Key updates from the AUA/ASRM male infertility guideline amendment

In this episode of Speaking of Urology^®, Robert E. Brannigan, MD, speaks with Juan J. Andino, MD, MBA, on the recent amendment to the American Urological Association (AUA)/American Society for Reproductive Medicine (ASRM) guideline on male infertility.¹ Brannigan is the vice chair of clinical urology and the chief of male reproductive medicine and men’s health at Northwestern University in Chicago, Illinois, as well as one of the Guideline Amendment Chairs for the AUA male infertility guideline. Andino is an assistant professor of urology at the University of California, Los Angeles (UCLA) Health.

This discussion originally took place during a live X (formerly Twitter) Spaces event held by Urology Times^®.

During the discussion, Brannigan and Andino highlight 3 key changes to the male infertility guideline, which include:

• The recommendation for lower the sperm concentration threshold to perform Y chromosome microdeletion testing (statement 13)
• The recommendation to add pelvic MRI imaging an option for men with suspected ejaculatory duct obstruction. Formerly, the main option was TRUS/Seminal Vesicle aspiration (statement 23)
• The recommendation to add use of testicular sperm as an option in the setting of men with elevated sperm DNA fragmentation testing and infertility (statement 32)

Other key changes addressed throughout the discussion include the additional situations in which a male should be evaluated even if the semen analysis is normal; the avoidance of exogenous therapy if a patient is interested in current or near future fertility; and the situations where a scrotal ultrasound may be useful, give that is not needed as a routine test. Brannigan and Andino also touch on the potential role for seminal vesiculoscopy, which is not included in the guidelines, and the ASRM’s broadened definition of infertility.

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Reference

1. Brannigan RE, Hermanson L, Kaczmarek J, Kim SK, Kirkby E, Tanrikut C. Updates to male infertility: AUA/ASRM guideline (2024). J Urol. August 15, 2024. Accessed September 23, 2024. doi:10.1097/JU.0000000000004180