Clinical Recommendations for the Management of Male Infertility: A Consensus from the Korean Society for Sexual Medicine and Andrology (KSSMA) Clinical Practice Guideline Committee

Male infertility significantly contributes to the global reproductive burden and serves as a critical indicator of overall male health. As clinical pathways have historically focused on female-factor evaluation and assisted reproductive technology (ART), there is an increasing need for etiology-directed and time-sensitive male management strategies. This Clinical Recommendation, developed by the Korean Society for Sexual Medicine and Andrology Guideline Committee, synthesizes recent evidence from major international guidelines with specific considerations for the Korean healthcare environment. Management should be couple-centered, integrating the female partner’s reproductive timeline to avoid preventable delays in effective therapy. Core recommendations emphasize addressing modifiable risk factors as foundational care, while restricting empiric pharmacotherapy to phenotype-driven, time-limited trials. Disease-specific pathways for varicocele, endocrine disorders, and obstructive/nonobstructive azoospermia are delineated, emphasizing the individualized selection between microsurgical reconstruction and surgical sperm retrieval. In the ART interface, the selective use of intracytoplasmic sperm injection is recommended, prioritizing safety and the prevention of multiple pregnancies. Furthermore, structured follow-up should prioritize patient-important outcomes, such as live birth and treatment burden, over intermediate semen parameter changes. By harmonizing international evidence with local clinical constraints, including national insurance structures and referral patterns, these recommendations aim to facilitate consistent, safe, and patient-centered care for infertile men in Korea.