Figure 1.

Summary algorithm for initial management of the infertile male as presented in the AUA and EAU guidelines * Earlier evaluation may be warranted if male or female infertility risk factors present or if the male questions his fertility potential. ** EAU guideline recommends second semen analysis if first noted to be abnormal § Except in patients with bilateral vasal agenesis or clinical signs of hypogonadism. §§ Some recommend TRUS for oligospermic patients with low volume ejaculates, palpable vasa and normal testicular size. Ø Ideally treated at less than 1 year of age. ∞ Including azoospermia, impaired sexual function, or clinical findings of possible endocrinopathy