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varicocele, or if speci c risk factors (such as increased age, presence of systemic or genital infections, exposure to environmental toxins or ionizing radiation) are present [8].

ASA testing should be considered only if the presence of antibodies will affect the management of the patient. Detection of antibodies has been reported to be associated with vasal or epididymal obstruction, and prior testicular trauma or surgery. The presence of ASA may negatively affect some forms of assisted reproduction techniques (ART), such as intrauterine insemination (IUI), but these effects may be bypassed with other forms of ART like intracytoplasmic sperm injection (ICSI) [9].

Imaging

No routine imaging is recommended during the evaluation of infertile men [1]. However, some imaging studies may be considered in special circumstances. Scrotal ultrasound imaging can be performed when the body habitus or consistency of the scrotal contents precludes a thorough examination of the spermatic cord or it is unclear whether a varicocele is present. When obtaining a scrotal ultrasound for varicocele evaluation, the size of and fow in the paratesticular veins should be the focus. The ultrasonographer should measure these parameters with the patient in the standing and supine positions with and without Valsalva maneuvers. Reversal of fow with Valsalva maneuvers should be documented. Typically, varicoceles are present if the veins are greater than 2.5 mm in diameters, or if the veins are serpiginous in appearances, or there is reversal of fow.

Renal ultrasonography may be considered in patients with vasal agenesis to evaluate for renal abnormalities [1]. Because the male reproductive tract is derived from the Wolf an duct, during embryogenesis, anomalies in the reproductive tract can occur with concomitant anomalies in the urinary tract. In men with unilateral absence of the vas deferens, 26–75% may have ipsilateral renal anomalies (including renal agenesis), whereas approximately 10% of men with bilateral absence of the vas deferens have renal anomalies [10].

In conclusion, speci c guidelines exist for the evaluation of the infertile male in an evidence-based manner. Our patient suffered from severe oligozoospermia as well as asthenospermia (low motility) and teratozoospermia (abnormal morphology). His underlying spermatogenic dysfunction was likely due to his history of cryptorchidism. Despite early xation of the testes in the scrotum by orchiopexy, irreversible damage to the testes can occur resulting in subor infertility. A thorough history and physical as well as laboratory testing is important so that appropriate counseling and effective treatments can be provided to the patient.