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Practical approaches to the diagnosis and management of male infertility

Nature Clinical Practice Urology volume 2, pages 226–238 (2005)Cite this article

Abstract

Male infertility affects 10% of couples of reproductive age worldwide, and is treatable in many cases. In addition to well-established etiologies, genetic causes of male infertility are now diagnosed more commonly, as our knowledge of genomic medicine advances. Using principles of evidence-based medicine, this review outlines diagnostic and treatment algorithms that guide clinical management. In order of importance, randomized controlled clinical trials, basic scientific studies, meta-analyses, case-controlled cohort studies, best-practice policy recommendations and reviews from peer-reviewed literature were incorporated into algorithms that provide organized and timely guidelines to the current management of male infertility. The strength of the evidence for treatment recommendations is also classified when appropriate.

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Figure 1
Figure 2: Algorithm for evaluation of absent or low ejaculate volume.
Figure 3: Algorithm for evaluation of semen-analysis abnormalities.
Figure 4: Algorithm for evaluation of azoospermia or no sperm in the ejaculate.
Figure 5: General algorithm for treatment of male infertility.
Figure 6: Level of assisted reproduction needed for conception based on semen quality determined by total motile count (volume × concentration × motile fraction).

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Author information

Authors and Affiliations

  1. associate professor in the departments of Urology, Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco

    Paul J Turek

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  1. Paul J Turek
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Corresponding author

Correspondence to Paul J Turek.

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The author declares no competing financial interests.

Glossary

ORCHIDOPEXY

Surgery to place an undescended testis into a more normal position in the scrotum or to untwist a testis that has undergone torsion

CHORDEE

Congential curvature of the penis

VARICOCELE

Dilated plexus of veins draining the testis

IN VITRO FERTILIZATION (IVF)

A method of assisted reproduction in which female eggs are fertilized in vitro after controlled stimulation of egg development with gonadotropins, with subsequent transfer of embryos to the uterus for pregnancy

HYPOANDROGENISM

A low-testosterone state

INTRAUTERINE INSEMINATION (IUI)

The process whereby ejaculated sperm are washed, concentrated and then carefully placed with a syringe past the female cervix and into the uterus to facilitate pregnancy

Y MICRODELETIONS

Regions on the long arm of the Y chromosome that harbor genes important for normal sperm production. These regions have been grouped as azoospermia factor regions AZFa, AZFb and AZFc

INTRACYTOPLASMIC SPERM INJECTION (ICSI)

A micromanipulation strategy used in assisted reproduction in which a single spermatozoa is injected past the egg shell (zona pellucida) directly into the cytoplasm of the egg to facilitate fertilization

NONOBSTRUCTIVE AZOOSPERMIA

No sperm in the ejaculate due to testis failure and atrophy

OBSTRUCTIVE AZOOSPERMIA

No sperm in the ejaculate due to congenital or acquired blockage in the excurrent ductal system of the male reproductive tract

VASOVASOSTOMY

Directly suturing two ends of the vas deferens together using microsurgery to bypass congenital or acquired blockages and facilitate pregnancy

FNA MAPPING

Fine-needle aspiration of the testis performed systemically to acquire information about sperm presence and location for future sperm retrieval

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Turek, P. Practical approaches to the diagnosis and management of male infertility. Nat Rev Urol 2, 226–238 (2005). https://doi.org/10.1038/ncpuro0166

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