElreavey K. Effects of transmission of Y chromosome AZFc deletions. Lancet. 2002 Oct 19. 360 (9341):1222-4. [QxMD MEDLINE Link].
Siffroi JP, Le Bourhis C, Krausz C, Barbaux S, Quintana-Murci L, Kanafani S, et al. Sex chromosome mosaicism in males carrying Y chromosome long arm deletions. Hum Reprod. 2000 Dec. 15 (12):2559-62. [QxMD MEDLINE Link].
Colombo JB, Naz RK. Modulation of insulin-like growth factor-1 in the seminal plasma of infertile men. J Androl. 1999 Jan-Feb. 20 (1):118-25. [QxMD MEDLINE Link].
Naderi G, Mohseni Rad H, Tabassomi F, Latif A. Seminal insulin-like growth factor-I may be involved in the pathophysiology of infertility among patients with clinical varicocele. Hum Fertil (Camb). 2015 Jun. 18 (2):92-5. [QxMD MEDLINE Link].
Yamamoto M, Hibi H, Hirata Y, Miyake K, Ishigaki T. Effect of varicocelectomy on sperm parameters and pregnancy rate in patients with subclinical varicocele: a randomized prospective controlled study. J Urol. 1996 May. 155 (5):1636-8. [QxMD MEDLINE Link].
Ding H, Tian J, Du W, Zhang L, Wang H, Wang Z. Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta-analysis of randomized controlled trials. BJU Int. 2012 Nov. 110 (10):1536-42. [QxMD MEDLINE Link].
Tollner TL, Venners SA, Hollox EJ, Yudin AI, Liu X, Tang G, et al. A common mutation in the defensin DEFB126 causes impaired sperm function and subfertility. Sci Transl Med. 2011 Jul 20. 3 (92):92ra65. [QxMD MEDLINE Link].
Diao R, Fok KL, Chen H, Yu MK, Duan Y, Chung CM, et al. Deficient human β-defensin 1 underlies male infertility associated with poor sperm motility and genital tract infection. Sci Transl Med. 2014 Aug 13. 6 (249):249ra108. [QxMD MEDLINE Link].
Smith HC. Fertility in men with cystic fibrosis assessment, investigations and management. Paediatr Respir Rev. 2010 Jun. 11 (2):80-3. [QxMD MEDLINE Link].
Zahalsky MP, Berman AJ, Nagler HM. Evaluating the risk of epididymal injury during hydrocelectomy and spermatocelectomy. J Urol. 2004 Jun. 171(6 Pt 1):2291-2. [QxMD MEDLINE Link].
Purohit RS, Wu DS, Shinohara K, Turek PJ. A prospective comparison of 3 diagnostic methods to evaluate ejaculatory duct obstruction. J Urol. 2004 Jan. 171(1):232-5; discussion 235-6. [QxMD MEDLINE Link].
World Health Organization, Department of Reproductive Health and Research. WHO laboratory manual for the examination and processing of human semen. Fifth Edition. 2010. 1-287. [Full Text].
Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010 May-Jun. 16(3):231-45. [QxMD MEDLINE Link].
Pierik FH, Dohle GR, van Muiswinkel JM, Vreeburg JT, Weber RF. Is routine scrotal ultrasound advantageous in infertile men?. J Urol. 1999 Nov. 162(5):1618-20. [QxMD MEDLINE Link].
Raman JD, Nobert CF, Goldstein M. Increased incidence of testicular cancer in men presenting with infertility and abnormal semen analysis. J Urol. 2005 Nov. 174(5):1819-22; discussion 1822. [QxMD MEDLINE Link].
Yanagimachi R, Yanagimachi H, Rogers BJ. The use of zona-free animal ova as a test-system for the assessment of the fertilizing capacity of human spermatozoa. Biol Reprod. 1976 Nov. 15(4):471-6. [QxMD MEDLINE Link].
Finkel DM, Phillips JL, Snyder PJ. Stimulation of spermatogenesis by gonadotropins in men with hypogonadotropic hypogonadism. N Engl J Med. 1985 Sep 12. 313 (11):651-5. [QxMD MEDLINE Link].
Santi D, Granata AR, Simoni M. FSH treatment of male idiopathic infertility improves pregnancy rate: a meta-analysis. Endocr Connect. 2015 Sep. 4 (3):R46-58. [QxMD MEDLINE Link].
Pavlovich CP, King P, Goldstein M, Schlegel PN. Evidence of a treatable endocrinopathy in infertile men. J Urol. 2001 Mar. 165 (3):837-41. [QxMD MEDLINE Link].
Whitten SJ, Nangia AK, Kolettis PN. Select patients with hypogonadotropic hypogonadism may respond to treatment with clomiphene citrate. Fertil Steril. 2006 Dec. 86 (6):1664-8. [QxMD MEDLINE Link].
Chua ME, Escusa KG, Luna S, Tapia LC, Dofitas B, Morales M. Revisiting oestrogen antagonists (clomiphene or tamoxifen) as medical empiric therapy for idiopathic male infertility: a meta-analysis. Andrology. 2013 Sep. 1 (5):749-57. [QxMD MEDLINE Link].
Omu AE, al-Qattan F, Abdul Hamada B. Effect of low dose continuous corticosteroid therapy in men with antisperm antibodies on spermatozoal quality and conception rate. Eur J Obstet Gynecol Reprod Biol. 1996 Nov. 69 (2):129-34. [QxMD MEDLINE Link].
Bals-Pratsch M, Dören M, Karbowski B, Schneider HP, Nieschlag E. Cyclic corticosteroid immunosuppression is unsuccessful in the treatment of sperm antibody-related male infertility: a controlled study. Hum Reprod. 1992 Jan. 7 (1):99-104. [QxMD MEDLINE Link].
Reynolds JC, McCall A, Kim ED, Lipshultz LI. Bladder neck collagen injection restores antegrade ejaculation after bladder neck surgery. J Urol. Apr 1998. 159(4):1303. [QxMD MEDLINE Link].
Sadaghiani S, Fallahi S, Heshmati H, Teshnizi SH, Chaijan HA, Ebrahimi FFA, et al. Effect of antioxidant supplements on sperm parameters in infertile male smokers: a single-blinded clinical trial. AIMS Public Health. 2020. 7 (1):92-99. [QxMD MEDLINE Link]. [Full Text].
Safarinejad MR, Safarinejad S, Shafiei N, Safarinejad S. Effects of the reduced form of coenzyme q(10) (ubiquinol) on semen parameters in men with idiopathic infertility: a double-blind, placebo controlled, randomized study. J Urol. 2012 Aug. 188(2):526-31. [QxMD MEDLINE Link].
Binsaleh S, Lo KC. Varicocelectomy: microsurgical inguinal varicocelectomy is the treatment of choice. Can Urol Assoc J. 2007 Sep. 1 (3):277-8. [QxMD MEDLINE Link].
Huang HC, Huang ST, Chen Y, Hsu YC, Chang PC, Hsieh ML. Prognostic factors for successful varicocelectomy to treat varicocele-associated male infertility. Reprod Fertil Dev. 2014 Mar. 26 (3):485-90. [QxMD MEDLINE Link].
Kondo Y, Ishikawa T, Yamaguchi K, Fujisawa M. Predictors of improved seminal characteristics by varicocele repair. Andrologia. 2009 Feb. 41 (1):20-3. [QxMD MEDLINE Link].
Al Bakri A, Lo K, Grober E, Cassidy D, Cardoso JP, Jarvi K. Time for improvement in semen parameters after varicocelectomy. J Urol. 2012 Jan. 187(1):227-31. [QxMD MEDLINE Link].
Abdel-Meguid TA, Al-Sayyad A, Tayib A, Farsi HM. Does Varicocele Repair Improve Male Infertility? An Evidence-Based Perspective From a Randomized, Controlled Trial. Eur Urol. 2010 Dec 21. [QxMD MEDLINE Link].
Wang J, Xia SJ, Liu ZH, Tao L, Ge JF, Xu CM, et al. Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: a meta-analysis. Asian J Androl. 2015 Jan-Feb. 17 (1):74-80. [QxMD MEDLINE Link].
Parekattil SJ, Gudeloglu A. Robotic assisted andrological surgery. Asian J Androl. 2013 Jan. 15 (1):67-74. [QxMD MEDLINE Link].
Etafy M, Gudeloglu A, Brahmbhatt JV, Parekattil SJ. Review of the role of robotic surgery in male infertility. Arab J Urol. 2018 Mar. 16 (1):148-156. [QxMD MEDLINE Link].
Trost L, Parekattil S, Wang J, Hellstrom WJ. Intracorporeal robot-assisted microsurgical vasovasostomy for the treatment of bilateral vasal obstruction occurring following bilateral inguinal hernia repairs with mesh placement. J Urol. 2014 Apr. 191 (4):1120-5. [QxMD MEDLINE Link].
Gudeloglu A, Brahmbhatt JV, Parekattil SJ. Robotic microsurgery in male infertility and urology-taking robotics to the next level. Transl Androl Urol. 2014 Mar. 3 (1):102-12. [QxMD MEDLINE Link].
Belker AM, Thomas AJ, Fuchs EF. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. 1991 Mar. 145(3):505-11. [QxMD MEDLINE Link].
Fenig DM, Kattan MW, Mills JN, et al. Nomogram to preoperatively predict the probability of requiring epididymovasostomy during vasectomy reversal. J Urol. 2012 Jan. 187(1):215-8. [QxMD MEDLINE Link].
Hsiao W, Sultan R, Lee R, Goldstein M. Increased Follicle-Stimulating Hormone is Associated With Higher Assisted Reproduction Use After Vasectomy Reversal. J Urol. 2011 Jun. 185(6):2266-71. [QxMD MEDLINE Link].
Anger JT, Goldstein M. Intravasal "toothpaste" in men with obstructive azoospermia is derived from vasal epithelium, not sperm. J Urol. 2004 Aug. 172(2):634-6. [QxMD MEDLINE Link].
Berger RE. Triangulation end-to-side vasoepididymostomy. J Urol. 1998 Jun. 159(6):1951-3. [QxMD MEDLINE Link].
Dickey RM, Pastuszak AW, Hakky TS, Chandrashekar A, Ramasamy R, Lipshultz LI. The evolution of vasectomy reversal. Curr Urol Rep. 2015 Jun. 16 (6):40. [QxMD MEDLINE Link].
McCallum S, Li PS, Sheynkin Y, Su LM, Chan P, Goldstein M. Comparison of intussusception pull-through end-to-side and conventional end-to-side microsurgical vasoepididymostomy: prospective randomized controlled study in male wistar rats. J Urol. 2002 May. 167 (5):2284-8. [QxMD MEDLINE Link].
Chan PT, Brandell RA, Goldstein M. Prospective analysis of outcomes after microsurgical intussusception vasoepididymostomy. BJU Int. 2005 Sep. 96 (4):598-601. [QxMD MEDLINE Link].
Halpern J, Mittal S, Pereira K, Bhatia S, Ramasamy R. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications. Asian J Androl. 2016 Mar-Apr. 18 (2):234-8. [QxMD MEDLINE Link]. [Full Text].
Cantoro U, Polito M, Muzzonigro G. Reassessing the role of subclinical varicocele in infertile men with impaired semen quality: a prospective study. Urology. 2015 Apr. 85 (4):826-30. [QxMD MEDLINE Link].
Pasqualotto FF, Lucon AM, de Góes PM, Sobreiro BP, Hallak J, Pasqualotto EB, et al. Is it worthwhile to operate on subclinical right varicocele in patients with grade II-III varicocele in the left testicle?. J Assist Reprod Genet. 2005 May. 22 (5):227-31. [QxMD MEDLINE Link].
Sávio LF, Palmer J, Prakash NS, Clavijo R, Adamu D, Ramasamy R. Transurethral resection of ejaculatory ducts: a step-by-step guide. Fertil Steril. 2017 Jun. 107 (6):e20. [QxMD MEDLINE Link].
Hauser R, Yogev L, Paz G, Yavetz H, Azem F, Lessing JB, et al. Comparison of efficacy of two techniques for testicular sperm retrieval in nonobstructive azoospermia: multifocal testicular sperm extraction versus multifocal testicular sperm aspiration. J Androl. 2006 Jan-Feb. 27(1):28-33. [QxMD MEDLINE Link].
Lewis R. Freezing sperm a viable option in azoospermic men. Medscape Medical News. August 12, 2013. [Full Text].
Omurtag K, Cooper A, Bullock A, et al. Sperm recovery and IVF after testicular sperm extraction (TESE): effect of male diagnosis and use of off-site surgical centers on sperm recovery and IVF. PLoS One. 2013. 8(7):e69838. [QxMD MEDLINE Link]. [Full Text].
Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999 Jan. 14 (1):131-5. [QxMD MEDLINE Link].
Belker AM, Sherins RJ, Dennison-Lagos L, Thorsell LP, Schulman JD. Percutaneous testicular sperm aspiration: a convenient and effective office procedure to retrieve sperm for in vitro fertilization with intracytoplasmic sperm injection. J Urol. 1998 Dec. 160(6 Pt 1):2058-62. [QxMD MEDLINE Link].
Brindley GS. Reflex ejaculation under vibratory stimulation in paraplegic men. Paraplegia. 1981. 19 (5):299-302. [QxMD MEDLINE Link].
Mathieu C, Ecochard R, Bied V, Lornage J, Czyba JC. Cumulative conception rate following intrauterine artificial insemination with husband's spermatozoa: influence of husband's age. Hum Reprod. 1995 May. 10 (5):1090-7. [QxMD MEDLINE Link].
Bellver J, Garrido N, Remohí J, Pellicer A, Meseguer M. Influence of paternal age on assisted reproduction outcome. Reprod Biomed Online. 2008 Nov. 17 (5):595-604. [QxMD MEDLINE Link].
Olson CK, Keppler-Noreuil KM, Romitti PA, Budelier WT, Ryan G, Sparks AE, et al. In vitro fertilization is associated with an increase in major birth defects. Fertil Steril. 2005 Nov. 84(5):1308-15. [QxMD MEDLINE Link].
Silver RI, Rodriguez R, Chang TS, Gearhart JP. In vitro fertilization is associated with an increased risk of hypospadias. J Urol. 1999 Jun. 161(6):1954-7. [QxMD MEDLINE Link].
Jakab A, Sakkas D, Delpiano E, Cayli S, Kovanci E, Ward D, et al. Intracytoplasmic sperm injection: a novel selection method for sperm with normal frequency of chromosomal aneuploidies. Fertil Steril. 2005 Dec. 84 (6):1665-73. [QxMD MEDLINE Link].
Van Steirteghem AC, Liu J, Joris H, Nagy Z, Janssenswillen C, Tournaye H, et al. Higher success rate by intracytoplasmic sperm injection than by subzonal insemination. Report of a second series of 300 consecutive treatment cycles. Hum Reprod. 1993 Jul. 8(7):1055-60. [QxMD MEDLINE Link].
Wald M, Ross LS, Prins GS, Cieslak-Janzen J, Wolf G, Niederberger CS. Analysis of outcomes of cryopreserved surgically retrieved sperm for IVF/ICSI. J Androl. 2006 Jan-Feb. 27(1):60-5. [QxMD MEDLINE Link].
Rehman R, Fatima SS, Hussain M, Khan R, Khan TA. Effect of endometrial thickness on pregnancy outcome after intracytoplasmic sperm injection. J Pak Med Assoc. 2015 May. 65 (5):448-51. [QxMD MEDLINE Link].
Scott R, MacPherson A, Yates RW, Hussain B, Dixon J. The effect of oral selenium supplementation on human sperm motility. Br J Urol. 1998 Jul. 82(1):76-80. [QxMD MEDLINE Link].
Klemetti R, Gissler M, Sevon T, Koivurova S, Ritvanen A, Hemminki E. Children born after assisted fertilization have an increased rate of major congenital anomalies. Fertil Steril. 2005 Nov. 84(5):1300-7. [QxMD MEDLINE Link].
Agbugui JO, Omokhudu O. Posterior urethral valve: an unusual cause of primary male infertility. J Reprod Infertil. 2015 Apr-Jun. 16 (2):113-5. [QxMD MEDLINE Link].
Mechlin C, Mccullough A. V1590 robotic microsurgical varicocele repair: initial experience and surgical outcomes from a single academic center. J Urol. 2013. 189:e652-3. [Full Text].
[Guideline] Jarow J, Sigman M, Kolettis PN, Lipshultz LR, McClure RD, Nangia AK, et al. The Management of Obstructive Azoospermia. American Urologic Association Best Practice Statements. Available at http://www.auanet.org/guidelines/male-infertility-management-of-obstructive-azoospermia-(reviewed-and-validity-confirmed-2011). 2011; Accessed: June 6, 2020.

Media Gallery

Male infertility. Hypothalamic-pituitary-gonadal axis stimulatory and inhibitory signals. Gonadotropin-releasing hormone (GnRH) from the hypothalamus stimulates the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary. FSH stimulates the Sertoli cells to facilitate sperm production, while LH stimulates testosterone release from the Leydig cells. Feedback inhibition is from testosterone and inhibin.
Male infertility. Testicular histology magnified 500 times. Leydig cells reside in the interstitium. Spermatogonia and Sertoli cells lie on the basement membrane of the seminiferous tubules. Germ cells interdigitate with the Sertoli cells and undergo ordered maturation, migrating toward the lumen as they mature.
Male infertility. Normal male ductal anatomy.
Male infertility. Varicocele. A - Physical examination revealing the characteristic "bag of worms." B - Anatomy of the dilated pampiniform plexus of veins.
Male infertility. Technique of open vasography: The vas distal to the site of incision is determined to be patent if saline is injected without resistance. Alternatively, radiographic contrast dye is injected through the vas deferens and radiography is performed, or blue dye may be injected and visualized in the urine to confirm patency. A vasovasostomy or vasoepididymostomy may then be performed at this level.
Male infertility. Technique of microscopic varicocelectomy. The individual veins of the pampiniform plexus are isolated (top) and ligated, taking care to preserve the testicular artery (bottom) isolated using the intraoperative Doppler.
Male infertility. Technique of vasovasostomy: Upper left is confirmation of sperm from the proximal vas deferens, proving proximal patency. Upper right is the inner layer anastomosis using interrupted #10-0 Prolene. Lower left is the inner layer anastomosis completed. Lower right is the outer layer anastomosis using #9-0 Prolene completed.
Male infertility. Technique of vasoepididymostomy. Left upper is confirmation of mature sperm in epididymis. Right upper is the inner layer anastomosis of the end of the vas to the side of the epididymal tubule using interrupted #10-0 Prolene. Left lower is the inner layer completed. Right lower is the outer layer anastomosis using interrupted #9-0 Prolene completed.
Male infertility. Technique of intracytoplasmic sperm injection (ICSI). A micropipette is used to inject a single sperm directly into an egg.

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Author

Chirag N Dave, MD Physician in Sexual and Male Reproductive Medicine and Urology, Advanced Urology Institute of Georgia

Chirag N Dave, MD is a member of the following medical societies: American Urological Association, Sexual Medicine Society of North America

Disclosure: Nothing to disclose.

Coauthor(s)

Anisha Dave, BS MD Candidate, St Matthew's University School of Medicine

Anisha Dave, BS is a member of the following medical societies: American Medical Association, American College of Obstetricians and Gynecologists, American College of Physicians, American College of Surgeons, American Medical Women's Association, HIV Medicine Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Kristen Meier, MD Resident Physician, Department of Urology, Oakland University William Beaumont School of Medicine

Kristen Meier, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Phi Beta Kappa, Phi Kappa Phi

Disclosure: Nothing to disclose.

Richard C Bennett, MD Assistant Professor of Urology, Oakland University William Beaumont School of Medicine; Urologist, Comprehensive Urology

Richard C Bennett, MD is a member of the following medical societies: American Society for Reproductive Medicine, American Urological Association, Michigan State Medical Society, Sexual Medicine Society of North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Mark Jeffrey Noble, MD Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, The Scientific Research Honor Society, Society of University Urologists, SWOG

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Urology, Department of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Endo, Antares.

Additional Contributors

Daniel B Rukstalis, MD Professor of Urology, Wake Forest Baptist Health System, Wake Forest University School of Medicine

Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science, American Urological Association

Disclosure: Nothing to disclose.

Jonathan Rubenstein, MD Urologist, Chesapeake Urology Associates

Jonathan Rubenstein, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Robert E Brannigan, MD Associate Professor, Department of Urology, Northwestern University, Feinberg School of Medicine

Robert E Brannigan, MD is a member of the following medical societies: American Society for Reproductive Medicine, American Society of Andrology, Society for the Study of Reproduction, Society for the Study of Male Reproduction, American Urological Association, Endocrine Society

Disclosure: Nothing to disclose.

Kassem Faraj Oakland University William Beaumont School of Medicine

Kassem Faraj is a member of the following medical societies: American Medical Association, American Medical Student Association/Foundation, American Urological Association, Michigan State Medical Society

Disclosure: Nothing to disclose.

Paras Vakharia, PharmD Medical Student Researcher, Department of Dermatology, Henry Ford Hospital; Medical Student Researcher, Department of Ophthalmology and Department of Radiation Oncology, Oakland University William Beaumont School of Medicine

Paras Vakharia, PharmD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hematology, Michigan State Medical Society

Disclosure: Nothing to disclose.

Sections Male Infertility
Overview
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- Physical
- Causes
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Treatment
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References

Analysis	Finding	Conclusion/Further investigation
Ejaculate volume	Low (< 1.5 mL)	Postejaculation urine (retrograde ejaculation) TRUS (absence of vas deferens) Hormonal evaluation (hypogonadism)
	High (>5 mL)	Likely contaminant
Semen quality	Does not coagulate	TRUS (ejaculatory duct obstruction)
	Does not liquefy	Hormonal analysis
Sperm density	Oligospermia (< 20 million per mL) Severe oligospermia (< 5 million per mL)	TRUS (partial ejaculatory duct obstruction) Antisperm antibody evaluation Hormonal analysis Physical examination for varicocele
	Azoospermia	Sperm centrifuged to verify azoospermia Postejaculation urine (retrograde ejaculation) Hormonal evaluation Testicular biopsy (testicular failure) TRUS (ejaculatory duct obstruction)
Motility	Decreased	Antisperm antibodies Physical examination for varicocele
*All semen analyses with abnormal results should be repeated.

Male Infertility Guidelines

Guidelines Summary

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