Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline Part I
Abstract
PURPOSE: The summary presented herein represents Part I of the two-part series dedicated to the Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. Part I outlines the appropriate evaluation of the male in an infertile couple. Recommendations proceed from obtaining an appropriate history and physical exam (Appendix I), as well as diagnostic testing, where indicated. MATERIALS/METHODS: The Emergency Care Research Institute Evidence-based Practice Center team searched PubMed®, Embase®, and Medline from January, 2000 through May, 2019. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (table 1[Table: see text]). This summary is being simultaneously published in Fertility and Sterility and The Journal of Urology. RESULTS: This Guideline provides updated, evidence-based recommendations regarding evaluation of male infertility as well as the association of male infertility with other important health conditions. The detection of male infertility increases the risk of subsequent development of health problems for men. In addition, specific medical conditions are associated with some causes for male infertility. Evaluation and treatment recommendations are summarized in the associated algorithm (figure[Figure: see text]). CONCLUSION: The presence of male infertility is crucial to the health of patients and its effects must be considered for the welfare of society. This document will undergo updating as the knowledge regarding current treatments and future treatment options continues to expand.
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Babakhanzadeh, E., Hoseininasab, F.-A., Khodadadian, A., Nazari, M., Hajati, R., & Ghafouri‐Fard, S. (2024) · Hereditas · doi:10.1186/s41065-024-00346-8 · Cited by 10 · see citing works
“Despite this, up to 25% of couples are never tested, highlighting the need for a more comprehensive testing [6–8].”
Chromosome defects and male factor infertility
Lamb, D. J. (2025) · Fertility and Sterility · doi:10.1016/j.fertnstert.2025.04.034 · Cited by 10 · see citing works
Self-citationHamoda, T. A.-A. A.-M., Shah, R. S., Mostafa, T., et al. (2025) · The World Journal of Men s Health · doi:10.5534/wjmh.250037 · Cited by 10 · see citing works
Self-citationThe first Australian evidence‐based guidelines on male infertility
Katz, D. J., O’Donnell, L., McLachlan, R. I., et al. (2025) · The Medical Journal of Australia · doi:10.5694/mja2.70080 · Cited by 10 · see citing works
“7,31 As such, it is advisable that clinicians perform a cardiometabolic assessment to identify comorbidities such as obesity, obstructive sleep apnoea, hypertension, and undiagnosed or poorly controlled diabetes.”
Wu, J., Zhu, X., He, J., Ye, C., Pang, B., Zhao, T., & Bao, T. (2022) · Computational and Mathematical Methods in Medicine · doi:10.1155/2022/8438131 · Cited by 10 · see citing works
“Three-dimensional power Doppler ultrasound combined with virtual organ computer-aided analysis (VOCAL) software is more accurate in measuring OV [6].”
MethodRetractedBachelot, G., Lamazière, A., Czernichow, S., Faure, C., Racine, C., Lévy, R., Dupont, C., & Nutrition and Fertility (ALIFERT) Group (2024) · Asian Journal of Andrology · doi:10.4103/aja20247 · Cited by 9 · see citing works
The Evolutionary Route of in vitro Human Spermatogenesis: What is the Next Destination?
Gizer, M., Önen, S., & Korkusuz, P. (2024) · Stem Cell Reviews and Reports · doi:10.1007/s12015-024-10726-2 · Cited by 9 · see citing works
“Infertility occurs in nearly 12–15% of couples and approximately 50% of these cases are due to male factors [20, 21].”
BackgroundA Grounded Theory Approach to Understanding Men Confronting Infertility
Abdullahzadeh, M., Vanaki, Z., Mohammadi, E., & Mohtashami, J. (2024) · Journal of Holistic Nursing · doi:10.1177/08980101241275201 · Cited by 9 · see citing works
“Confronting male infertility can be a complex and challenging process that requires more than just treating a medical condition (Schlegel et al., 2021).”
Çayan, S., Farkouh, A., Agarwal, A. K., et al. (2025) · The World Journal of Men s Health · doi:10.5534/wjmh.250005 · Cited by 9 · see citing works
“SDF testing is currently not endorsed as a routine assessment of sperm by any of the medical organizations, likely because controversies continue to exist regarding its actual clinical utility [17,18].”
Self-citationProtein disulfide isomerase is essential for spermatogenesis in mice
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Kayra, M. V., Şahin, A., Toksöz, S., Serındere, M., Altıntaş, E., Özer, H., & Gül, M. (2024) · Andrology · doi:10.1111/andr.13776 · Cited by 8 · see citing works
Review of potential spermatogenic and aphrodisiac effects of the Ferula genus
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“Infertility treatments vary for several reasons and range from simple drug therapies to laboratory procedures and advanced surgery [4].”
BackgroundExpanding the role of chromosomal microarray analysis in the evaluation of recurrent pregnancy loss
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Anti-sperm Antibody Positivity in Men with Varicocele: A Systematic Review and Meta-Analysis
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Global Andrology Forum Clinical Guidelines on Antioxidant Use in the Treatment of Male Infertility.
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“8 15 The effectiveness and accuracy of AI-powered responses can significantly influence patient decisions and their subsequent interaction with healthcare professionals.”
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Is It Time for Andrology and Endocrinology Professionals in Assisted Reproduction Centers?
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“Due to these data, the ASRM recommended against the massive use of ICSI in couples undergoing to ART without confirmed male factor infertility [35].”
Thomas, J., Arbeláez, M. C. S., Narasimman, M., Weber, A. R., Blachman-Braun, R., White, J. T., Ledesma, B. R., Ghomeshi, A., Jara-Palacios, M. Á., & Ramasamy, R. (2023) · Cureus · doi:10.7759/cureus.41476 · Cited by 7 · see citing works
“Hypogonadism was defined as serum TT <300 ng/dL with clinical symptoms of hypogonadism, including erectile dysfunction, poor libido, and fatigue [14].”
BackgroundChallenges in completing a successful vasectomy reversal
Andino, J. J., Gonzalez, D. C., Dupree, J. M., Marks, S. F., & Ramasamy, R. (2021) · Andrologia · doi:10.1111/and.14066 · Cited by 7 · see citing works
“…Urological Association (AUA) 2020 male infertility guidelines highlight that couples desiring conception after vasectomy have the option of surgical reconstruction, surgical sperm retrieval, or both reconstruction and simultaneous sperm retrieval for cryopreservation (Schlegel et al., 2020).”
BackgroundInfluential
- Authors
- Schlegel, P. N., Sigman, M., Collura, B., De Jonge, C. J., Eisenberg, M. L., Lamb, D. J., Mulhall, J. P., Niederberger, C., Sandlow, J. I., Sokol, R. Z., Spandorfer, S. D., Tanrikut, C., Treadwell, J. R., Oristaglio, J. T., & Zini, A.
- Affiliations
- NewYork–Presbyterian Hospital (US)
- Brown University (US)
- ReSoLVE Center of Excellence (FI)
- University of Minnesota School of Medicine
- Stanford Medicine (US)
- Weill Cornell Medicine (US)
- Memorial Sloan Kettering Cancer Center (US)
- University of Illinois Chicago (US)
- University of Southern California (US)
- Georgetown University (US)
- ECRI Institute (US)
- McGill University (CA)
- ORCID
- Venue
- Journal of Urology
- Published
- 2021-01
- Volume
- 205
- Issue
- 1
- Pages
- 36-43
- ISSN
- 0022-5347 (ISSN-L)
- 1527-3792
- OpenAlex
- W4254230981
- Cited by
- 274
- References
- 0
- Citations by year
- 2026: 53 · 2025: 51 · 2024: 67 · 2023: 43 · 2022: 39 · 2021: 21
- FWCI
- 18.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Urology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Keywords
- male infertility, infertility evaluation, infertility diagnosis, infertility treatment, clinical guidelines, diagnostic testing, history and physical examination
- MeSH terms
- Counseling, Humans, Infertility, Male, Life Style, Male, Scrotum, Societies, Medical, Ultrasonography, United States, Urology, Reproductive Medicine, Evidence-Based Medicine, Semen Analysis
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