Guidelines for management of male infertility published in Australia

The first Australian evidence-based guidelines for the clinical management of male infertility have been published by a panel of experts.

The guidelines include a total of 80 recommendations for assessing, diagnosing and managing male infertility problems. The authors recommend that GPs' initial assessment should include medical history, physical examination (including scrotal examination) and semen analysis. Evaluation of the female partner is recommended to take place in parallel. The complete guidelines are freely available on the Healthy Male website, an organisation funded by the Australian Government Department of Health, Disability and Ageing that aims to educate, inform and empower men about their health.

'By simultaneously evaluating fertility in both the male and female partner, it will mean men with fertility issues will be picked up earlier and could change the treatment course for the couple,' said Dr Liza O'Donnell, a senior research scientist at Griffith University, Brisbane, Australia, and co-author of the guidelines. 'By identifying male fertility issues early, women could potentially avoid unnecessary investigations and stress associated with not being able to conceive.'

The guidelines were developed by a multidisciplinary panel of experts and endorsed by the Urological Society of Australia and New Zealand, the Endocrine Society of Australia, and the Fertility Society of Australia and New Zealand.

Some of the recommendations are specific to further evaluations, to be performed only when required, such as genetic testing and imaging. Others refer to treating the causes of infertility once these are identified. These include hormone treatments, for example, and a variety of surgical and non-surgical treatments of azoospermia – the medical term for the absence of sperm cells in the semen.

'In Australia, one in three assisted reproductive technology cycles are used because of male factor infertility, and male factors solely explain 20-30 percent of cases and contribute to 50 percent [of] cases of couple infertility overall,' the authors wrote in an accompanying summary paper, published in the Medical Journal of Australia. They added that the aim of the guidelines is to support the variety of clinical specialists that manage male infertility in Australia.

The recommendations were based on recently published guidelines from the European Association of Urology and from the American Urological Association. The panel discussed each statement from these guidelines, analysed their applicability for the Australian context and graded the level of scientific evidence for their implementation from very low to high. Based on expert opinion and on the level of scientific evidence backing the statement, the guidance also categorises the strength of each recommendation for clinicians as 'suggested', 'recommended' or 'mandatory'.

'My hope is simple: that these guidelines bring men into the fertility conversation where they belong and give clinicians the clarity and confidence they need to deliver equitable, effective care,' said Professor Robert McLachlan, from Monash University, Melbourne, Australia, one of the authors, and medical director at Healthy Male.