Summary of the Clinical Practice Guidelines for Male Infertility by the Japanese Urological Association With the Support of the Japan Society for Reproductive Medicine

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).