Jin Zhou, Shenghui Wang, Zhen Cheng
Testicular microlithiasis (TM) is frequently observed in infertile men, but its clinical significance remains controversial. This study aimed to systematically summarize the testicular characteristics, semen parameters, and reproductive hormone profiles of infertile men with TM and to describe the differences across TM subtypes. A systematic literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science from inception to November 14, 2025. Eligible studies included infertile male patients with ultrasound-confirmed TM. Data on testicular history, semen parameters, and hormonal profiles were extracted. Pooled prevalence estimates or pooled mean values were calculated using fixed- or random-effects models. Subgroup analyses were performed based on TM classification: classical (CTM) and limited (LTM). Thirteen studies were included. The pooled prevalence estimates of cryptorchidism, testicular cancer, and varicocele in infertile men with TM were 10.0%, 7.0%, and 37.0%, respectively. The pooled prevalence estimates of cryptorchidism, testicular cancer, and varicocele in infertile men with TM were 10.0%, 7.0%, and 37.0%, respectively. The pooled mean sperm concentration was 20.17 × 106/mL. Subgroup analysis showed that CTM was associated with significantly lower sperm concentration than LTM (P = 0.042), whereas no significant differences were observed between CTM and LTM for sperm morphology or gonadotropin levels.. In conclusion, this meta-analysis provides a descriptive synthesis of clinical findings, semen characteristics, and endocrine profiles in infertile men with TM.