Male Infertility Treatment Guidelines

Diagnostic Evaluation

Both male and female partners should undergo concurrent assessment to properly direct therapy, including a detailed reproductive history and at least one semen analysis, according to the American Urological Association 1, 3
Men with abnormal semen parameters should be evaluated by a male reproductive expert for complete history, physical examination, and directed tests, as recommended by the American Urological Association 1, 4
Evaluation should be considered in couples with failed assisted reproductive technology cycles or recurrent pregnancy losses, as suggested by the American Urological Association 1

Varicocelectomy is indicated for infertile men with clinical varicocele, abnormal semen parameters, and otherwise unexplained infertility when the female partner has good ovarian reserve, according to the European Association of Urology 5
Varicocelectomy may be considered in men with elevated sperm DNA fragmentation with unexplained infertility or failure of assisted reproductive techniques, as recommended by the European Association of Urology 5

For ejaculatory duct obstruction, transurethral resection of ejaculatory ducts (TURED) and/or surgical sperm extraction may be considered, as suggested by the American Urological Association 2
For men with azoospermia due to obstruction, both epididymal and testicular sperm retrieval are viable options with similar fertilization, pregnancy, and live birth rates, according to the American Urological Association 2

In patients with hypogonadotropic hypogonadism, evaluate to determine the etiology and treat based on diagnosis, as recommended by the American Urological Association 2
Avoid exogenous testosterone therapy in men seeking fertility as it suppresses spermatogenesis, according to the American Urological Association 2

Testicular sperm may be considered in nonazoospermic males with elevated sperm DNA Fragmentation Index (DFI), as suggested by the American Urological Association 2
Recent meta-analysis shows improved clinical pregnancy rates, live births, and reduced pregnancy loss rates with testicular sperm in men with elevated DFI, according to the American Urological Association 2

Treat male accessory-gland infections to improve sperm quality, as recommended by the European Association of Urology 5
Refer sexual partners of patients with accessory sex gland infections caused by sexually transmitted diseases for evaluation and treatment, according to the European Association of Urology 5

All men with cancer must be offered sperm cryopreservation before gonadotoxic treatment or ablative surgery, as recommended by the European Association of Urology and the European Society of Human Reproduction and Embryology 6, 7
Preservation of ejaculated semen is the most cost-effective strategy for fertility preservation, according to the European Association of Urology 6
In cases of severe oligozoospermia or azoospermia, consider surgical sperm extraction (onco-TESE), as suggested by the European Association of Urology 6
Use contraception during and for at least 6 months after completion of gonadotoxic treatment, as recommended by the European Association of Urology and the European Society of Human Reproduction and Embryology 6, 7

Intrauterine insemination (IUI) and in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) are options for couples unable to achieve natural pregnancy, as suggested by the American Urological Association 2
IVF treatment typically allows for a 37% live delivery rate per initiated cycle, with results closely related to female age, according to the American Urological Association 2

Male factor conditions may be treatable with medical or surgical therapy, while others may require donor sperm or adoption, as recommended by the American Urological Association 1
Some conditions have health and genetic implications for the patient and potential offspring, according to the American Urological Association 1
Without adequate male evaluation, the female partner may pursue unnecessary costly, time-consuming, and invasive treatment options, as suggested by the American Urological Association 1