Diagnosis and Treatment of Infertility in Men: 2021 AUA/ASRM Guideline
A number of advancements have occurred in the field of male infertility over the past decade which have been effectively brought together in a coherent, evidence-based document produced with contributions from experts from the American Urological Association as well as the American Society for Reproductive Medicine. Key areas of clinically relevant new standards for care are outlined throughout this guideline, which was so extensive that it needed to be published in two sections, simultaneously presented in the Journal of Urology1,2 and Fertility and Sterility.3,4
A body of new data has identified the relationship between male infertility and a series of medical conditions. Men with infertility are at increased risk of medical comorbidities, and men with more severe defects in spermatogenesis have an increased risk of germ cell tumors. Overall morbidity is higher for men with more abnormal semen parameters as well. Of note, men with azoospermia have an increased risk of all cancers. These accumulated data provide urologists a clear rationale for counselling of infertile men regarding these medical conditions.
Standard evaluation of infertile men is emphasized as well as the relevance of varicoceles and the Level I evidence that supports varicocele repair for infertile men with impaired semen parameters and clinical varicoceles. Additional new guidance is provided for men with cancer, which is important for their future fertility potential. The importance of sperm banking prior to surgery or chemotherapy for cancer is emphasized in one of the guideline statements, as well as the importance of patient counselling regarding risks of aspermia after advanced testicular cancer therapy. The temporary adverse effect of chemotherapy or radiation on sperm quality is recognized by recommendations to defer fertility attempts for 1 year after treatment to limit risks of birth defects. The guideline statement emphasizing the value of semen analysis 1 to 2 years after chemotherapy also provides practical guidance for practitioners.
Taken together, this new guideline provides important guidance in a wide variety of areas important for the evaluation, management, and counselling of men in an infertile relationship. It is well worth the read.