Emerging Diagnostics Tools for Severe Male Infertility and Non-obstructive Azoospermia

A review of upcoming fertility tests genomics, AI, imaging with zero new data of its own

Journal: Urology | Published: 2026-02-20 | Type: Journal Article, Review | PMID: 41724393 Authors: Nelson Brantley (Baylor University), Smith Harrison (Baylor University), Smith Ryan P (University of Virginia), Kohn Taylor P (Baylor College of Medicine) Funding/COI: No funding listed. Ryan Smith discloses an employment relationship with PS Fertility, a fertility services company.

Summary

This is a narrative review, not a study. The authors round up emerging diagnostic approaches for severe male infertility and non-obstructive azoospermia, genomic and transcriptomic panels, proteomics, sperm function tests, newer imaging, and AI-assisted analysis, and argue the field has been diagnostically stagnant for a decade. There's no original data here, no patient cohort, and no quantified outcomes; it's a literature roundup of what other people's studies have found.

Claims

• Male infertility affects roughly 1 in 10 men (a background epidemiological figure, not a new finding).
• Diagnostic guidelines have seen "few changes" in the past decade despite advances elsewhere in the field.
• "-Omics" approaches (genomics, transcriptomics, proteomics), sperm function testing, advanced imaging, and AI integration are identified as emerging diagnostic categories worth watching.
• No effect sizes, sensitivity/specificity figures, or sample sizes are reported in the abstract for any specific tool.

Study Quality

This is a narrative review, the least rigorous review format. There's no stated systematic search strategy, no inclusion/exclusion criteria, no PRISMA flow diagram, and no quality appraisal of the underlying studies it cites. That means readers have no way to judge whether the "emerging tools" discussed represent a comprehensive picture of the field or a curated selection of what the authors found interesting or convenient to cite.

The abstract itself is aspirational rather than evidentiary, phrases like "hopefully allow to continue to unlock" signal the authors are describing potential, not demonstrated performance. Without the full text, no numbers can be verified here; this summary is limited to what the abstract discloses, which is essentially nothing quantitative.

Red Flags

• No systematic methodology disclosed, this is a narrative, not systematic, review
• No funding source listed
• Co-author Ryan Smith is employed by PS Fertility, a commercial fertility company, an undisclosed-scope conflict given the paper's subject matter overlaps with that company's business
• Abstract contains no effect sizes, sample sizes, or diagnostic accuracy statistics for any tool discussed
• No mention of which specific genomic panels, proteomic assays, or AI models were evaluated, or how

Strengths

• Multi-institutional author group spanning three academic urology programs (Baylor University, University of Virginia, Baylor College of Medicine)
• Addresses a genuinely under-discussed problem: diagnostic guideline stagnation in male infertility
• Broad scope covering multiple emerging modalities rather than a single technology, useful as a starting map for further reading

Verdict

This is a scoping opinion piece dressed as a review, useful as a reading list for clinicians wanting to know what's on the horizon, but it contains no data to critique and no methodology to evaluate. The undisclosed-scope industry tie (PS Fertility) combined with the absence of a systematic search process means this belongs in the "starting point for further reading" category, not the "evidence base" category.