ObjectivesTesticular ultrasound is important in the assessment of male infertility and adding strain elastography to the protocol can help clarify the underlying etiology. Material and Methods78 participants (64 with abnormal, 14 with normal semen parameters) underwent sperm analysis and testicular US including strain elastography. Semen parameters, testicular volumes, strain elastography parameters were compared between groups using independent samples T-tests, least squares regression, Spearman’s rank correlation. ResultsParticipants with abnormal semen parameters exhibited reduced testicular volumes (left: p<0.0003, right: p<0.0004) and epididymis diameters (left: p<0.01, right: p<0.006), and higher strain ratios (left: p<0.006, right: p<0.001). The first PLS latent variable explained a significant amount of variance in semen parameters (p<0.0002) and showed that bilateral strain ratios, left testicular volume and left appendix size were the most important predictors. Elevated strain ratios came with reduced sperm cell number (right: R=-0.45, p<0.0001; left: R=-0.46, p<0.0001), sperm concentration (right: R=-0.46, p<0.0001; left: R=-0.48, p<0.0001), total (right: R=-0.39, p<0.001) and progressive motility (right: R= -0.4, p<0.001), non-motility (left: R=-0.37, p<0.003) normal morphology (right: R=-0.37, p<0.003). ConclusionWe confirm previous reports of correlation between sperm parameters, testis volume and epididymis diameter. Furthermore, we show that strain elastography parameters are strong predictors of semen parameters.