Five patients who consulted for orchialgia in whom the diagnosis of testicular microlithiasis was made by means of scrotal sonography, are reported. Four of them showed oligo or azoosperm and also four had their testis diminished in size. The echographic findings are characteristic and they consist of multiple small echogenic non shadowing images, randomly distributed within both testis. Pathology was available in three cases. Atrophy of the germinal epithelium with impairment of the spermiogenesis associated with intratubular calcic microspheres was demonstrated. There are few reports in the literature regarding testicular microlithiasis and until now we have not heard about an association between testicular microlithiasis, orchialgia and oligo or azoosperm. The diagnosis can be done by means of scrotal sonography. This imaging method should be considered in the work-up of male infertility.