Athina Kaprara, Maria Karaflou, Dimitrios G. Goulis
Endocrinology Research and Practice - 2026;30(1):46-54
Male infertility represents a major and often under-recognized contributor to couple infertility, accounting for approximately half of all cases worldwide. Its etiology is heterogeneous, encom- passing pre-testicular, testicular, post-testicular, and idiopathic causes, frequently interacting with genetic, environmental, lifestyle, and systemic factors. Advances in reproductive medicine have significantly enhanced the diagnostic and therapeutic armamentarium available for evaluating and managing infertile men. This review provides a comprehensive overview of the physiology of male reproduction, the etiological classification of male infertility, and the contemporary clinical approach to evaluation, emphasizing the importance of detailed history taking, targeted physical examination, and evidence-based use of laboratory and imaging investigations to aid diagnosis. Particular atten- tion is given to the evolving role of advanced diagnostic modalities, including genetic testing, sperm DNA fragmentation assessment, and the use of emerging biomarkers. Management strategies are discussed across the full spectrum of care, ranging from lifestyle optimization and medical therapy to microsurgical interventions and assisted reproductive technologies. Special clinical scenarios, such as nonobstructive azoospermia, fertility preservation in oncology patients, and genetic counseling prior to assisted reproduction, underscore the need for individualized care. Finally, this review explores emerging technologies and future directions, including advanced genomic diagnostics, microfluidic sperm selection, and experimental stem cell-based approaches. By integrating recent advances with established clinical principles, this article aims to provide clinicians with a structured multidisciplinary framework for the modern management of male infertility while identifying current gaps in knowl- edge and priorities for future research.
