News

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Male infertility guidelines launched

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The first Australian guidelines to support GPs and other clinicians involved in diagnosing and treating male infertility have been published.
 
In an article in this month’s Medical Journal of Australia, authors state that the advice will ‘serve as a long overdue clinical aid to the large number of practitioners who provide services to men with infertility’ and includes ‘evidence‐based care for the most common areas of male infertility’.  
 
Its authors also note while the male contribution to couple infertility has been recognised by international clinical practice guidelines for more than 20 years, no Australian‐based version had previously existed.
 
‘There is a need for a unifying set of guidelines … relevant to the Australian context,’ they wrote, pointing towards the range of medical specialists, including GPs, urologists, endocrinologists, and obstetricians and gynaecologists, who manage male infertility.
 
‘By providing these guidelines, we are trying to give practitioners involved in fertility care a solid base of evidence upon which to learn more and to practice better,’ said co-author Professor Rob McLachlan.
 
An endocrinologist and andrologist who works as the Medical Director at Healthy Male, which provides evidence-based information on male health, Professor McLachlan said the management of male infertility in Australia has been ‘inconsistent, fragmented and often overlooked’.
 
‘Without clear national guidance, different specialties have been approaching infertility in their own way, sometimes without a strong evidence base,’ he said.
 
‘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.’
 
The guidelines include 80 recommendations, with eight specifically addressed to GPs.
 
With advice ranked according to the strength of the evidence, there are three ‘mandatory’ recommendations for GPs including that:

• an initial evaluation of male fertility should include a reproductive and medical history, physical (including scrotal) examination and semen analysis
• a concurrent evaluation of the female partner takes place
• semen analysis is offered according to current WHO Laboratory Manual for the Examination and Processing of Human Semen. If the first analysis is abnormal, a second semen analysis is performed around six weeks later, or longer if clinically indicated.

Five other actions are categorised as ‘recommended’, rather than mandatory:

• The female partner should undergo a parallel assessment of her fertility status, including ovarian reserve, as this might influence clinical decision-making regarding the timing and type of intervention (such as assisted reproductive technologies versus surgical intervention)
• Men with one or more abnormal semen parameters or those with suspected male factor infertility should be further evaluated by a specialist in male reproduction where available
• Do not perform antisperm antibody testing in the initial evaluation of male infertility
• Advise all men to undertake monthly testicular self-examination until the age of 55
• Do not routinely perform scrotal ultrasound in the initial evaluation

Research suggests infertility affects around one in every six couples worldwide, with male factors the sole cause in around 20–30% of cases and a combination of male and female factors responsible in a further 20–30% of cases.
 
The full guidelines are available on the Healthy Male website.
 
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clinical guidelines male infertility

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