AUA, ASRM release amendment to male infertility guideline

The American Urological Association (AUA), in collaboration with the American Society for Reproductive Medicine (ASRM), has released an amendment to the male infertility guideline, the AUA announced in a news release.¹

The guideline includes 54 recommendations on the evaluation and management of male infertility.

The guideline, which was first published in 2021, outlines recommendations for the evaluation and management of the male partner in an infertile couple.²

“We are excited to share this updated version of the male infertility guideline. This amendment builds on the outstanding, inaugural version of the male infertility guideline that was published in 2021. The updated guideline includes numerous new, important recommendations that will enhance the ability of urologists to provide optimal, state-of-the-art care for infertile males,” said Guideline Amendment Chair Robert E. Brannigan, MD, in the AUA news release.¹ Brannigan is also a professor of urology at Northwestern University’s Feinberg School of Medicine in Chicago, Illinois.

In total, the guideline includes 54 recommendations on the evaluation and management of male infertility.

According to the AUA, the updates to the guideline include:

• “Update to a recommendation on evaluating azoospermic patients
• Update to a recommendation on karyotype testing
• Updates on which imaging modalities should or should not be used when evaluating patients
• A new recommendation on utilization of testicular sperm in nonazoospermic patients
• Updates to the WHO reference ranges for human semen characteristics
• A new table defining common terms in semen analysis”¹

Paula Amato, MD, ASRM president, added in the news release,¹ “Male infertility contributes to 50% of cases and also provides a window into male general health. These guidelines will assist health care providers with the evaluation and management of male infertility, leading to improved male reproductive potential, offspring health, and men's general health.”

Overall, the 54 guideline statements span upfront assessment, lifestyle factors and relationships between infertility and general health, diagnosis/assessment/evaluation, imaging, and treatment of male infertility. The specific treatments covered in the guideline include varicocele repair/varicocelectomy; sperm retrieval; obstructive azoospermia, including post-vasectomy infertility; medical and nutraceutical interventions for fertility; and gonadotoxic therapies and fertility preservation.

For the guideline amendment, the guideline committee conducted an updated literature review and identified 125 studies that met the criteria for inclusion. Of these, 22 were chosen to inform the final evidence base. Included studies were published between January 2000 and May 2019.

According to the authors, future directions in male infertility may include the incorporation of next-generation sequencing, an understanding of the impact of certain lifestyle factors and behaviors, the advancement of therapeutics for male infertility, and exploration of gene therapy approaches.

The authors concluded, “In closing, the genomic revolution has placed us at the forefront of vastly improving our diagnostic abilities to define precise etiologies, co-morbidities, and eventually (perhaps) develop medically-based treatments for infertile males to improve not only their fertility potential, but also their overall health. Translation of the newer advances discussed above will be slower but will eventually move from the laboratory to the clinical arena to provide more therapeutic options for males. The future looks promising for improving the health and fertility of the infertile male through precision medicine and the application of advanced technologies.”²

References

1. American Urological Association releases Male Infertility Guideline Amendment. News release. American Urological Association. August 15, 2024. Accessed August 16, 2024. https://www.auanet.org/about-us/media-center/press-center/american-urological-association-releases-male-infertility-guideline-amendment

2. Brannigan RE, Hermanson L, Kaczmarek J, Kim SK, Kirkby E, Tanrikut C. Updates to male infertility: AUA/ASRM guideline (2024). J Urol. Published online August 15, 2024. doi:10.1097/JU.0000000000004180