These 2024 guidelines address male infertility amid Japan's declining birth rate, following the recent provision of national health insurance coverage for infertility treatments. Male factors contribute to approximately 50% of infertility cases, with spermatogenic dysfunction being the most common cause (82. 4%). The guidelines provide evidence-based recommendations for diagnosing and treating male infertility. Diagnostic approaches include comprehensive medical history, physical examination, semen analysis, hormone testing, genetic testing for severe cases, and appropriate imaging studies. Treatment recommendations cover both medical and surgical interventions. Medical treatments include gonadotropin therapy for hypogonadotropic hypogonadism (grade A), clomiphene citrate for oligozoospermia with low testosterone (grade B), and antioxidant therapy (limited evidence: grade C). Surgical treatments focus on varicocelectomy for palpable varicoceles (grade A), with microsurgical approaches preferred. Nonobstructive azoospermia is treated by microdissection testicular sperm extraction (micro-TESE) (grade A). The guidelines also emphasize preserving fertility before cancer treatment, managing sexual dysfunction with PDE5 inhibitors (grade A), and treating retrograde ejaculation with tricyclic antidepressants (grade B).
International journal of urology : official journal of the Japanese Urological Association. 2025 Jun 03 [Epub ahead of print]
Akira Tsujimura, Masashi Iijima, Yukihiro Umemoto, Hideyuki Kobayashi, Akira Komiya, Koji Shiraishi, Koji Chiba, Yasushi Hirota, Shinichiro Fukuhara, Yasushi Yumura
Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Japan., Department of Urology, Kanazawa Municipal Hospital, Kanazawa, Japan., Department of Urology, Nagoya City University West Medical Center, Nagoya, Japan., Department of Urology, Toho University Omori Medical Center, Tokyo, Japan., Department of Urology, Kameda Medical Center, Kamogawa, Japan., Department of Urology, Yamaguchi University Graduate School of Medicine, Ube, Japan., Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan., Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan., Department of Urology, The University of Osaka Graduate School of Medicine, Suita, Japan., Department of Urology, Reproductive Medicine Center, Medical Center, Yokohama City University, Yokohama, Japan.