To understand testicular microlithiasis, its possible effect on sperm health and what it means for fertility, we spoke with Dr Shwetha Krishnamurthy, Consultant - Obstetrics & Gynaecology, Laparoscopic surgeon, SPARSH Hospital, Yeswanthpur.
What Is Testicular Microlithiasis?
Testicular microlithiasis is a condition in which tiny calcium deposits, or microcalcifications, appear in testicular tissue on a scrotal ultrasound.These deposits usually appear as small, bright spots on the ultrasound. They are found in a relatively small proportion of men and may be detected when an ultrasound is performed for another reason.
The finding itself is not the same as testicular cancer. Testicular microlithiasis can also occur in men without cancer or other serious testicular problems.
What Causes Testicular Microlithiasis?
The exact reason why these tiny calcifications develop is not fully understood.It may form from changes or degeneration within the seminiferous tubules, where sperm are produced. The condition has also been observed alongside certain testicular and reproductive conditions.
Testicular microlithiasis has been reported in men with:
- Undescended testicles
- Infertility or impaired sperm production
- Testicular atrophy
- Varicocele
- Testicular torsion
- Klinefelter syndrome
- Hypogonadism
- A history of testicular germ cell tumour
How Is Testicular Microlithiasis Diagnosed?
A scrotal ultrasound is the main test used to identify testicular microlithiasis.If fertility is a concern, your doctor may also recommend:
- Semen analysis to assess sperm concentration, movement and morphology
- Physical examination of the testicles
- Hormonal tests when indicated
- Assessment for conditions such as varicocele or an undescended testicle
- Additional investigations based on your medical history
Does Testicular Microlithiasis Affect Fertility?
The relationship between testicular microlithiasis and fertility is not completely clear.A 2024 systematic review found that men with testicular microlithiasis generally had lower semen parameters, particularly sperm concentration, although the authors noted that pregnancy outcomes need further study.
Other research suggests that the effect may be more noticeable when microlithiasis is bilateral or occurs alongside other testicular conditions. This study also found that bilateral microlithiasis was associated with slightly lower testicular volume, sperm concentration, and total sperm count.
Testicular microlithiasis is an ultrasound finding and should not be interpreted as infertility by itself. When fertility is a concern, semen analysis and evaluation of the overall testicular health help us understand whether there is any impact on sperm production.
Does Testicular Microlithiasis Increase the Risk of Testicular Cancer?
This is an important part of understanding the condition.Testicular microlithiasis itself is not considered cancer, and most men with isolated microlithiasis may not develop testicular cancer. However, it can occur alongside established risk factors for testicular germ cell tumours.
According to the European Association of Urology, additional risk factors include:
- Previous testicular germ cell tumour
- Undescended testicle
- Testicular atrophy
- Infertility or impaired sperm production
- Bilateral microlithiasis in certain clinical settings
Is Treatment Needed for Testicular Microlithiasis?
No specific medicine removes testicular microlithiasis.If treatment is needed, it focuses on an associated condition rather than the calcifications themselves. For example, if a man has a separate fertility problem, such as a varicocele or abnormal semen parameters, the doctor may evaluate and manage that condition.
If fertility is a concern, your doctor may recommend semen testing and appropriate fertility evaluation.
When Should You See a Doctor?
Speak with a urologist or fertility specialist if:- You are trying to conceive and have an abnormal semen analysis
- Microlithiasis is present along with testicular atrophy
- You have a history of an undescended testicle
- You have previously had testicular cancer
- You notice a testicular lump, swelling or persistent discomfort
- You have concerns about your sperm count or fertility
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FAQs on Tiny Spots on Testicles: What Do They Mean for Fertility?
- Can testicular microlithiasis cause pain?
Usually, no. Persistent pain, swelling or a lump should be evaluated by a doctor. - Should I get a semen analysis if microlithiasis is found?
If you are trying to conceive, your doctor may recommend a semen analysis to check your sperm health. - Can testicular microlithiasis go away?
The calcifications usually remain visible on ultrasound, but they generally do not require treatment on their own.
