Erkek İnfertilitesi: Tanısal Algoritmalar ve Medikal Yaklaşımlar

Minhas S, Boeri L, Capogrosso P, Cocci A, Corona G, Dinkelman-Smit M, Falcone M, Jensen CF, Gül M, Kalkanli A, et al. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 Update on Male Infertility. European Urology (2025) 87:601–616. doi: 10.1016/j.eururo.2025.02.026

Schlegel PN, Sigman M, Collura B, De jonge C. Diagnosıs and treatment of infertility in men: aua/asrm guideline (2020; Amended 2024). (2024)

Latif T, Kold Jensen T, Mehlsen J, Holmboe SA, Brinth L, Pors K, Skouby SO, Jørgensen N, Lindahl-Jacobsen R. Semen quality as a predictor of subsequent morbidity: a Danish cohort study of 4,712 men with long-term follow-up. American journal of epidemiology (2017) 186:910–917.

Tzouma Z, Dourou P, Diamanti A, Harizopoulou V, Papalexis P, Karampas G, Liepinaitienė A, Dėdelė A, Sarantaki A. Associations between endocrine-disrupting chemical exposure and fertility outcomes: a decade of human epidemiological evidence. Life (2025) 15:993.

Rambhatla A, Shah R, Pinggera G-M, Mostafa T, Atmoko W, Saleh R, Chung E, Hamoda T, Cayan S, Park HJ. Pharmacological therapies for male infertility. Pharmacological reviews (2025) 77:100017.

Andrade DL, Viana MC, Esteves SC. Differential diagnosis of azoospermia in men with infertility. Journal of clinical medicine (2021) 10:3144.

Organization WH. WHO laboratory manual for the examination and processing of human semen. World Health Organization. (2021).

Chawre S, Khatib MN, Rawekar A, Mahajan S, Jadhav R, More A, Jadhav ER. A review of semen analysis: Updates from the WHO sixth edition manual and advances in male fertility assessment. Cureus (2024) 16:

Shin D, Sansone A, Krishnappa P, Baazeem A, Bernie HL, Ahsan MS, Thirumavalavan N, Hellstrom WJ, Shah R. Sexual dysfunctions in male patients with infertility: recommendations from the Fifth International Consultation for Sexual Medicine (ICSM 2024). Sexual Medicine Reviews (2026) 14:qeaf073.

Jankowska K, Suszczewicz N, Rabijewski M, Dudek P, Zgliczyński W, Maksym RB. Inhibin-b and FSH are good indicators of spermatogenesis but not the best indicators of fertility. Life (2022) 12:511.

Osadchiy V, Munoz-Lopez C, Jiang T, Naelitz BD, Parekh N, Vij SC, Mills JN, Lundy SD, Eleswarapu SV. Combination clomiphene citrate and anastrozole duotherapy improves semen parameters in a multi-institutional, retrospective cohort of infertile men. Translational Andrology and Urology (2024) 13:245–251.

Kanakis GA, Nordkap L, Bang AK, Calogero AE, Bártfai G, Corona G, Forti G, Toppari J, Goulis DG, Jørgensen N. EAA clinical practice guidelines—gynecomastia evaluation and management. Andrology (2019) 7:778–793. doi: 10.1111/andr.12636

Cohen PG. Obesity in men: the hypogonadal-estrogen receptor relationship and its effect on glucose homeostasis. Med Hypotheses (2008) 70:358–360. doi: 10.1016/j.mehy.2007.05.020

Dabaja AA, Schlegel PN. Medical treatment of male infertility. Translational andrology and urology (2014) 3:9.

Boehm U, Bouloux P-M, Dattani MT, De Roux N, Dodé C, Dunkel L, Dwyer AA, Giacobini P, Hardelin J-P, Juul A. European consensus statement on congenital hypogonadotropic hypogonadism—pathogenesis, diagnosis and treatment. Nature Reviews Endocrinology (2015) 11:547–564.

Zhang L, Cai K, Wang Y, Ji W, Cheng Z, Chen G, Liao Z. The pulsatile gonadorelin pump induces earlier spermatogenesis than cyclical gonadotropin therapy in congenital hypogonadotropic hypogonadism men. American journal of men’s health (2019) 13:1557988318818280.

Black K, Ølgaard S, Khoei AA, Glazer C, Ohl DA, Jensen CFS. The genetic landscape of male factor infertility and implications for men’s health and future generations. Uro (2025) 5:2.

Kohn TP, Kohn JR, Owen RC, Coward RM. The Prevalence of Y-chromosome Microdeletions in Oligozoospermic Men: A Systematic Review and Meta-analysis of European and North American Studies. Eur Urol (2019) 76:626–636. doi: 10.1016/j.eururo.2019.07.033

Colaco S, Modi D. Genetics of the human Y chromosome and its association with male infertility. Reprod Biol Endocrinol (2018) 16:14. doi: 10.1186/s12958-018-0330-5

de Souza DAS, Faucz FR, Pereira‐Ferrari L, Sotomaior VS, Raskin S. Congenital bilateral absence of the vas deferens as an atypical form of cystic fibrosis: reproductive implications and genetic counseling. Andrology (2018) 6:127–135.

Podgrajsek R, Hodzic A, Maver A, Stimpfel M, Andjelic A, Miljanovic O, Ristanovic M, Novakovic I, Plaseska-Karanfilska D, Noveski P. Genetic testing for monogenic forms of male infertility contributes to the clinical diagnosis of men with severe idiopathic male infertility. The world journal of men’s health (2025) 43:908.

Zhou F, Li Y, Zhang J, Wang X. Diagnostic yield of exome sequencing in nonobstructive azoospermia (NOA): A systematic review and meta-analysis. PLOS ONE (2025) 20:e0338892. doi: 10.1371/journal.pone.0338892

Oud MS, Houston BJ, Volozonoka L, Mastrorosa FK, Holt GS, Alobaidi BKS, Devries PF, Astuti G, Ramos L, Mclachlan RI. Exome sequencing reveals variants in known and novel candidate genes for severe sperm motility disorders. Human Reproduction (2021) 36:2597–2611.

Katz DJ, O’Donnell L, McLachlan RI, Moss TJ, Boothroyd CV, Jayadev V, Catford SR. The first Australian evidence‐based guidelines on male infertility. Medical Journal of Australia (2025) 223:653–663.

Japari A, El Ansari W. Varicocele repair for severe oligoasthenoteratozoospermia: Scoping review of published guidelines, and systematic review of the literature. Arab Journal of Urology (2025) 23:33–52.

Katz DJ, Nabulsi O, Tal R, Mulhall JP. Outcomes of clomiphene citrate treatment in young hypogonadal men. BJU Int (2012) 110:573–578. doi: 10.1111/j.1464-410X.2011.10702.x

Tadros NN, Sabanegh ES. Empiric medical therapy with hormonal agents for idiopathic male infertility. Indian Journal of Urology (2017) 33:194–198.

Chua ME, Escusa KG, Luna S, Tapia LC, Dofitas B, Morales M. Revisiting oestrogen antagonists (clomiphene or tamoxifen) as medical empiric therapy for idiopathic male infertility: a meta-analysis. Andrology (2013) 1:749–757. doi: 10.1111/j.2047-2927.2013.00107.x

Del Giudice F, Busetto GM, De Berardinis E, Sperduti I, Ferro M, Maggi M, Gross MS, Sciarra A, Eisenberg ML. A systematic review and meta-analysis of clinical trials implementing aromatase inhibitors to treat male infertility. Asian journal of andrology (2020) 22:360–367.

Naelitz BD, Jiang T, Munoz-Lopez C, Sigalos JT, Modiri N, Cannarella R, Mills JN, Parekh N, Nowacki AS, Vij SC. Testosterone and luteinizing hormone predict semen parameter improvement in infertile men treated with anastrozole. Fertility and Sterility (2023) 120:746–754.

de Ligny W, Smits RM, Mackenzie-Proctor R, Jordan V, Fleischer K, de Bruin JP, Showell MG. Antioxidants for male subfertility. Cochrane database of systematic reviews (2022)

Alahmar AT, Sengupta P, Dutta S, Calogero AE. Coenzyme Q10, oxidative stress markers, and sperm DNA damage in men with idiopathic oligoasthenoteratospermia. Clin Exp Reprod Med (2021) 48:150–155. doi: 10.5653/cerm.2020.04084

de Ligny WR, de Bruin JP, Smits RM, Goovaerts IGF, Peeters K, Nap AW, Boxmeer JC, Donker RB, Schoonenberg M, Koks CAM, et al. Antioxidant Treatment and the Chance to Conceive in Men Seeking Fertility Care: The SUMMER Randomized Clinical Trial. JAMA Netw Open (2025) 8:e2532405. doi: 10.1001/jamanetworkopen.2025.32405

Bouhadana D, Godin Pagé M-H, Montjean D, Bélanger M-C, Benkhalifa M, Miron P, Petrella F. The Role of Antioxidants in Male Fertility: A Comprehensive Review of Mechanisms and Clinical Applications. Antioxidants (2025) 14:1013. doi: 10.3390/antiox14081013

Zhang C, Zhang G, Sun K, Ren J, Zhou J, Liu X, Lin F, Yang H, Cao J, Nie L. Association of mixed exposure to microplastics with sperm dysfunction: a multi-site study in China. EBioMedicine (2024) 108:

Mottola F, Carannante M, Palmieri I, Ibello L, Montano L, Pezzullo M, Mosca N, Potenza N, Rocco L. Impact of Polystyrene Microplastics on Human Sperm Functionality: An In Vitro Study of Cytotoxicity, Genotoxicity and Fertility-Related Genes Expression. Toxics (2025) 13:605. doi: 10.3390/toxics13070605

Oliveira LCS de L, Costa EC, Martins FDG, da Rocha AS, Brasil GA. Probiotics supplementation in the treatment of male infertility: A Systematic Review. JBRA Assist Reprod (2024) 28:341–348. doi: 10.5935/1518-0557.20240013

Magill RG, MacDonald SM. Male infertility and the human microbiome. Front Reprod Health (2023) 5: doi: 10.3389/frph.2023.1166201

Minhas S, Boeri L, Capogrosso P, Cocci A, Corona G, Dinkelman-Smit M, Falcone M, Jensen CF, Gül M, Kalkanli A, et al. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 Update on Male Infertility. European Urology (2025) 87:601–616. doi: 10.1016/j.eururo.2025.02.026

Schlegel PN, Sigman M, Collura B, De jonge C. Diagnosıs and treatment of infertility in men: aua/asrm guideline (2020; Amended 2024). (2024)

Latif T, Kold Jensen T, Mehlsen J, Holmboe SA, Brinth L, Pors K, Skouby SO, Jørgensen N, Lindahl-Jacobsen R. Semen quality as a predictor of subsequent morbidity: a Danish cohort study of 4,712 men with long-term follow-up. American journal of epidemiology (2017) 186:910–917.

Tzouma Z, Dourou P, Diamanti A, Harizopoulou V, Papalexis P, Karampas G, Liepinaitienė A, Dėdelė A, Sarantaki A. Associations between endocrine-disrupting chemical exposure and fertility outcomes: a decade of human epidemiological evidence. Life (2025) 15:993.

Rambhatla A, Shah R, Pinggera G-M, Mostafa T, Atmoko W, Saleh R, Chung E, Hamoda T, Cayan S, Park HJ. Pharmacological therapies for male infertility. Pharmacological reviews (2025) 77:100017.

Andrade DL, Viana MC, Esteves SC. Differential diagnosis of azoospermia in men with infertility. Journal of clinical medicine (2021) 10:3144.

Organization WH. WHO laboratory manual for the examination and processing of human semen. World Health Organization. (2021).

Chawre S, Khatib MN, Rawekar A, Mahajan S, Jadhav R, More A, Jadhav ER. A review of semen analysis: Updates from the WHO sixth edition manual and advances in male fertility assessment. Cureus (2024) 16:

Shin D, Sansone A, Krishnappa P, Baazeem A, Bernie HL, Ahsan MS, Thirumavalavan N, Hellstrom WJ, Shah R. Sexual dysfunctions in male patients with infertility: recommendations from the Fifth International Consultation for Sexual Medicine (ICSM 2024). Sexual Medicine Reviews (2026) 14:qeaf073.

Jankowska K, Suszczewicz N, Rabijewski M, Dudek P, Zgliczyński W, Maksym RB. Inhibin-b and FSH are good indicators of spermatogenesis but not the best indicators of fertility. Life (2022) 12:511.

Osadchiy V, Munoz-Lopez C, Jiang T, Naelitz BD, Parekh N, Vij SC, Mills JN, Lundy SD, Eleswarapu SV. Combination clomiphene citrate and anastrozole duotherapy improves semen parameters in a multi-institutional, retrospective cohort of infertile men. Translational Andrology and Urology (2024) 13:245–251.

Kanakis GA, Nordkap L, Bang AK, Calogero AE, Bártfai G, Corona G, Forti G, Toppari J, Goulis DG, Jørgensen N. EAA clinical practice guidelines—gynecomastia evaluation and management. Andrology (2019) 7:778–793. doi: 10.1111/andr.12636

Cohen PG. Obesity in men: the hypogonadal-estrogen receptor relationship and its effect on glucose homeostasis. Med Hypotheses (2008) 70:358–360. doi: 10.1016/j.mehy.2007.05.020

Dabaja AA, Schlegel PN. Medical treatment of male infertility. Translational andrology and urology (2014) 3:9.

Boehm U, Bouloux P-M, Dattani MT, De Roux N, Dodé C, Dunkel L, Dwyer AA, Giacobini P, Hardelin J-P, Juul A. European consensus statement on congenital hypogonadotropic hypogonadism—pathogenesis, diagnosis and treatment. Nature Reviews Endocrinology (2015) 11:547–564.

Zhang L, Cai K, Wang Y, Ji W, Cheng Z, Chen G, Liao Z. The pulsatile gonadorelin pump induces earlier spermatogenesis than cyclical gonadotropin therapy in congenital hypogonadotropic hypogonadism men. American journal of men’s health (2019) 13:1557988318818280.

Black K, Ølgaard S, Khoei AA, Glazer C, Ohl DA, Jensen CFS. The genetic landscape of male factor infertility and implications for men’s health and future generations. Uro (2025) 5:2.

Kohn TP, Kohn JR, Owen RC, Coward RM. The Prevalence of Y-chromosome Microdeletions in Oligozoospermic Men: A Systematic Review and Meta-analysis of European and North American Studies. Eur Urol (2019) 76:626–636. doi: 10.1016/j.eururo.2019.07.033

Colaco S, Modi D. Genetics of the human Y chromosome and its association with male infertility. Reprod Biol Endocrinol (2018) 16:14. doi: 10.1186/s12958-018-0330-5

de Souza DAS, Faucz FR, Pereira‐Ferrari L, Sotomaior VS, Raskin S. Congenital bilateral absence of the vas deferens as an atypical form of cystic fibrosis: reproductive implications and genetic counseling. Andrology (2018) 6:127–135.

Podgrajsek R, Hodzic A, Maver A, Stimpfel M, Andjelic A, Miljanovic O, Ristanovic M, Novakovic I, Plaseska-Karanfilska D, Noveski P. Genetic testing for monogenic forms of male infertility contributes to the clinical diagnosis of men with severe idiopathic male infertility. The world journal of men’s health (2025) 43:908.

Zhou F, Li Y, Zhang J, Wang X. Diagnostic yield of exome sequencing in nonobstructive azoospermia (NOA): A systematic review and meta-analysis. PLOS ONE (2025) 20:e0338892. doi: 10.1371/journal.pone.0338892

Oud MS, Houston BJ, Volozonoka L, Mastrorosa FK, Holt GS, Alobaidi BKS, Devries PF, Astuti G, Ramos L, Mclachlan RI. Exome sequencing reveals variants in known and novel candidate genes for severe sperm motility disorders. Human Reproduction (2021) 36:2597–2611.

Katz DJ, O’Donnell L, McLachlan RI, Moss TJ, Boothroyd CV, Jayadev V, Catford SR. The first Australian evidence‐based guidelines on male infertility. Medical Journal of Australia (2025) 223:653–663.

Japari A, El Ansari W. Varicocele repair for severe oligoasthenoteratozoospermia: Scoping review of published guidelines, and systematic review of the literature. Arab Journal of Urology (2025) 23:33–52.

Katz DJ, Nabulsi O, Tal R, Mulhall JP. Outcomes of clomiphene citrate treatment in young hypogonadal men. BJU Int (2012) 110:573–578. doi: 10.1111/j.1464-410X.2011.10702.x

Tadros NN, Sabanegh ES. Empiric medical therapy with hormonal agents for idiopathic male infertility. Indian Journal of Urology (2017) 33:194–198.

Chua ME, Escusa KG, Luna S, Tapia LC, Dofitas B, Morales M. Revisiting oestrogen antagonists (clomiphene or tamoxifen) as medical empiric therapy for idiopathic male infertility: a meta-analysis. Andrology (2013) 1:749–757. doi: 10.1111/j.2047-2927.2013.00107.x

Del Giudice F, Busetto GM, De Berardinis E, Sperduti I, Ferro M, Maggi M, Gross MS, Sciarra A, Eisenberg ML. A systematic review and meta-analysis of clinical trials implementing aromatase inhibitors to treat male infertility. Asian journal of andrology (2020) 22:360–367.

Naelitz BD, Jiang T, Munoz-Lopez C, Sigalos JT, Modiri N, Cannarella R, Mills JN, Parekh N, Nowacki AS, Vij SC. Testosterone and luteinizing hormone predict semen parameter improvement in infertile men treated with anastrozole. Fertility and Sterility (2023) 120:746–754.

de Ligny W, Smits RM, Mackenzie-Proctor R, Jordan V, Fleischer K, de Bruin JP, Showell MG. Antioxidants for male subfertility. Cochrane database of systematic reviews (2022)

Alahmar AT, Sengupta P, Dutta S, Calogero AE. Coenzyme Q10, oxidative stress markers, and sperm DNA damage in men with idiopathic oligoasthenoteratospermia. Clin Exp Reprod Med (2021) 48:150–155. doi: 10.5653/cerm.2020.04084

de Ligny WR, de Bruin JP, Smits RM, Goovaerts IGF, Peeters K, Nap AW, Boxmeer JC, Donker RB, Schoonenberg M, Koks CAM, et al. Antioxidant Treatment and the Chance to Conceive in Men Seeking Fertility Care: The SUMMER Randomized Clinical Trial. JAMA Netw Open (2025) 8:e2532405. doi: 10.1001/jamanetworkopen.2025.32405

Bouhadana D, Godin Pagé M-H, Montjean D, Bélanger M-C, Benkhalifa M, Miron P, Petrella F. The Role of Antioxidants in Male Fertility: A Comprehensive Review of Mechanisms and Clinical Applications. Antioxidants (2025) 14:1013. doi: 10.3390/antiox14081013

Zhang C, Zhang G, Sun K, Ren J, Zhou J, Liu X, Lin F, Yang H, Cao J, Nie L. Association of mixed exposure to microplastics with sperm dysfunction: a multi-site study in China. EBioMedicine (2024) 108:

Mottola F, Carannante M, Palmieri I, Ibello L, Montano L, Pezzullo M, Mosca N, Potenza N, Rocco L. Impact of Polystyrene Microplastics on Human Sperm Functionality: An In Vitro Study of Cytotoxicity, Genotoxicity and Fertility-Related Genes Expression. Toxics (2025) 13:605. doi: 10.3390/toxics13070605

Oliveira LCS de L, Costa EC, Martins FDG, da Rocha AS, Brasil GA. Probiotics supplementation in the treatment of male infertility: A Systematic Review. JBRA Assist Reprod (2024) 28:341–348. doi: 10.5935/1518-0557.20240013

Magill RG, MacDonald SM. Male infertility and the human microbiome. Front Reprod Health (2023) 5: doi: 10.3389/frph.2023.1166201