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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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“Similarly, the 2021 US-American AUA/ASRM guideline for male infertility advises simultaneous fertility evaluation for both partners before treatment initiation [11].”
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“Among infertile couples, half of the reported cases have been attributed to male factor infertility, necessitating easy and affordable access to treatments tailored to male infertility [3].”
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“…a child, the routine use of MAR in basic fertility examinations is unreasonable; moreover, the American Society of Re-productive Medicine, the American Society of Urology, and the European Society of Urology do not support ASA testing as a fi rst-line test for evaluating male fertility [31, 32].”
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“…American Urological Association and the European Association of Urology guideline strongly recommend CFTR genetic testing for all men with CBAVD [7, 8], such a recommendation is notably absent from the current clinical practice guidelines for male infertility issued by the Japanese Urological…”
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Scrotal Pain Alters Doppler Findings in Varicocele: A Prospective Evaluation
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“Infertility is a major reproductive health problem, affecting approximately 15% of couples of reproductive age worldwide [1].”
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Sperm capacitation ability, as evaluated by Cap-Score™, has little impact on ICSI success
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“Current professional society guidelines support SDF testing in selected clinical scenarios, particularly unexplained infertility, RPL, and ART failure, while not recommending its routine use in the initial evaluation of all infertile men (9, 10).”
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“These findings therefore favor individualized evaluation rather than assuming that azoospermia or oligozoospermia corresponds to a particular hormonal pattern [11].”
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Izah, S. C., Dunga, K. E., Aseibai, E. R., Etim, N. G., Ogwu, M. C., Promise, V. I., Alum, E. U., & Ohanusi, I. N. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1922443
“Very low volume, azoospermia, or severe oligozoospermia can direct speci fi c diagnostic pathways but do not de fi ne masculinity or predict fertility alone (8; 4).”
InfluentialXiao, H., Yilang, D., Hu, Y., et al. (2026) · Andrology · doi:10.1111/andr.70412
Reversibility of Male Factor Infertility: Mechanisms and Evidence from the Literature
Vignera, S. L., Calogero, A. E., Cannarella, R., Crafa, A., Barbagallo, F., & Condorelli, R. A. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27208968
“Recent comprehensive guidelines from the Japanese Urological Association and other international bodies emphasize the multifactorial nature of male infertility and the importance of systematic evaluation to identify reversible causes [2,7].”
Metadata
- 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 › Medicine › Urology › 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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