Fertility problems: assessment and treatment

  • NICE guideline
  • NG257
  • Published: 
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Management of male factor fertility problems

1.24 Medical management

1.24.1

Offer gonadotrophin therapy to treat men, and trans women and non-binary people with male reproductive organs who have hypogonadotropic hypogonadism. [2026]

1.24.2

Only consider gonadotrophin or anti-oestrogen therapy for men, and trans women and non-binary people with male reproductive organs who have impaired semen parameters and no hypogonadotropic hypogonadism as part of a clinical trial. [2026]

1.24.3

Do not offer androgens to treat semen abnormalities. [2026]

1.24.4

Explain that the significance of antisperm antibodies is unclear and the effectiveness of systemic corticosteroid treatment for antisperm antibodies is uncertain. [2004]

1.24.5

Do not offer antibiotic treatment to treat leukocytes in the semen unless there is an identified infection because there is no evidence that this improves pregnancy rates. [2004]

1.24.6

Do not offer supplements, antioxidants or medical treatments to improve sperm DNA integrity (fragmentation). [2026]

For a short explanation of why the committee made the 2026 recommendations and how they might affect practice, see the rationale and impact section on medical management of male factor fertility problems.

Full details of the evidence and the committee's discussion are in:

1.25 Azoospermia

1.25.1

Offer men, and trans women and non-binary people with male reproductive organs surgical correction or surgical sperm retrieval to treat obstructive azoospermia. When deciding which treatment to offer, take into account the following factors:

  • female fertility factors (for example, age, ovarian reserve, tubal patency and ovulatory status)

  • the obstructive interval if known

  • the risks and benefits of the surgical intervention

  • the person's preference. [2026]

1.25.2

Offer surgical sperm retrieval to manage non-obstructive azoospermia. [2026]

1.25.3

When carrying out surgical sperm retrieval for non-obstructive azoospermia (see recommendation 1.25.2), consider microscopic testicular sperm extraction (micro-TESE). [2026]

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on azoospermia.

Full details of the evidence and the committee's discussion are in:

1.26 Y chromosome microdeletions

1.26.1

Do not offer surgical sperm retrieval in the presence of Y chromosome AZF a or b microdeletion. [2026]

For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on Y chromosome microdeletions.

Full details of the evidence and the committee's discussion are in evidence review T: Y chromosome microdeletion.

1.27 Reduced sperm DNA integrity

1.27.1

Do not offer surgical sperm retrieval as a way to improve outcomes for men, and trans women and non-binary people with male reproductive organs who have non-azoospermia and reduced sperm DNA integrity (elevated fragmentation levels). [2026]

For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on reduced sperm DNA integrity.

Full details of the evidence and the committee's discussion are in evidence review S: sperm DNA fragmentation.

1.28 Varicocele

1.28.1

Consider radiological or surgical treatment (taking into account female fertility factors) for men, and trans women and non-binary people with male reproductive organs who have varicocele detected on clinical examination, and who:

  • are trying to conceive spontaneously, and

  • have reduced semen parameters. [2026]

For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on varicocele.

Full details of the evidence and the committee's discussion are in evidence review X: treatments for varicocele.

1.29 Ejaculatory failure

1.29.1

For men, and trans women and non-binary people with male reproductive organs who have ejaculatory failure, identify the cause to determine the most appropriate and least invasive method of managing the issue. [2026]

For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on management of ejaculatory failure.

Full details of the evidence and the committee's discussion are in evidence review V: treatments for ejaculatory failure.