Summary
Definition
History and exam
Diagnostic tests
Tests to consider
- scrotal ultrasound with color flow Doppler imaging
- semen analysis
- serum follicle-stimulating hormone (FSH) (± GnRH stimulation)
- serum testosterone
- DNA fragmentation index (DFI)
- CT abdomen/pelvis
- MRI abdomen/pelvis
- retroperitoneal ultrasound
Treatment algorithm
Contributors
Authors
Jay Ira Sandlow, MD
Professor and Chair
Department of Urology
Medical College of Wisconsin
Milwaukee
WI
Disclosures
JIS declares that he has received stock options as a member of the Scientific Advisory Board for Contraline, Inc. and has served as a faculty member on the Vasectomy course for the American Urological Association.
Daniel L. Pelzman, MD
Assistant Professor
Massachusetts General Hospital
Boston
MA
Disclosures
DLP declares that he has no competing interests.
Acknowledgements
Dr Jay Ira Sandlow and Dr Daniel L. Pelzman would like to gratefully acknowledge Dr Jagan K. Kansal, Dr Pravin Rao, Dr Miguel Pineda, Dr John C. Thomas, and Dr Wayne Kuang, previous contributors to this topic.
Disclosures
JKK, PR, MP, JCT, and WK declare that they have no competing interests.
Peer reviewers
Siam Oottamasathien, MD
Assistant Professor
Division of Pediatric Urology
University of Utah
Primary Children's Medical Center
Salt Lake City
UT
Disclosures
SO declares that she has no competing interests.
Jeffrey Donohoe, MD
Assistant Professor
Pediatric Urology
Medical College of Georgia
Augusta
GA
Disclosures
JD declares that he has no competing interests.
Daniel H. Williams, MD
Assistant Professor
Department of Urology
Head
Section of Male Infertility and Andrology
University of Wisconsin School of Medicine and Public Health
Madison
WI
Disclosures
DHW declares that he has no competing interests.
Edmund Sabanegh, Jr, MD
Director
Center for Male Fertility
Glickman Urological and Kidney Institute
Cleveland
OH
Disclosures
ES declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Brannigan RE, Hermanson L, Kaczmarek J, et al. Updates to male infertility: AUA/ASRM guideline (2024). J Urol. 2024 Dec;212(6):789-99. Abstract
European Association of Urology. Sexual and reproductive health guidelines. Apr 2025 [internet publication].Full text
Persad E, O'Loughlin CA, Kaur S, et al. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database Syst Rev. 2021 Apr 23;4:CD000479.Full text Abstract
European Association of Urology. Guidelines on paediatric urology. Apr 2024 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available here.
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