Skip to main content
WoMWeb of Medicine
SearchGraphHistory
Urology›Condition·Updated Jul 11, 2026·v1

Male Infertility

Male infertility affects 7-15% of couples and is primarily caused by varicocele, obstructive azoospermia, genetic abnormalities, and idiopathic spermatogenic failure. Evaluation is systematic: history, physical, semen analysis, hormonal profile, genetic testing (YCM ≤1M/mL, karyotype, CFTR), and imaging. Management is cause-specific: microsurgical varicocelectomy, vasovasostomy/epididymovasostomy for obstruction, mTESE for NOA, letrozole for idiopathic oligoasthenoteratospermia, and gonadotropins for hypogonadotropic hypogonadism. ART (IVF, ICSI) is reserved for refractory cases, with evidence that routine ICSI offers no advantage over IVF for non-severe male factor. Male infertility is a marker of increased long-term mortality, underscoring the need for comprehensive health evaluation.

High Evidence191 references·9,837 words·40 min read·v1
male infertilityvaricoceleazoospermiaoligozoospermiaspermatogenic failurereproductive urologysemen analysisY-chromosome microdeletionKlinefelter syndromeCFTRmTESEICSIletrozole

Quick Reference

RxDrug of choiceLetrozole 2.5 mg daily for idiopathic oligoasthenoteratospermia - achieves WHO sperm concentration category upgrade in 14.3% of men; NNT 11.
AltAlternativesSelenium 200 μg + NAC 600 mg daily for 26 weeks; hCG 1,500-2,000 IU SC 2-3 times/week for hypogonadotropic hypogonadism; clomiphene citrate 50 mg daily/every other day (off-label) for low testosterone.
⊘AvoidExogenous testosterone (suppresses pituitary gonadotropins and impairs spermatogenesis); non-dihydropyridine CCBs; routine ICSI for non-severe male factor infertility.
DxTest of choiceSemen analysis (WHO 2010) - two samples ≥2 weeks apart; lower reference limits: sperm concentration ≥15 ×10⁶/mL, total motility ≥40%, normal morphology ≥4%.
ScKey scoreAPHRODITE hormonal classification system - stratifies patients into 5 categories based on FSH, total testosterone, and semen parameters; used to guide hormonal therapy in clinical trials.
→When to referAbnormal semen analysis (especially azoospermia or severe oligozoospermia); infertility >12 months; clinical varicocele; suspected genetic abnormality; need for sperm retrieval or ART.
Male infertility is a treatable condition in most cases. Varicocelectomy, surgical reconstruction for obstruction, and gonadotropin therapy for hypogonadotropic hypogonadism are highly effective. Genetic testing (YCM, karyotype, CFTR) is essential for severe cases. Male infertility also signals increased long-term mortality, making the fertility evaluation a health screening opportunity.
Male infertility, defined as a disease of the male reproductive system causing inability to conceive after 12 months of unprotected intercourse, contributes to approximately 50% of infertility cases. The cause is most often a correctable condition, varicocele, obstructive azoospermia, or hypogonadotropic hypogonadism, with genetic and idiopathic forms accounting for the remainder. Evaluation begins with a semen analysis and proceeds through hormonal profiling, genetic testing, and imaging. Management is cause-specific: microsurgical varicocelectomy, surgical reconstruction for obstruction, gonadotropins for hypogonadotropic hypogonadism, and assisted reproductive technologies for refractory cases. Male infertility also signals elevated long-term mortality risk, making the fertility evaluation an opportunity for broader health screening.

Overview and Recommendations

Background

  • •Male infertility is a disease of the male reproductive system defined by the inability to conceive after 12 months of unprotected intercourse, affecting approximately 7-15% of couples and contributing to roughly 50% of all infertility cases. The condition is not benign: men with a diagnosis of infertility have a high burden of comorbidities, 3.4% have cancer, diabetes, 8.8% depression, and a 42% higher all-cause mortality (HR 1.42) compared with fertile counterparts, with azoospermia doubling that risk (HR 2.01).
  • •The most common correctable cause is varicocele, which accounts for 30-40% of male infertility and operates through heat stress, oxidative injury, and apoptosis. Microsurgical varicocelectomy, the gold-standard treatment, improves spontaneous pregnancy rates from 14% to 33% (NNT 5.3) and restores normal semen parameters in 60-80% of men.
  • •Obstructive azoospermia (OA) and nonobstructive azoospermia (NOA) represent the two major categories of azoospermia. OA, caused by physical blockage (e.g., congenital bilateral absence of vas deferens, prior vasectomy, infection), accounts for ~29% of azoospermia and is typically correctable with microsurgical reconstruction. NOA, due to primary testicular failure, accounts for ~71% and is managed with sperm retrieval (mTESE) and ICSI.
  • •Genetic etiologies are increasingly recognized: Y-chromosome microdeletions (especially AZFc) are found in 5% of men with severe oligozoospermia (sperm concentration ≤1 million/mL), and Klinefelter syndrome (47,XXY) is the most common chromosomal abnormality, present in 5-10% of azoospermic men. CFTR mutations cause congenital bilateral absence of vas deferens and are identified in 75% of men with isolated CAVD.
  • •The paradigm for management has shifted from empirical hormonal therapy to evidence-based, cause-specific interventions. Landmark trials, including the randomized comparison of varicocelectomy versus observation (Abdel‑Meguid 2010) and the mTESE versus TESA trial (Jensen 2022), have established microsurgical repair and microdissection TESE as the standards of care. The role of ART is being refined: routine ICSI for non-severe male factor does not improve live birth over conventional IVF (Wang 2024).

Evaluation

  • •Suspect male infertility in any couple unable to conceive after 12 months of regular unprotected intercourse. A thorough history should include duration of infertility, prior fertility, coital frequency, childhood disorders (cryptorchidism, hernia repair), systemic illnesses (diabetes, cystic fibrosis), medications (anabolic steroids, sulfasalazine, testosterone, SSRIs), and lifestyle factors (cigarette smoking, cannabis use, excessive heat exposure).
  • •Ask about symptoms of underlying conditions: testicular pain or swelling (varicocele, infection), chronic respiratory symptoms (sinusitis, wet cough) suggesting primary ciliary dyskinesia or cystic fibrosis, and sexual dysfunction (erectile dysfunction, ejaculatory disorders, low libido) that may both contribute to and result from infertility.
  • •Examine for testicular volume using an orchidometer or ultrasound; volume <12 mL is associated with impaired spermatogenesis. Palpate for testicular inhomogeneity, cryptorchidism, testicular microlithiasis, and varicocele (graded in standing position with Valsalva). Bilateral absence of the vas deferens suggests CFTR mutation and warrants CF genetic testing. Signs of hypogonadism, reduced body hair, gynecomastia, small phallus, should be noted.
  • •Order two semen analyses at least 2 weeks apart after 2-7 days of abstinence, performed according to WHO 2010 methods. Lower reference limits: semen volume ≥1.5 mL, sperm concentration ≥15 ×10⁶/mL, total motility ≥40%, progressive motility ≥32%, normal morphology ≥4% (strict criteria). A single abnormal result requires confirmation.
  • •Order a hormonal profile (FSH, LH, total testosterone) if sperm concentration <10 ×10⁶/mL or if clinical features suggest endocrinopathy. An elevated FSH (>12.1 IU/L) has a positive predictive value >0.7 for subfertility. Inhibin B, produced by Sertoli cells, correlates with spermatogenesis and can be used in predictive nomograms. Prolactin and estradiol are reserved for men with suspected pituitary pathology or gynecomastia.
  • •Perform scrotal ultrasound as the first-line imaging for all infertile men with abnormal semen analysis or abnormal physical exam. It measures testicular volume, detects subclinical varicoceles (with Doppler), and identifies incidental small testicular masses (hypoechoic lesions <10 mm), which occur in 2.9% of infertile men and can be safely surveilled if <5 mm and avascular.
  • •Order transrectal ultrasound when ejaculate volume is low (<1.5 mL) with normal testicular size, to rule out distal obstruction (e.g., ejaculatory duct cysts, seminal vesicle dilation). MRI is reserved for complex cases such as suspected renal agenesis with ipsilateral seminal vesicle pathology.
  • •Order genetic testing in men with azoospermia or severe oligozoospermia (sperm concentration <5 ×10⁶/mL). The threshold for Y-chromosome microdeletion testing should be ≤1 ×10⁶ sperm/mL (sensitivity 100%, specificity 31%). Karyotype analysis is indicated in men with azoospermia or severe oligozoospermia, especially if FSH is elevated. CFTR mutation testing is indicated in men with congenital bilateral absence of the vas deferens or unexplained obstructive azoospermia with low ejaculate volume.
  • •Diagnostic criteria for azoospermia are based on the absence of sperm in the ejaculate after centrifugation. Classification into obstructive (OA) vs. nonobstructive (NOA) is guided by testicular volume, FSH, and genetic testing. OA: normal testicular volume, palpable vas often absent, normal FSH. NOA: small testes, elevated FSH, possible genetic abnormality.
  • •Also consider specialized testing in selected cases: sperm DNA fragmentation (TUNEL) may be useful in idiopathic infertility or recurrent pregnancy loss, with a cutoff of 19.25% providing 100% specificity in one study, but routine use is not recommended due to lack of standardization. Seminal ROS levels can be measured but are not widely available.
  • •The evaluation should be systematic: Step 1 - history and physical; Step 2 - two semen analyses; Step 3 - hormonal profile; Step 4 - genetic testing if indicated; Step 5 - imaging (scrotal ultrasound, TRUS); Step 6 - specialized testing in selected cases. Do not label a man as having NOA without a hormonal profile and genetic screen.

Management

  • •Initiate treatment for a clinical varicocele (palpable grade II-III) with abnormal semen parameters and infertility ≥1 year. Perform microsurgical subinguinal varicocelectomy: it improves sperm concentration by a mean of 12.32 million/mL and total motility by 10.86%, and yields a spontaneous pregnancy rate of 32.9% at 12 months (NNT 5.3). Recurrence rate is 2.6% and hydrocele formation 0% with microsurgery.
  • •For obstructive azoospermia due to prior vasectomy, perform vasovasostomy (two-layer microsurgical anastomosis) - patency rates exceed 90% when performed within 10 years of vasectomy. For epididymal obstruction, perform epididymovasostomy; a novel one-layer technique achieves patency in 67% of patients. If sperm are absent from the testicular vas fluid, perform epididymovasostomy rather than vasovasostomy.
  • •For nonobstructive azoospermia (NOA), perform microdissection testicular sperm extraction (mTESE) - sperm retrieval rate is 43% versus 22% with TESA (NNT 4.8). Note that mTESE carries a 6% risk of surgical complications requiring intervention. Salvage mTESE after failed TESA raises the combined retrieval rate to 29%. TESA is simpler and safer but less effective.
  • •For hypogonadotropic hypogonadism, initiate gonadotropin therapy: inject human chorionic gonadotropin (hCG) 1,500-2,000 IU subcutaneously 2-3 times weekly, then add recombinant FSH (75-150 IU) 3 times weekly after 6 months if sperm do not appear. Monitor testosterone and semen parameters every 3 months; treatment is effective in the majority of men.
  • •For idiopathic oligoasthenoteratospermia, consider a trial of letrozole 2.5 mg daily plus vitamins C and E for 3 months: it achieves a WHO sperm concentration category upgrade in 14.3% of men (risk difference 9.2%; NNT 11). Letrozole increases gonadotropins and testosterone while decreasing estradiol; monitor for decreased libido (12.2% incidence).
  • •For idiopathic infertility with oxidative stress, supplement with selenium 200 μg daily plus N-acetyl-cysteine (NAC) 600 mg daily for 26 weeks - this improves sperm concentration, motility, and morphology. Antioxidant therapy (L-carnitine, acetyl-L-carnitine, vitamins, and other nutrients) also increases sperm concentration and motility, with greater benefit in men ≤35 years and normal BMI.
  • •For couples with non-severe male factor infertility, use conventional IVF rather than routine ICSI - ICSI does not improve live birth rate (33.8% vs 36.6%; adjusted RR 0.92). Reserve ICSI for prior poor fertilization or severe male factor.
  • •For couples with severe male infertility undergoing ICSI, consider preimplantation genetic testing for aneuploidy (PGT-A) - it does not improve live birth after first transfer (48.4% vs 46.2%) but significantly reduces pregnancy loss (5.8% vs 19.1%; NNT 7.5).
  • •Manage select cases with active surveillance: incidental small testicular masses (<10 mm) on ultrasound can be safely followed with serial imaging (mean growth rate -0.01 mm/year). Leydig cell tumors in compliant patients can be managed with active surveillance rather than immediate surgery.
  • •Avoid routine use of empiric hormonal therapy (e.g., clomiphene, anastrozole) in men with nonobstructive azoospermia and normal FSH - it does not improve outcomes. Avoid varicocelectomy for subclinical varicocele (detected only by ultrasound) or normal semen parameters. Avoid non-dihydropyridine CCBs (diltiazem, verapamil) - they may exacerbate any underlying condition.
  • •Monitor after treatment: repeat semen analysis every 3 months until pregnancy is achieved or a plateau is reached. For hormonal therapy, check testosterone, LH, FSH at 3-month intervals to adjust dosing. If no improvement after 6-12 months, escalate to ART.
  • •Refer to a reproductive urologist if semen analysis is abnormal, especially if azoospermia or severe oligozoospermia is present, or if the couple has been trying for >12 months. Also refer for genetic counseling if a genetic abnormality is identified.
  • •Discharge criteria: Natural conception occurs; or the couple achieves pregnancy via IUI, IVF, or ICSI; or the patient elects to use donor sperm or pursue adoption. If no pregnancy after 6-12 months of optimal treatment, reassess and consider alternative strategies.

Board Review — High Yield

  • •Varicocele - Most common correctable cause of male infertility; microsurgical subinguinal varicocelectomy is gold standard (recurrence 2.6%, hydrocele 0%).
  • •Nonobstructive azoospermia (NOA) - Primary testicular failure; mTESE has higher sperm retrieval rate than TESA (43% vs 22%); NNT 4.8.
  • •Obstructive azoospermia - Normal FSH and testicular volume; treat with vasovasostomy or epididymovasostomy - patency >90% for vasovasostomy within 10 years.
  • •Y-chromosome microdeletion (AZFc) - Screen only if sperm concentration ≤1 million/mL; 99% of deletions occur below this threshold.
  • •Klinefelter syndrome (47,XXY) - Most common chromosomal abnormality in infertile men (5-10% of azoospermia); elevated FSH, small testes.
  • •CFTR mutations - Cause congenital bilateral absence of vas deferens (CBAVD); test in men with azoospermia, low volume, absent vas.
  • •Letrozole for spermatogenic failure - 2.5 mg daily for 3 months upgrades WHO sperm concentration category in 14.3% of men (NNT 11).
  • •Routine ICSI - Does not improve live birth over conventional IVF for non-severe male factor (adjusted RR 0.92).
  • •PGT-A - Reduces pregnancy loss (5.8% vs 19.1%) but does not improve live birth in severe male infertility.
  • •Mortality risk - Infertile men have 42% higher all-cause mortality (HR 1.42); azoospermia carries HR 2.01.

Deep Dive — Evidence Details

References

  1. [1]

    Minhas S, Boeri L, Capogrosso P et al.. “European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 Update on Male Infertility.” European urology (2025). PMID: 40118737 ↗

    L1GUIDELINECited in: Definition, Classification & Nomenclature, History and Evolution of Treatment
  2. [2]

    Gudeman SR, Townsend B, Fischer K et al.. “Etiology of azoospermia in a military population.” The Journal of urology (2014). PMID: 25444960 ↗

    L4OTHERCited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors, Endoscopic & Procedural Technique Considerations
  3. [3]

    Schmid FA, Held U, Eberli D et al.. “Erectile dysfunction and penile rehabilitation after pelvic fracture: a systematic review and meta-analysis.” BMJ open (2021). PMID: 34049910 ↗

    L1SR_OBSCited in: Definition, Classification & Nomenclature
  4. [4]

    Duffy JMN, Bhattacharya S, Bhattacharya S et al.. “Standardizing definitions and reporting guidelines for the infertility core outcome set: an international consensus development study†  ‡.” Human reproduction (Oxford, England) (2020). PMID: 33252643 ↗

    L5SR_OBSCited in: Definition, Classification & Nomenclature
  5. [5]

    Fantus RJ, Alter K, Chang C et al.. “Characterizing the Epidemiology and Provider Landscape of Male Infertility Care in the United States.” Urology (2021). PMID: 33891924 ↗

    L2OTHERCited in: Definition, Classification & Nomenclature
  6. [6]

    Esteves SC, Humaidan P, Ubaldi FM et al.. “APHRODITE criteria: addressing male patients with hypogonadism and/or infertility owing to altered idiopathic testicular function.” Reproductive biomedicine online (2023). PMID: 38367592 ↗

    L5OTHERCited in: Definition, Classification & Nomenclature
  7. [7]

    Esteves SC, Humaidan P. “Towards infertility care on equal terms: a prime time for male infertility.” Reproductive biomedicine online (2023). PMID: 37202319 ↗

    L5OTHERCited in: Definition, Classification & Nomenclature
  8. [8]

    Carbone A, Palleschi G, Tomiselli G et al.. “Renal aplastic dysplasia and ipsilateral ectopic ureter obstructing the seminal via: a possible cause of male infertility.” European urology (2007). PMID: 17321038 ↗

    L4CASE_REPORTCited in: Pathophysiology & Mechanism, Diagnosis & Workup, History and Evolution of Treatment
  9. [9]

    Lundy SD, Sangwan N, Parekh NV et al.. “Functional and Taxonomic Dysbiosis of the Gut, Urine, and Semen Microbiomes in Male Infertility.” European urology (2021). PMID: 33573862 ↗

    L3OTHERCited in: Pathophysiology & Mechanism, Diagnosis & Workup, History and Evolution of Treatment
  10. [10]

    Tilki D, Kilic E, Tauber R et al.. “The complex structure of the smooth muscle layer of spermatic veins and its potential role in the development of varicocele testis.” European urology (2006). PMID: 17113704 ↗

    L3OTHERCited in: Pathophysiology & Mechanism
  11. [11]

    Kumar R, Gautam G, Gupta NP. “Drug therapy for idiopathic male infertility: rationale versus evidence.” The Journal of urology (2006). PMID: 16952617 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Diagnosis & Workup, History and Evolution of Treatment, Prognosis & Natural History
  12. [12]

    Zalata AA, Mokhtar N, Atwa A et al.. “The Role of Protamine 2 Gene Expression and Caspase 9 Activity in Male Infertility.” The Journal of urology (2015). PMID: 26392304 ↗

    L5OTHERCited in: Pathophysiology & Mechanism
  13. [13]

    Lee R, Goldstein M, Ullery BW et al.. “Value of serum antisperm antibodies in diagnosing obstructive azoospermia.” The Journal of urology (2008). PMID: 19013620 ↗

    L3OTHERCited in: Pathophysiology & Mechanism, History and Evolution of Treatment
  14. [14]

    Shiraishi K, Shimabukuro T, Naito K. “Effects of hemodialysis on testicular volume and oxidative stress in humans.” The Journal of urology (2008). PMID: 18554652 ↗

    L3OTHERCited in: Pathophysiology & Mechanism
  15. [15]

    Georgiadis AP, Kishore A, Zorrilla M et al.. “High quality RNA in semen and sperm: isolation, analysis and potential application in clinical testing.” The Journal of urology (2014). PMID: 25088949 ↗

    L4OTHERCited in: Pathophysiology & Mechanism, Prognosis & Natural History
  16. [16]

    Johnson M, Raheem A, De Luca F et al.. “An analysis of the frequency of Y-chromosome microdeletions and the determination of a threshold sperm concentration for genetic testing in infertile men.” BJU international (2018). PMID: 30113756 ↗

    L3OTHERCited in: Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors, Diagnosis & Workup
  17. [17]

    Shteinberg M, Haq IJ, Polineni D et al.. “Cystic fibrosis.” Lancet (London, England) (2021). PMID: 34090606 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Diagnosis & Workup, Prognosis & Natural History
  18. [18]

    Melhem SJ, Melhem M, Haddad R et al.. “Pharmacologic and Nutritional Therapies in Idiopathic Male Infertility: A Systematic Review and Meta-Analysis.” Andrology (2026). PMID: 42206761 ↗

    L1SR_OBSCited in: Pathophysiology & Mechanism, Special Populations & Pregnancy
  19. [19]

    Qinyu Z, Jitao S, Yang X et al.. “Chronic prostatitis and male infertility: association mechanism and research progress.” World journal of urology (2025). PMID: 41055724 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Clinical Presentation, History and Evolution of Treatment
  20. [20]

    Cardoso JP, Cocuzza M, Elterman D. “Optimizing male fertility: oxidative stress and the use of antioxidants.” World journal of urology (2019). PMID: 30719570 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Special Populations & Pregnancy
  21. [21]

    Shen S, Wang J, Liang J et al.. “Comparative proteomic study between human normal motility sperm and idiopathic asthenozoospermia.” World journal of urology (2013). PMID: 23455884 ↗

    L3OTHERCited in: Pathophysiology & Mechanism, Diagnosis & Workup, Endoscopic & Procedural Technique Considerations
  22. [22]

    Shiraishi K, Takihara H, Matsuyama H. “Elevated scrotal temperature, but not varicocele grade, reflects testicular oxidative stress-mediated apoptosis.” World journal of urology (2009). PMID: 19655149 ↗

    L4OTHERCited in: Pathophysiology & Mechanism, Diagnosis & Workup
  23. [23]

    Agarwal A, Sharma R, Durairajanayagam D et al.. “Differential proteomic profiling of spermatozoal proteins of infertile men with unilateral or bilateral varicocele.” Urology (2015). PMID: 25733269 ↗

    L2OTHERCited in: Pathophysiology & Mechanism, Prognosis & Natural History
  24. [24]

    Desai N, Sabanegh E, Kim T et al.. “Free radical theory of aging: implications in male infertility.” Urology (2009). PMID: 19616285 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, History and Evolution of Treatment
  25. [25]

    Kojima Y, Mizuno K, Kohri K et al.. “Advances in molecular genetics of cryptorchidism.” Urology (2009). PMID: 19589567 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors, Endoscopic & Procedural Technique Considerations
  26. [26]

    Nelson B, Smith H, Smith RP et al.. “Emerging Diagnostics Tools for Severe Male Infertility and Non-Obstructive Azoospermia.” Urology (2026). PMID: 41724393 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism
  27. [27]

    Sharma B, Shah R, Shankarayan R et al.. “PARP Gene Variants and Male Infertility: A Genetic Prescriptive From a North-Indian Cohort.” Urology (2026). PMID: 41865772 ↗

    L3OTHERCited in: Pathophysiology & Mechanism
  28. [28]

    Cocuzza M, Athayde KS, Agarwal A et al.. “Age-related increase of reactive oxygen species in neat semen in healthy fertile men.” Urology (2008). PMID: 18342194 ↗

    L2OTHERCited in: Pathophysiology & Mechanism
  29. [29]

    Li L, Li H, Wang Q et al.. “Sperm 28S ribosomal RNA fragments as a potential biomarker for embryo quality in in vitro fertilization.” Journal of assisted reproduction and genetics (2026). PMID: 42430032 ↗

    L3OTHERCited in: Pathophysiology & Mechanism
  30. [30]

    Onemli D, Sati L. “Bioinformatics and multi-omics approaches in male infertility: implications for diagnosis and assisted reproduction.” Journal of assisted reproduction and genetics (2026). PMID: 42426441 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, History and Evolution of Treatment
  31. [31]

    Cao H, Liu X, Nie H et al.. “Alterations in the protein lactylation landscape of sperm from patients with varicocele-associated asthenozoospermia.” Frontiers in endocrinology (2026). PMID: 42416903 ↗

    L4OTHERCited in: Pathophysiology & Mechanism, Diagnosis & Workup
  32. [32]

    Yu H, Zhang N, Liu X et al.. “PRRC2A deficiency disrupts m6A-dependent RNA processing and meiosis in human spermatogenesis.” Molecular human reproduction (2026). PMID: 42411761 ↗

    L4OTHERCited in: Pathophysiology & Mechanism
  33. [33]

    Bowman JD, Silva N, Schüftan E et al.. “Pervasive relaxed selection on spermatogenesis genes coincident with the evolution of polygyny in gorillas.” eLife (2026). PMID: 42411604 ↗

    L5OTHERCited in: Pathophysiology & Mechanism
  34. [34]

    Al-Said S, Al-Naimi A, Al-Ansari A et al.. “Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches.” The Journal of urology (2008). PMID: 18499176 ↗

    L1RCTCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup, Long-term & Definitive Management: Medical vs Endourologic/Surgical, History and Evolution of Treatment, Endoscopic & Procedural Technique Considerations, Special Populations & Pregnancy
  35. [35]

    Ding H, Tian J, Du W et al.. “Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta-analysis of randomized controlled trials.” BJU international (2012). PMID: 22642226 ↗

    L1SR_MA_RCTCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup, Special Populations & Pregnancy
  36. [36]

    Sharma R, Harlev A, Agarwal A et al.. “Cigarette Smoking and Semen Quality: A New Meta-analysis Examining the Effect of the 2010 World Health Organization Laboratory Methods for the Examination of Human Semen.” European urology (2016). PMID: 27113031 ↗

    L2SR_OBSCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup
  37. [37]

    Kohn TP, Kohn JR, Owen RC et al.. “The Prevalence of Y-chromosome Microdeletions in Oligozoospermic Men: A Systematic Review and Meta-analysis of European and North American Studies.” European urology (2019). PMID: 31400948 ↗

    L4SR_OBSCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup, Prevention, Screening & Surveillance
  38. [38]

    Bieniek JM, Juvet T, Margolis M et al.. “Prevalence and Management of Incidental Small Testicular Masses Discovered on Ultrasonographic Evaluation of Male Infertility.” The Journal of urology (2017). PMID: 28789946 ↗

    L3OTHERCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup, History and Evolution of Treatment, Prevention, Screening & Surveillance
  39. [39]

    Yatsenko AN, Yatsenko SA, Weedin JW et al.. “Comprehensive 5-year study of cytogenetic aberrations in 668 infertile men.” The Journal of urology (2010). PMID: 20172548 ↗

    L4OTHERCited in: Epidemiology, Etiology & Risk Factors
  40. [40]

    de Souza GL, Hallak J. “Anabolic steroids and male infertility: a comprehensive review.” BJU international (2011). PMID: 21682835 ↗

    L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Special Populations & Pregnancy
  41. [41]

    Xiao H, Ding YL, Yang P et al.. “A nomogram of testicular volume, follicle-stimulating hormone, and inhibin B for predicting live birth after varicocelectomy.” BJU international (2026). PMID: 41744044 ↗

    L2OTHERCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup, Severity, Staging & Risk Stratification, Prognosis & Natural History, Special Populations & Pregnancy
  42. [42]

    Yuan P, Liang Z, Zhou L et al.. “Spectrum and Classification of CFTR and ADGRG2 Variants in Chinese Patients With Isolated CAVD: A Large Cohort Study and Risk Assessment of CFTR Variant Carriage in Couples.” Human mutation (2026). PMID: 42199298 ↗

    L4COHORTCited in: Epidemiology, Etiology & Risk Factors
  43. [43]

    Huang C, Long X, Jing S et al.. “Ureaplasma urealyticum and Mycoplasma hominis infections and semen quality in 19,098 infertile men in China.” World journal of urology (2015). PMID: 26537883 ↗

    L3OTHERCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup
  44. [44]

    Li Q, Qiao D, Song NH et al.. “Association of DAZ1/DAZ2 deletion with spermatogenic impairment and male infertility in the South Chinese population.” World journal of urology (2013). PMID: 23512232 ↗

    L3OTHERCited in: Epidemiology, Etiology & Risk Factors
  45. [45]

    Patel SR, Sigman M. “Prevalence of testicular size discrepancy in infertile men with and without varicoceles.” Urology (2009). PMID: 19969336 ↗

    L4OTHERCited in: Epidemiology, Etiology & Risk Factors
  46. [46]

    Deng Y, Zhang W, Su D et al.. “Some single nucleotide polymorphisms of MSY2 gene might contribute to susceptibility to spermatogenic impairment in idiopathic infertile men.” Urology (2008). PMID: 18372033 ↗

    L3OTHERCited in: Epidemiology, Etiology & Risk Factors
  47. [47]

    Alrabeeah K, Yafi F, Flageole C et al.. “Testicular sperm aspiration for nonazoospermic men: sperm retrieval and intracytoplasmic sperm injection outcomes.” Urology (2014). PMID: 25432825 ↗

    L4OTHERCited in: Epidemiology, Etiology & Risk Factors, Prognosis & Natural History
  48. [48]

    Rajan T, Revnew A, Lee D et al.. “Urologist Participation in Medicare Are Impacted by Subspecialty, Tenure, and Practice Type: A Retrospective Analysis of Opt-out Affidavits.” Urology (2025). PMID: 41106520 ↗

    L4OTHERCited in: Epidemiology, Etiology & Risk Factors
  49. [49]

    Margiana R, Abdulrahman Najim M, Tariq Abed A et al.. “Air pollution and male infertility: A meta-umbrella study of evidence on semen quality.” Medicine (2026). PMID: 41790664 ↗

    L2SR_OBSCited in: Epidemiology, Etiology & Risk Factors
  50. [50]

    Madhavanprabhakaran G, Al Farsi A, Francis F et al.. “Etiology and Risk Factors of Infertility Among Omani Couples: A Retrospective Study from a Tertiary Referral Center.” Oman medical journal (2026). PMID: 42136888 ↗

    L4COHORTCited in: Epidemiology, Etiology & Risk Factors
  51. [51]

    Patel SKJK, Mahapatra PC, Sinha S et al.. “The Potential Role of Chromosomal Polymorphic Variations Attributed to Male Infertility: A Retrospective Cohort Study.” Journal of reproduction & infertility (2025). PMID: 42038774 ↗

    L3COHORTCited in: Epidemiology, Etiology & Risk Factors
  52. [52]

    Zhang J, He W. “Diagnostic accuracy of sperm DNA fragmentation index in male infertility: A cohort study.” Journal of medical biochemistry (2026). PMID: 41799707 ↗

    L3COHORTCited in: Epidemiology, Etiology & Risk Factors
  53. [53]

    Grande G, Graziani A, Caretta N et al.. “Pathophysiology-Based Classification of Male Infertility: Evidence from an 800-patient Prospective Cohort.” The Journal of clinical endocrinology and metabolism (2026). PMID: 42400272 ↗

    L2OTHERCited in: Epidemiology, Etiology & Risk Factors
  54. [54]

    Shin D, Sansone A, Krishnappa P et al.. “Sexual dysfunctions in male patients with infertility: recommendations from the Fifth International Consultation for Sexual Medicine (ICSM 2024).” Sexual medicine reviews (2026). PMID: 41504423 ↗

    L5GUIDELINECited in: Clinical Presentation
  55. [55]

    Lotti F, Studniarek M, Balasa C et al.. “The role of the radiologist in the evaluation of male infertility: recommendations of the European Society of Urogenital Radiology-Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for scrotal imaging.” European radiology (2024). PMID: 39083089 ↗

    L5GUIDELINECited in: Clinical Presentation
  56. [56]

    Dieckmann KP, Linke J, Pichlmeier U et al.. “Spermatogenesis in the contralateral testis of patients with testicular germ cell cancer: histological evaluation of testicular biopsies and a comparison with healthy males.” BJU international (2007). PMID: 17244285 ↗

    L3OTHERCited in: Clinical Presentation, Diagnosis & Workup, Prognosis & Natural History
  57. [57]

    Tsujimura A, Iijima M, Umemoto Y et al.. “Summary of the Clinical Practice Guidelines for Male Infertility by the Japanese Urological Association With the Support of the Japan Society for Reproductive Medicine.” International journal of urology : official journal of the Japanese Urological Association (2025). PMID: 40459122 ↗

    L1GUIDELINECited in: Clinical Presentation
  58. [58]

    Tian Z, Zhang C, Liao X et al.. “Trends in acupuncture for infertility: a scoping review with bibliometric and visual analysis.” Frontiers in endocrinology (2024). PMID: 38894745 ↗

    L5SR_OBSCited in: Clinical Presentation
  59. [59]

    Tanrikut C, Schlegel PN. “Antidepressant-associated changes in semen parameters.” Urology (2007). PMID: 17270655 ↗

    L4CASE_REPORTCited in: Clinical Presentation, Diagnosis & Workup
  60. [60]

    Markulić J, Fuller M. “Diagnostic yield of cystic fibrosis from a South Australian monocentric cohort: a retrospective study.” BMJ open (2025). PMID: 39855646 ↗

    L3COHORTCited in: Clinical Presentation, Prevention, Screening & Surveillance
  61. [61]

    Weidner W, Pilatz A, Diemer T et al.. “Male urogenital infections: impact of infection and inflammation on ejaculate parameters.” World journal of urology (2013). PMID: 23857546 ↗

    L5REVIEW_NARRATIVECited in: Clinical Presentation, Diagnosis & Workup, History and Evolution of Treatment
  62. [62]

    Awad F, Abukhaizaran R, Al Jabi S et al.. “Expanding the phenotypic spectrum associated with CFAP43 mutations: a case report of familial male infertility with respiratory manifestations.” Frontiers in reproductive health (2025). PMID: 41341611 ↗

    L4CASE_REPORTCited in: Clinical Presentation
  63. [63]

    Jungwirth A, Giwercman A, Tournaye H et al.. “European Association of Urology guidelines on Male Infertility: the 2012 update.” European urology (2012). PMID: 22591628 ↗

    L1GUIDELINECited in: Diagnosis & Workup, History and Evolution of Treatment
  64. [64]

    Schlegel PN, Sigman M, Collura B et al.. “Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline Part I.” The Journal of urology (2020). PMID: 33295257 ↗

    L1GUIDELINECited in: Diagnosis & Workup, Acute Management & Decompression, History and Evolution of Treatment
  65. [65]

    Schlegel PN, Sigman M, Collura B et al.. “Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline PART II.” The Journal of urology (2020). PMID: 33295258 ↗

    L1GUIDELINECited in: Diagnosis & Workup, Acute Management & Decompression, History and Evolution of Treatment, Prognosis & Natural History
  66. [66]

    Jensen CFS, Ohl DA, Fode M et al.. “Microdissection Testicular Sperm Extraction Versus Multiple Needle-pass Percutaneous Testicular Sperm Aspiration in Men with Nonobstructive Azoospermia: A Randomized Clinical Trial.” European urology (2022). PMID: 35599183 ↗

    L1RCTCited in: Diagnosis & Workup, Long-term & Definitive Management: Medical vs Endourologic/Surgical, History and Evolution of Treatment, Endoscopic & Procedural Technique Considerations
  67. [67]

    Baazeem A, Belzile E, Ciampi A et al.. “Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair.” European urology (2011). PMID: 21733620 ↗

    L1SR_OBSCited in: Diagnosis & Workup, History and Evolution of Treatment, Complications, Prognosis & Natural History, Special Populations & Pregnancy
  68. [68]

    Payne KS, Mazur DJ, Hotaling JM et al.. “Cannabis and Male Fertility: A Systematic Review.” The Journal of urology (2019). PMID: 30916627 ↗

    L5SR_OBSCited in: Diagnosis & Workup
  69. [69]

    Sharma RK, Sabanegh E, Mahfouz R et al.. “TUNEL as a test for sperm DNA damage in the evaluation of male infertility.” Urology (2010). PMID: 20573380 ↗

    L3RCTCited in: Diagnosis & Workup, History and Evolution of Treatment
  70. [70]

    Ahmadi MH, Mirsalehian A, Sadighi Gilani MA et al.. “Asymptomatic Infection With Mycoplasma hominis Negatively Affects Semen Parameters and Leads to Male Infertility as Confirmed by Improved Semen Parameters After Antibiotic Treatment.” Urology (2016). PMID: 27871827 ↗

    L3RCTCited in: Diagnosis & Workup, History and Evolution of Treatment
  71. [71]

    Xiao H, Yao RJ, He HN et al.. “Surgical efficacy and predictors of outcome in varicocelectomy: a meta-analysis of multivariable studies.” World journal of urology (2025). PMID: 40423814 ↗

    L2SR_OBSCited in: Diagnosis & Workup, Prognosis & Natural History
  72. [72]

    Abdelwahab K, Eliwa AM, Seleem MM et al.. “Role of Preoperative Testicular Shear Wave Elastography in Predicting Improvement of Semen Parameters After Varicocelectomy for Male Patients With Primary Infertility.” Urology (2017). PMID: 28456539 ↗

    L4TRIAL_NONRANDOMCited in: Diagnosis & Workup
  73. [73]

    Ventimiglia E, Capogrosso P, Boeri L et al.. “When to Perform Karyotype Analysis in Infertile Men? Validation of the European Association of Urology Guidelines with the Proposal of a New Predictive Model.” European urology (2016). PMID: 27343001 ↗

    L3OTHERCited in: Diagnosis & Workup, Severity, Staging & Risk Stratification
  74. [74]

    Boman JM, Libman J, Zini A. “Microsurgical varicocelectomy for isolated asthenospermia.” The Journal of urology (2008). PMID: 18804226 ↗

    L3OTHERCited in: Diagnosis & Workup, Prognosis & Natural History, Special Populations & Pregnancy
  75. [75]

    Hayon S, Kumar SKS, Greenberg D et al.. “Distribution and Positive Predictive Value of Follicle Stimulating Hormone Among Nonazoospermic Men.” The Journal of urology (2024). PMID: 38603647 ↗

    L3OTHERCited in: Diagnosis & Workup
  76. [76]

    Del Giudice F, Kasman AM, Chen T et al.. “The Association between Mortality and Male Infertility: Systematic Review and Meta-analysis.” Urology (2021). PMID: 33819517 ↗

    L2SR_OBSCited in: Diagnosis & Workup, Prognosis & Natural History
  77. [77]

    Sharma AP, Sharma G, Kumar R. “Systematic Review and Meta-analysis on Effect of Carnitine, Coenzyme Q10 and Selenium on Pregnancy and Semen Parameters in Couples With Idiopathic Male Infertility.” Urology (2021). PMID: 34871624 ↗

    L1SR_OBSCited in: Diagnosis & Workup, Special Populations & Pregnancy
  78. [78]

    Hussein A. “A new one-layer epididymovasostomy technique.” BJU international (2014). PMID: 24924910 ↗

    L4OTHERCited in: Diagnosis & Workup, Endoscopic & Procedural Technique Considerations, Prognosis & Natural History
  79. [79]

    Gordetsky J, van Wijngaarden E, O'Brien J. “Redefining abnormal follicle-stimulating hormone in the male infertility population.” BJU international (2011). PMID: 22177092 ↗

    L2OTHERCited in: Diagnosis & Workup
  80. [80]

    Fariello RM, Pariz JR, Spaine DM et al.. “Association between obesity and alteration of sperm DNA integrity and mitochondrial activity.” BJU international (2012). PMID: 22300410 ↗

    L4OTHERCited in: Diagnosis & Workup
  81. [81]

    Chandrapal JC, Nielson S, Patel DP et al.. “Characterising the safety of clomiphene citrate in male patients through prostate-specific antigen, haematocrit, and testosterone levels.” BJU international (2016). PMID: 27226135 ↗

    L4OTHERCited in: Diagnosis & Workup, History and Evolution of Treatment
  82. [82]

    Nagirnaja L, Mørup N, Nielsen JE et al.. “Variant PNLDC1, Defective piRNA Processing, and Azoospermia.” The New England journal of medicine (2021). PMID: 34347949 ↗

    L4OTHERCited in: Diagnosis & Workup
  83. [83]

    Agarwal A, Baskaran S, Parekh N et al.. “Male infertility.” Lancet (London, England) (2020). PMID: 33308486 ↗

    L5REVIEW_NARRATIVECited in: Diagnosis & Workup
  84. [84]

    Sun Y, Yao C, Liu G et al.. “Letrozole and Infertility Among Males With Spermatogenic Failure: A Randomized Clinical Trial.” JAMA network open (2026). PMID: 42313386 ↗

    L1RCTCited in: Diagnosis & Workup, Long-term & Definitive Management: Medical vs Endourologic/Surgical, History and Evolution of Treatment, Prognosis & Natural History
  85. [85]

    Cito G, Picone R, Fucci R et al.. “Reproductive Outcomes in Infertile Men With Spinal Cord Injury (SCI): A Retrospective Case-Control Analysis.” Urology (2020). PMID: 32305548 ↗

    L3CASE_CONTROLCited in: Diagnosis & Workup, Prognosis & Natural History, Special Populations & Pregnancy
  86. [86]

    Kallinikas G, Tsoporis JN, Haronis G et al.. “The role of oral antioxidants in the improvement of sperm parameters in infertile men.” World journal of urology (2024). PMID: 38315192 ↗

    L5REVIEW_NARRATIVECited in: Diagnosis & Workup, Special Populations & Pregnancy
  87. [87]

    Rusz A, Pilatz A, Wagenlehner F et al.. “Influence of urogenital infections and inflammation on semen quality and male fertility.” World journal of urology (2011). PMID: 21748371 ↗

    L5REVIEW_NARRATIVECited in: Diagnosis & Workup, History and Evolution of Treatment
  88. [88]

    Boujemaa S, Suri GS, Kaur G. “Impact of Mycoplasma hominis on Sperm Quality Among Infertile Men: A Systematic Review and Meta-Analysis.” Health science reports (2026). PMID: 42011280 ↗

    L2SR_OBSCited in: Diagnosis & Workup, History and Evolution of Treatment, Endoscopic & Procedural Technique Considerations
  89. [89]

    Zhang G, Nelli G, Hoe SZ et al.. “Vitamin D supplementation in infertile men: a systematic review and meta-analysis of effects on semen quality and endocrine function.” PeerJ (2026). PMID: 42004696 ↗

    L2SR_OBSCited in: Diagnosis & Workup, Special Populations & Pregnancy
  90. [90]

    Xu Q, Wan Z, Xiong Z et al.. “The global evaluation of the effects of antioxidants on seminal outcomes in infertile men: a systematic review and meta-analysis.” Human fertility (Cambridge, England) (2026). PMID: 41983308 ↗

    L2SR_OBSCited in: Diagnosis & Workup, History and Evolution of Treatment
  91. [91]

    Febriansyah NA, De Niro AJN, Rizaldi F. “Effect of adjuvant vitamin E supplementation on sperm parameters after varicocelectomy: a systematic review and meta-analysis.” Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica (2026). PMID: 42165159 ↗

    L1SR_OBSCited in: Diagnosis & Workup, Prognosis & Natural History, Special Populations & Pregnancy
  92. [92]

    Gül M, Şahin A, Özer C et al.. “Machine Learning-Based Prediction of Sperm Retrieval Outcomes in Patients With Klinefelter Syndrome: A Multicenter Study With External Validation.” Andrology (2026). PMID: 42384919 ↗

    L2OTHERCited in: Diagnosis & Workup
  93. [93]

    Vitthala S, El-Toukhy T, Maheshwari A. “Should we routinely perform sperm DNA fragmentation testing in fertility clinics?” Human reproduction open (2026). PMID: 42318091 ↗

    L5OTHERCited in: Diagnosis & Workup
  94. [94]

    Freeman S, Bertolotto M, Richenberg J et al.. “Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading.” European radiology (2019). PMID: 31332561 ↗

    L1GUIDELINECited in: Severity, Staging & Risk Stratification
  95. [95]

    Qu P, Chen L, Zhao D et al.. “Nomogram for the cumulative live birth in women undergoing the first IVF cycle: Base on 26, 689 patients in China.” Frontiers in endocrinology (2022). PMID: 36093101 ↗

    L4RCTCited in: Severity, Staging & Risk Stratification
  96. [96]

    Wang QH, Ye JJ, Chen ZY et al.. “Current risk factors for male infertility and semen parameters: an umbrella review of systematic reviews and meta-analyses.” Asian journal of andrology (2026). PMID: 41527944 ↗

    L2SR_OBSCited in: Severity, Staging & Risk Stratification
  97. [97]

    Hamed MA, Akhigbe TM, Adeogun AE et al.. “Impact of organophosphate pesticides exposure on human semen parameters and testosterone: a systematic review and meta-analysis.” Frontiers in endocrinology (2023). PMID: 37964951 ↗

    L2SR_OBSCited in: Severity, Staging & Risk Stratification
  98. [98]

    Flores-Lovon K, Soriano-Moreno DR, Medina-Ramirez SA et al.. “Effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis: a systematic review.” BMJ open (2023). PMID: 37758670 ↗

    L2SR_OBSCited in: Severity, Staging & Risk Stratification
  99. [99]

    Wang S, Lu R, Shi H et al.. “Safety and efficacy of acupuncture for varicocele-induced male infertility: a systematic review protocol.” BMJ open (2022). PMID: 36456023 ↗

    L5SR_OBSCited in: Severity, Staging & Risk Stratification
  100. [100]

    Schlegel PN, Sigman M, Collura B et al.. “Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I.” Fertility and sterility (2020). PMID: 33309062 ↗

    L1GUIDELINECited in: Acute Management & Decompression
  101. [101]

    Schlegel PN, Sigman M, Collura B et al.. “Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II.” Fertility and sterility (2020). PMID: 33309061 ↗

    L1GUIDELINECited in: Acute Management & Decompression
  102. [102]

    Han Z, Tian T, Zhang N et al.. “Cumulative live births and predictive factors of emergency oocyte cryopreservation: a retrospective cohort study.” Reproductive biology and endocrinology : RB&E (2025). PMID: 40457462 ↗

    L3COHORTCited in: Acute Management & Decompression
  103. [103]

    Huyghe E, Graziana JP, Methorst C et al.. “[Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of andrological and sexual medicine pathologies during the COVID-19 crisis].” Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie (2020). PMID: 33941462 ↗

    L5GUIDELINECited in: Acute Management & Decompression
  104. [104]

    Golzardi M, Hromić-Jahjefendić A, Šutković J et al.. “The Aftermath of COVID-19: Exploring the Long-Term Effects on Organ Systems.” Biomedicines (2024). PMID: 38672267 ↗

    L5REVIEW_NARRATIVECited in: Acute Management & Decompression
  105. [105]

    Punjani N, Marinaro JA, Kang C et al.. “Gabapentin for Postoperative Pain Control and Opioid Reduction in Scrotal Surgery: A Randomized Controlled Clinical Trial.” The Journal of urology (2024). PMID: 38382042 ↗

    L1RCTCited in: Long-term & Definitive Management: Medical vs Endourologic/Surgical, History and Evolution of Treatment
  106. [106]

    Abdel-Meguid TA, Al-Sayyad A, Tayib A et al.. “Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial.” European urology (2010). PMID: 21196073 ↗

    L1RCTCited in: Long-term & Definitive Management: Medical vs Endourologic/Surgical, History and Evolution of Treatment, Special Populations & Pregnancy
  107. [107]

    Safarinejad MR, Safarinejad S. “Efficacy of selenium and/or N-acetyl-cysteine for improving semen parameters in infertile men: a double-blind, placebo controlled, randomized study.” The Journal of urology (2008). PMID: 19091331 ↗

    L1RCTCited in: Long-term & Definitive Management: Medical vs Endourologic/Surgical, History and Evolution of Treatment, Prognosis & Natural History
  108. [108]

    Wang Y, Li R, Yang R et al.. “Intracytoplasmic sperm injection versus conventional in-vitro fertilisation for couples with infertility with non-severe male factor: a multicentre, open-label, randomised controlled trial.” Lancet (London, England) (2024). PMID: 38330980 ↗

    L1RCTCited in: Long-term & Definitive Management: Medical vs Endourologic/Surgical, History and Evolution of Treatment
  109. [109]

    Baka S, Grigoriou O, Hassiakos D et al.. “Treatment of sperm with platelet-activating factor does not improve intrauterine insemination outcome in unselected cases of mild male factor infertility: a prospective double-blind randomized crossover study.” Urology (2009). PMID: 19716589 ↗

    L1RCTCited in: Long-term & Definitive Management: Medical vs Endourologic/Surgical, Special Populations & Pregnancy
  110. [110]

    Ciftci H, Verit A, Savas M et al.. “Effects of N-acetylcysteine on semen parameters and oxidative/antioxidant status.” Urology (2009). PMID: 19428083 ↗

    L4RCTCited in: Long-term & Definitive Management: Medical vs Endourologic/Surgical, History and Evolution of Treatment
  111. [111]

    Lin X, Wu D, Zhang C et al.. “Preimplantation genetic testing for aneuploidy versus no genetic testing in couples undergoing intracytoplasmic sperm injection for severe male infertility: multicentre, open label, randomised controlled trial.” BMJ (Clinical research ed.) (2025). PMID: 41436190 ↗

    L1RCTCited in: Long-term & Definitive Management: Medical vs Endourologic/Surgical, Special Populations & Pregnancy
  112. [112]

    Shamohammadi I, Jamzad S, Jamzad S et al.. “Evaluating Silicone Gel Efficacy in Reducing Scar Formation Following Microscopic Inguinal Varicocelectomy: A Double-Blind Prospective Controlled Trial.” International wound journal (2025). PMID: 41192060 ↗

    L1RCTCited in: Long-term & Definitive Management: Medical vs Endourologic/Surgical
  113. [113]

    Yahyavi SK, Jorsal MJ, Wulff SM et al.. “Effect of Denosumab on Sperm Concentration in Men With Severe Oligospermia: A Randomized Controlled Trial.” The Journal of clinical endocrinology and metabolism (2026). PMID: 40858297 ↗

    L1RCTCited in: Long-term & Definitive Management: Medical vs Endourologic/Surgical
  114. [114]

    Yahyavi SK, Holt R, Jorsal MJ et al.. “Effect of denosumab on semen quality in infertile men selected by serum level of antimüllerian hormone: a randomized controlled trial.” Fertility and sterility (2025). PMID: 40403914 ↗

    L1RCTCited in: Long-term & Definitive Management: Medical vs Endourologic/Surgical
  115. [115]

    Kamphuis D, van Welie N, van Rijswijk J et al.. “The effect of prior hysterosalpingo-foam sonography or hysterosalpingography on tubal patency: a secondary analysis of a randomized controlled trial.” Human reproduction (Oxford, England) (2024). PMID: 39190881 ↗

    L1RCTCited in: Long-term & Definitive Management: Medical vs Endourologic/Surgical
  116. [116]

    Holt R, Yahyavi SK, Wall-Gremstrup G et al.. “Low-serum antimüllerian hormone is linked with poor semen quality in infertile men screened for participation in a randomized controlled trial.” Fertility and sterility (2024). PMID: 38522503 ↗

    L4RCTCited in: Long-term & Definitive Management: Medical vs Endourologic/Surgical
  117. [117]

    Busetto GM, Rodrigues BF, Virmani A et al.. “Antioxidant treatment for oligoasthenoteratozoospermia and varicocele: a DBPC trial to evaluate the impact of age and body mass index.” Asian journal of andrology (2024). PMID: 38305695 ↗

    L1RCTCited in: Long-term & Definitive Management: Medical vs Endourologic/Surgical
  118. [118]

    Brannigan RE, Hermanson L, Kaczmarek J et al.. “Updates to Male Infertility: AUA/ASRM Guideline (2024).” The Journal of urology (2024). PMID: 39145501 ↗

    L1GUIDELINECited in: History and Evolution of Treatment, Special Populations & Pregnancy
  119. [119]

    Barbalias GA, Liatsikos EN, Nikiforidis G et al.. “Treatment of varicocele for male infertility: a comparative study evaluating currently used approaches.” European urology (1998). PMID: 9803001 ↗

    L1RCTCited in: History and Evolution of Treatment
  120. [120]

    Ozgök Y, Tan MO, Kilciler M et al.. “Diagnosis and treatment of ejaculatory duct obstruction in male infertility.” European urology (2001). PMID: 11173935 ↗

    L4REVIEW_NARRATIVECited in: History and Evolution of Treatment
  121. [121]

    Raman JD, Schlegel PN. “Aromatase inhibitors for male infertility.” The Journal of urology (2002). PMID: 11792932 ↗

    L3OTHERCited in: History and Evolution of Treatment
  122. [122]

    Seabra CM, Quental S, Lima AC et al.. “The mutational spectrum of WT1 in male infertility.” The Journal of urology (2014). PMID: 25451826 ↗

    L4OTHERCited in: History and Evolution of Treatment
  123. [123]

    Fernandez-Encinas A, García-Peiró A, Ribas-Maynou J et al.. “Characterization of Nuclease Activity in Human Seminal Plasma and its Relationship to Semen Parameters, Sperm DNA Fragmentation and Male Infertility.” The Journal of urology (2015). PMID: 26231555 ↗

    L4OTHERCited in: History and Evolution of Treatment
  124. [124]

    Vandekerckhove P, Lilford R, Vail A et al.. “WITHDRAWN: Androgens versus placebo or no treatment for idiopathic oligo/asthenospermia.” The Cochrane database of systematic reviews (2007). PMID: 17636603 ↗

    L1SR_OBSCited in: History and Evolution of Treatment, Special Populations & Pregnancy
  125. [125]

    Vandekerckhove P, Lilford R, Vail A et al.. “Androgens versus placebo or no treatment for idiopathic oligo/asthenospermia.” The Cochrane database of systematic reviews (2000). PMID: 10796496 ↗

    L1SR_OBSCited in: History and Evolution of Treatment
  126. [126]

    Vandekerckhove P, Lilford R, Vail A et al.. “WITHDRAWN: Bromocriptine for idiopathic oligo/asthenospermia.” The Cochrane database of systematic reviews (2007). PMID: 17636605 ↗

    L1SR_OBSCited in: History and Evolution of Treatment, Special Populations & Pregnancy
  127. [127]

    Dohle GR, Smit M, Weber RF. “Androgens and male fertility.” World journal of urology (2003). PMID: 14566423 ↗

    L5REVIEW_NARRATIVECited in: History and Evolution of Treatment
  128. [128]

    Bar-Chama N, Fisch H. “Infection and pyospermia in male infertility.” World journal of urology (1993). PMID: 8343798 ↗

    L5REVIEW_NARRATIVECited in: History and Evolution of Treatment
  129. [129]

    Paick J, Kim SH, Kim SW. “Ejaculatory duct obstruction in infertile men.” BJU international (2000). PMID: 10759673 ↗

    L4OTHERCited in: History and Evolution of Treatment
  130. [130]

    Goyal A, Delves GH, Chopra M et al.. “Prostate cells exposed to lycopene in vitro liberate lycopene-enriched exosomes.” BJU international (2006). PMID: 16978292 ↗

    L5OTHERCited in: History and Evolution of Treatment
  131. [131]

    Raivio T, Falardeau J, Dwyer A et al.. “Reversal of idiopathic hypogonadotropic hypogonadism.” The New England journal of medicine (2007). PMID: 17761590 ↗

    L4OTHERCited in: History and Evolution of Treatment
  132. [132]

    Takihara H. “The treatment of obstructive azoospermia in male infertility--past, present, and future.” Urology (1998). PMID: 9610572 ↗

    L5REVIEW_NARRATIVECited in: History and Evolution of Treatment
  133. [133]

    Sharma RK, Agarwal A. “Role of reactive oxygen species in male infertility.” Urology (1996). PMID: 8973665 ↗

    L5REVIEW_NARRATIVECited in: History and Evolution of Treatment
  134. [134]

    Barazani Y, Agarwal A, Sabanegh ES. “Functional sperm testing and the role of proteomics in the evaluation of male infertility.” Urology (2014). PMID: 25065986 ↗

    L5REVIEW_NARRATIVECited in: History and Evolution of Treatment
  135. [135]

    Petok WD. “Procreation, Potency, and the Price of Paternity: The Social and Psychological Impact of a Diagnosis of Male Factor Infertility.” Urology (2026). PMID: 41539401 ↗

    L5REVIEW_NARRATIVECited in: History and Evolution of Treatment
  136. [136]

    Wang J, Huang W, Tan M et al.. “Global research trends on the impact of obesity on male infertility: a bibliometric analysis.” Frontiers in nutrition (2026). PMID: 42199749 ↗

    L5SR_OBSCited in: History and Evolution of Treatment
  137. [137]

    Shulman S, Harlin B, Davis P. “New method of treatment of immune infertility.” Urology (1978). PMID: 726181 ↗

    L4CASE_REPORTCited in: History and Evolution of Treatment
  138. [138]

    Rong J, Wang L, Yan H et al.. “Metabolic Reprogramming in Male Infertility: Mechanistic Integration and Translational Perspectives From Mouse Models.” Andrology (2026). PMID: 42286955 ↗

    L5REVIEW_NARRATIVECited in: History and Evolution of Treatment
  139. [139]

    Voros C, Chatzinikolaou F, Papadimas G et al.. “Isoprostanes and Isofurans in Infertility and Assisted Reproduction: What Do We Know So Far?” International journal of molecular sciences (2026). PMID: 42278246 ↗

    L5REVIEW_NARRATIVECited in: History and Evolution of Treatment
  140. [140]

    Zhou J, Hu S, Ouyang Y et al.. “Immunological mechanisms and precision stratification in male infertility: from testicular immune privilege and danger signal amplification to seminal immune biomarkers and mechanism-tailored intervention.” Frontiers in immunology (2026). PMID: 42206031 ↗

    L5REVIEW_NARRATIVECited in: History and Evolution of Treatment
  141. [141]

    Ma Z, Geng Q, Zhu H et al.. “Mitochondrial Metabolism Governs Spermatogonial Stem Cell Fate Decisions.” Andrology (2026). PMID: 42179108 ↗

    L5REVIEW_NARRATIVECited in: History and Evolution of Treatment
  142. [142]

    Jothiraman DK, Mariajoseph-Antony LF, Loganathan C et al.. “Role of microRNAs in the Regulation of Leydig Cell Function.” Andrology (2026). PMID: 42108776 ↗

    L5REVIEW_NARRATIVECited in: History and Evolution of Treatment
  143. [143]

    Beland LE, Davis MF, Aiyar S et al.. “Adolescent varicocele: a surgical conundrum.” Fertility and sterility (2026). PMID: 42066978 ↗

    L5REVIEW_NARRATIVECited in: History and Evolution of Treatment
  144. [144]

    Zhou J, Ouyang Y, Hu S et al.. “From incidentaloma to actionable insight: a clinical-molecular-imaging framework for risk-stratified management of testicular microlithiasis.” Frontiers in endocrinology (2026). PMID: 42064772 ↗

    L2REVIEW_NARRATIVECited in: History and Evolution of Treatment, Prevention, Screening & Surveillance
  145. [145]

    Dupree JM, Coward RM, Hsieh TC et al.. “The Impact of Physician Productivity Models on Access to Subspecialty Care: A White Paper From the Society for the Study of Male Reproduction and the Society for Male Reproduction and Urology.” Urology (2021). PMID: 33484822 ↗

    L1GUIDELINECited in: Endoscopic & Procedural Technique Considerations
  146. [146]

    McCormack MC, McCallum S, Behr B. “A novel microfluidic device for male subfertility screening.” The Journal of urology (2006). PMID: 16697844 ↗

    L4OTHERCited in: Endoscopic & Procedural Technique Considerations
  147. [147]

    Hotaling JM, Patel DP, Brant WO et al.. “Demographic and socio-economic differences between men seeking infertility evaluation and those seeking surgical sterilization: from the National Survey of Family Growth.” BJU international (2015). PMID: 25777585 ↗

    L2OTHERCited in: Endoscopic & Procedural Technique Considerations
  148. [148]

    Safarinejad MR, Shafiei N, Safarinejad S. “Evaluating the role of the FSH receptor gene Thr307-Ala and Asn680-Ser polymorphisms in male infertility and their association with semen quality and reproductive hormones.” BJU international (2010). PMID: 21105990 ↗

    L3OTHERCited in: Endoscopic & Procedural Technique Considerations
  149. [149]

    Attia AM, Al-Inany HG, Farquhar C et al.. “Gonadotrophins for idiopathic male factor subfertility.” The Cochrane database of systematic reviews (2007). PMID: 17943837 ↗

    L1SR_OBSCited in: Endoscopic & Procedural Technique Considerations, Special Populations & Pregnancy
  150. [150]

    Aboukhshaba A, Almajed E, Bin Shunayf M et al.. “Effect of Varicocelectomy on Testosterone Parameters in Hypogonadism: A Systematic Review and Meta-Analysis.” The world journal of men's health (2026). PMID: 41946661 ↗

    L1SR_OBSCited in: Endoscopic & Procedural Technique Considerations
  151. [151]

    Marozzi J, Hanly M, Venetis C et al.. “Male infertility and risk of cardiometabolic conditions: a population-based cohort study.” Human reproduction (Oxford, England) (2026). PMID: 41285026 ↗

    L2COHORTCited in: Endoscopic & Procedural Technique Considerations
  152. [152]

    Castro S, Ng Yin K, d'Aniello F et al.. “Effect of pubertal induction with combined gonadotropin therapy on testes development and spermatogenesis in males with gonadotropin deficiency: a cohort study.” Human reproduction open (2025). PMID: 40463510 ↗

    L2COHORTCited in: Endoscopic & Procedural Technique Considerations
  153. [153]

    Wang L, Huang X, Ding Y. “Shear wave elastography in assessing stiffness and volume of varicocele-affected and normal testes: a systematic review and meta-analysis.” Basic and clinical andrology (2025). PMID: 40859142 ↗

    L2SR_OBSCited in: Endoscopic & Procedural Technique Considerations
  154. [154]

    Lau FS, Pereira JK, Jiwane A et al.. “Paediatric Varicocele Embolisation: Clinical Experience, Insights and Long Term Clinical Outcomes Over 14 Years at a Tertiary Centre-A Cohort Study.” Journal of medical imaging and radiation oncology (2025). PMID: 40600623 ↗

    L2COHORTCited in: Endoscopic & Procedural Technique Considerations
  155. [155]

    Shabto JM, Patil D, Poulose K et al.. “Access to Care for Infertile Men: Referral Patterns of Fertility Clinics in the United States.” Urology (2022). PMID: 35217029 ↗

    L2OTHERCited in: Endoscopic & Procedural Technique Considerations
  156. [156]

    Shandley LM, Kahlenberg Z, Kotha R et al.. “Barriers to Male Infertility Care and Strategic Solutions for Advancement: Increasing Access, Health Policy, and Advocacy Efforts.” Urology (2026). PMID: 41621460 ↗

    L5REVIEW_NARRATIVECited in: Endoscopic & Procedural Technique Considerations
  157. [157]

    Waggener K, Wolff D, Snipes M et al.. “Microsurgical Education in Reproductive Urology: A Review of Current Techniques and Opportunities for Improved Access to Learning Experiences.” Urology (2025). PMID: 39824365 ↗

    L5REVIEW_NARRATIVECited in: Endoscopic & Procedural Technique Considerations
  158. [158]

    Persily JB, Thakker S, Beaty W et al.. “Are Infertile Men Less Healthy Than Fertile Men? An Analysis of the National Survey for Family Growth.” Urology (2021). PMID: 34129892 ↗

    L2OTHERCited in: Endoscopic & Procedural Technique Considerations
  159. [159]

    Fattahi A, Khodadadi I, Amiri I et al.. “The Role of G22 A Adenosine Deaminase 1 Gene Polymorphism and the Activities of ADA Isoenzymes in Fertile and Infertile Men.” Urology (2015). PMID: 26166670 ↗

    L3OTHERCited in: Endoscopic & Procedural Technique Considerations
  160. [160]

    Hoseini ZS, Kohan L. “miR-222 and miR-146a Variants in Idiopathic Male Infertility: A Case-Control Study.” International journal of fertility & sterility (2025). PMID: 40590288 ↗

    L3CASE_CONTROLCited in: Endoscopic & Procedural Technique Considerations
  161. [161]

    Lee JD, Jeng SY, Lee TH. “Increased expression of hypoxia-inducible factor-1alpha in the internal spermatic vein of patients with varicocele.” The Journal of urology (2006). PMID: 16469614 ↗

    L3OTHERCited in: Complications, Prognosis & Natural History
  162. [162]

    Ng A, Wai-Shun Chan V, Asif A et al.. “LEARN: A multi-centre, cross-sectional evaluation of Urology teaching in UK medical schools.” BJU international (2022). PMID: 35488402 ↗

    L2OTHERCited in: Complications
  163. [163]

    Preto M, Boeri L, Cirigliano L et al.. “Preliminary Results of Microsurgical Sperm Retrieval in Azoospermic Patients: A Randomized Controlled Trial Comparing Operating Microscope vs. Surgical Loupes.” Journal of clinical medicine (2025). PMID: 39941640 ↗

    L1RCTCited in: Complications
  164. [164]

    Chua ME, Escusa KG, Luna S et al.. “Revisiting oestrogen antagonists (clomiphene or tamoxifen) as medical empiric therapy for idiopathic male infertility: a meta-analysis.” Andrology (2013). PMID: 23970453 ↗

    L1SR_OBSCited in: Complications
  165. [165]

    Pozza C, Pofi R, Tenuta M et al.. “Clinical presentation, management and follow-up of 83 patients with Leydig cell tumors of the testis: a prospective case-cohort study.” Human reproduction (Oxford, England) (2019). PMID: 31532522 ↗

    L2COHORTCited in: Complications, Prevention, Screening & Surveillance
  166. [166]

    Abou Chakra M, Duquesne I, Mima M et al.. “Male reproductive and sexual health outcomes following intravesical therapy for non-muscle invasive bladder cancer.” World journal of urology (2025). PMID: 41175262 ↗

    L5REVIEW_NARRATIVECited in: Complications, Prognosis & Natural History
  167. [167]

    Ciam A, Adriansjah R. “Beyond Tying Knots: Can Venous Bypass Shape the Future of Testicular Hemodynamics in Varicocele Treatment? - A Systematic Review.” Research and reports in urology (2025). PMID: 41367405 ↗

    L2SR_OBSCited in: Complications
  168. [168]

    Kasunic D, Crebert M, Treacy PJ et al.. “Comparing the efficacy of different embolisation materials in improving pain and fertility outcomes in patients with varicoceles: A systematic review.” Journal of medical imaging and radiation oncology (2024). PMID: 39462435 ↗

    L2SR_OBSCited in: Complications
  169. [169]

    Minhas S, Bettocchi C, Boeri L et al.. “European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility.” European urology (2021). PMID: 34511305 ↗

    L1OTHERCited in: Prognosis & Natural History
  170. [170]

    Baazeem A, Boman JM, Libman J et al.. “Microsurgical varicocelectomy for infertile men with oligospermia: differential effect of bilateral and unilateral varicocele on pregnancy outcomes.” BJU international (2009). PMID: 19338535 ↗

    L2OTHERCited in: Prognosis & Natural History, Special Populations & Pregnancy
  171. [171]

    Oroojan AA, Etedali H, Shirani Lapari H. “A systematic review on the impact of type 2 diabetes on Leydig and Sertoli cells: Molecular mechanisms and functional consequences.” Diabetes & metabolic syndrome (2026). PMID: 42097114 ↗

    L2SR_OBSCited in: Prognosis & Natural History
  172. [172]

    Budihastuti UR, Murti B, Prakosa T et al.. “Effectiveness of electroacupuncture in improving sperm motility and morphology in men with varicocele.” African journal of reproductive health (2026). PMID: 41537313 ↗

    L1RCTCited in: Prognosis & Natural History
  173. [173]

    Vitthala S, Nedelcu S, El-Toukhy T et al.. “Value of sperm DNA fragmentation (SDF) in predicting reproductive outcomes - a systematic review and meta-analysis.” Human fertility (Cambridge, England) (2026). PMID: 41693253 ↗

    L2SR_OBSCited in: Prognosis & Natural History, Special Populations & Pregnancy
  174. [174]

    Del Giudice F, Kasman AM, Li S et al.. “Increased Mortality Among Men Diagnosed With Impaired Fertility: Analysis of US Claims Data.” Urology (2020). PMID: 33017614 ↗

    L2OTHERCited in: Prognosis & Natural History, Prevention, Screening & Surveillance
  175. [175]

    Ibis MA, Unal S, Aydog E et al.. “Correlation of 17-OH Progesterone Changes With Semen Parameters and Pregnancy Outcomes in Hypogonadal and Eugonadal Patients After Varicocelectomy.” Urology (2025). PMID: 40086513 ↗

    L2OTHERCited in: Prognosis & Natural History
  176. [176]

    Wu Y, Deng H, Sun J et al.. “Case Report: Diabetic ketoacidosis in a patient with Klinefelter syndrome: a rare and complex presentation.” Frontiers in endocrinology (2026). PMID: 41613957 ↗

    L4CASE_REPORTCited in: Prognosis & Natural History
  177. [177]

    Ko EY, Siddiqi K, Brannigan RE et al.. “Empirical medical therapy for idiopathic male infertility: a survey of the American Urological Association.” The Journal of urology (2012). PMID: 22264467 ↗

    L5OTHERCited in: Special Populations & Pregnancy
  178. [178]

    Ng L, Kocur OM, Xie P et al.. “Timing of Testicular Biopsy in Relation to Oocyte Retrieval and the Outcomes of Intracytoplasmic Sperm Injection.” The Journal of urology (2024). PMID: 38375822 ↗

    L2OTHERCited in: Special Populations & Pregnancy
  179. [179]

    Weedin JW, Bennett RC, Fenig DM et al.. “Early versus late maturation arrest: reproductive outcomes of testicular failure.” The Journal of urology (2011). PMID: 21684558 ↗

    L3OTHERCited in: Special Populations & Pregnancy
  180. [180]

    Ni K, Steger K, Yang H et al.. “Sperm protamine mRNA ratio and DNA fragmentation index represent reliable clinical biomarkers for men with varicocele after microsurgical varicocele ligation.” The Journal of urology (2014). PMID: 24582535 ↗

    L2OTHERCited in: Special Populations & Pregnancy
  181. [181]

    Libman J, Jarvi K, Lo K et al.. “Beneficial effect of microsurgical varicocelectomy is superior for men with bilateral versus unilateral repair.” The Journal of urology (2006). PMID: 17085170 ↗

    L3OTHERCited in: Special Populations & Pregnancy
  182. [182]

    McGarry P, Alrabeeah K, Jarvi K et al.. “Is varicocelectomy beneficial in men previously deemed subfertile but with normal semen parameters based on the new guidelines? A retrospective study.” Urology (2014). PMID: 25623687 ↗

    L3COHORTCited in: Special Populations & Pregnancy
  183. [183]

    Kayimu K, Berntsen S, Fu Y et al.. “Does intracytoplasmic sperm injection outperform conventional in vitro fertilization in couples without severe male factor infertility? A systematic review and meta-analysis of randomized controlled trials.” Human reproduction (Oxford, England) (2026). PMID: 42172285 ↗

    L1SR_MA_RCTCited in: Special Populations & Pregnancy
  184. [184]

    Attia AM, Al-Inany HG, Proctor ML. “Gonadotrophins for idiopathic male factor subfertility.” The Cochrane database of systematic reviews (2006). PMID: 16437514 ↗

    L1SR_OBSCited in: Special Populations & Pregnancy
  185. [185]

    Konnyu K, Imamura M, Hudson J et al.. “The effectiveness of hormonal treatment to improve reproductive outcomes in normo-gonadotropic men with abnormal semen parameters: Results of two linked systematic reviews.” The Journal of clinical endocrinology and metabolism (2026). PMID: 42030403 ↗

    L2SR_OBSCited in: Special Populations & Pregnancy
  186. [186]

    Jiang L, Zhou J, Huang H et al.. “Do different male infertility factors impact embryological, cumulative pregnancy and neonatal outcomes in IVF/ICSI cycles? A retrospective cohort study.” Human reproduction open (2025). PMID: 41394017 ↗

    L3COHORTCited in: Special Populations & Pregnancy
  187. [187]

    Ziouziou I, Rambhatla A, Shah R et al.. “Sperm DNA fragmentation and infertility: a narrative review.” World journal of urology (2024). PMID: 38990348 ↗

    L5REVIEW_NARRATIVECited in: Special Populations & Pregnancy
  188. [188]

    Li P, Liu S, Chen K et al.. “Divergent long-term trends in semen quality and reproductive hormones across the COVID-19 pandemic era in infertile men: an age-stratified retrospective study.” Basic and clinical andrology (2026). PMID: 41888649 ↗

    L3COHORTCited in: Prevention, Screening & Surveillance
  189. [189]

    Martinez MS, Motrich RD. “Macrophages in the male genital tract.” Biomedical journal (2025). PMID: 40865908 ↗

    L5OTHERCited in: Prevention, Screening & Surveillance
  190. [190]

    Sun XH, Lan YH, Wang N. “Human papillomavirus infection in males: implications for fertility, assisted reproductive outcomes, and vaccination strategies.” Virology journal (2025). PMID: 40581640 ↗

    L5REVIEW_NARRATIVECited in: Prevention, Screening & Surveillance
  191. [191]

    Kaltsas A, Koumenis A, Stavropoulos M et al.. “Male Infertility and Reduced Life Expectancy: Epidemiology, Mechanisms, and Clinical Implications.” Journal of clinical medicine (2025). PMID: 40507691 ↗

    L5REVIEW_NARRATIVECited in: Prevention, Screening & Surveillance

Revision History

All updates applied to this page

Loading revisions…