madman
Super Moderator
European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility (2021)
Abstract Context: The European Association of Urology (EAU) has updated its guidelines on sexual and reproductive health for 2021.
Objective: To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health, including advances and areas of controversy in male infertility. Evidence acquisition: The panel performed a comprehensive literature review of novel data up to January 2021. The guidelines were updated and a strength rating for each recommendation was included that was based either on a systematic review of the literature or consensus opinion from the expert panel, where applicable.
Evidence synthesis: The male partner in infertile couples should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors causing fertility impairment. Infertile men are at a higher risk of harboring and developing other diseases including malignancy and cardiovascular disease and should be screened for potentially modifiable risk factors, such as hypogonadism. Sperm DNA fragmentation testing has emerged as a novel biomarker that can identify infertile men and provide information on the outcomes from assisted reproductive techniques. The role of hormone stimulation therapy in hypergonadotropic hypogonadal or eugonadal patients is controversial and is not recommended outside of clinical trials. Furthermore, there is insufficient evidence to support the widespread use of other empirical treatments and surgical interventions in clinical practice (such as antioxidants and surgical sperm retrieval in men without azoospermia). There is low-quality evidence to support the routine use of testicular fine-needle mapping as an alternative diagnostic and predictive tool before testicular sperm extraction (TESE) in men with nonobstructive azoospermia (NOA), and either conventional or microdissection TESE remains the surgical modality of choice for men with NOA.
Conclusions: All infertile men should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors. Increasing data indicate that infertile men are at higher risk of cardiovascular mortality and of developing cancers and should be screened and counseled accordingly. There is low-quality evidence supporting the use of empirical treatments and interventions currently used in clinical practice; the efficacy of these therapies needs to be validated in large-scale randomized controlled trials.
Patient summary: Approximately 50% of infertility will be due to problems with the male partner. Therefore, all infertile men should be assessed by a specialist with the expertise to not only help optimize their fertility but also because they are at higher risk of developing cardiovascular disease and cancer long term and therefore require appropriate counseling and management. There are many treatments and interventions for male infertility that have not been validated in high-quality studies and caution should be applied to their use in routine clinical practice.
1. Introduction
Infertility is defined as the failure to achieve a spontaneous pregnancy despite 1 yr of practicing regular sexual intercourse without a contraceptive [1]. It has been reported that infertility affects 15% of all couples and contemporary evidence suggests that there has been a decline in global fertility rates from 4.7 to 2.4 live births between 1950 and 2017 [2]. In addition, there has been a parallel decline in sperm counts (0.70 million/ml/yr) observed between 1981 and 2013 [3].
There have been a number of technological advances in both the diagnostic and therapeutic management of male infertility, necessitating an update of the European Association of Urology (EAU) guidelines on male infertility [4]. The male infertility guidelines were first published in 2001 and last updated in 2018 [4]. There are several controversial aspects to the contemporary management of infertile males, confounded by a number of medical specialties that manage these patients, with no clear protocols and guidance on treatment options, resulting in variance in outcomes for patients.
2. Evidence acquisition
3. Evidence synthesis
3.1. Epidemiology and aetiology
3.2. Diagnostic workup
3.2.1. The role of molecular testing
3.2.2. Hormone testing
3.2.3. Genetic testing
3.2.4. Imaging
3.3. Specific conditions
3.3.1. Cryptorchidism
3.3.2. Germ cell tumours
3.3.3. Varicocele
3.3.4. Male accessory gland infections
3.4. Management of male infertility
The management of male infertility can be divided into noninvasive and invasive treatments.
3.4.1. Noninvasive treatments
3.4.2. Surgical management
3.4.2.1. Obstructive azoospermia. OA is the absence of sperm in
3.4.2.2. Nonobstructive azoospermia
3.4.2.3. TESE for men without azoospermia
3.4.2.4. Assisted reproductive technologies
4. Conclusions
The present text represents a summary of the 2021 EAU guidelines on sexual and reproductive health pertaining to male infertility. For approximately 50% of couples with infertility, the cause will be related to a male factor and therefore all infertile men should undergo urological assessment. Increasing data indicate that infertile men are at higher risk of non-oncological and oncological comorbidities and must be screened and counseled accordingly. Currently, there is insufficient evidence to support the plethora of empirical treatments and interventions being used in clinical practice and these therapies need to be validated in large-scale RCTs. For more detailed information and a full list of references, refer to the full-text version available on the EAU website (Uroweb - European Association of Urology (EAU) guideline/sexual-and-reproductive-health/)
Abstract Context: The European Association of Urology (EAU) has updated its guidelines on sexual and reproductive health for 2021.
Objective: To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health, including advances and areas of controversy in male infertility. Evidence acquisition: The panel performed a comprehensive literature review of novel data up to January 2021. The guidelines were updated and a strength rating for each recommendation was included that was based either on a systematic review of the literature or consensus opinion from the expert panel, where applicable.
Evidence synthesis: The male partner in infertile couples should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors causing fertility impairment. Infertile men are at a higher risk of harboring and developing other diseases including malignancy and cardiovascular disease and should be screened for potentially modifiable risk factors, such as hypogonadism. Sperm DNA fragmentation testing has emerged as a novel biomarker that can identify infertile men and provide information on the outcomes from assisted reproductive techniques. The role of hormone stimulation therapy in hypergonadotropic hypogonadal or eugonadal patients is controversial and is not recommended outside of clinical trials. Furthermore, there is insufficient evidence to support the widespread use of other empirical treatments and surgical interventions in clinical practice (such as antioxidants and surgical sperm retrieval in men without azoospermia). There is low-quality evidence to support the routine use of testicular fine-needle mapping as an alternative diagnostic and predictive tool before testicular sperm extraction (TESE) in men with nonobstructive azoospermia (NOA), and either conventional or microdissection TESE remains the surgical modality of choice for men with NOA.
Conclusions: All infertile men should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors. Increasing data indicate that infertile men are at higher risk of cardiovascular mortality and of developing cancers and should be screened and counseled accordingly. There is low-quality evidence supporting the use of empirical treatments and interventions currently used in clinical practice; the efficacy of these therapies needs to be validated in large-scale randomized controlled trials.
Patient summary: Approximately 50% of infertility will be due to problems with the male partner. Therefore, all infertile men should be assessed by a specialist with the expertise to not only help optimize their fertility but also because they are at higher risk of developing cardiovascular disease and cancer long term and therefore require appropriate counseling and management. There are many treatments and interventions for male infertility that have not been validated in high-quality studies and caution should be applied to their use in routine clinical practice.
1. Introduction
Infertility is defined as the failure to achieve a spontaneous pregnancy despite 1 yr of practicing regular sexual intercourse without a contraceptive [1]. It has been reported that infertility affects 15% of all couples and contemporary evidence suggests that there has been a decline in global fertility rates from 4.7 to 2.4 live births between 1950 and 2017 [2]. In addition, there has been a parallel decline in sperm counts (0.70 million/ml/yr) observed between 1981 and 2013 [3].
There have been a number of technological advances in both the diagnostic and therapeutic management of male infertility, necessitating an update of the European Association of Urology (EAU) guidelines on male infertility [4]. The male infertility guidelines were first published in 2001 and last updated in 2018 [4]. There are several controversial aspects to the contemporary management of infertile males, confounded by a number of medical specialties that manage these patients, with no clear protocols and guidance on treatment options, resulting in variance in outcomes for patients.
2. Evidence acquisition
3. Evidence synthesis
3.1. Epidemiology and aetiology
3.2. Diagnostic workup
3.2.1. The role of molecular testing
3.2.2. Hormone testing
3.2.3. Genetic testing
3.2.4. Imaging
3.3. Specific conditions
3.3.1. Cryptorchidism
3.3.2. Germ cell tumours
3.3.3. Varicocele
3.3.4. Male accessory gland infections
3.4. Management of male infertility
The management of male infertility can be divided into noninvasive and invasive treatments.
3.4.1. Noninvasive treatments
3.4.2. Surgical management
3.4.2.1. Obstructive azoospermia. OA is the absence of sperm in
3.4.2.2. Nonobstructive azoospermia
3.4.2.3. TESE for men without azoospermia
3.4.2.4. Assisted reproductive technologies
4. Conclusions
The present text represents a summary of the 2021 EAU guidelines on sexual and reproductive health pertaining to male infertility. For approximately 50% of couples with infertility, the cause will be related to a male factor and therefore all infertile men should undergo urological assessment. Increasing data indicate that infertile men are at higher risk of non-oncological and oncological comorbidities and must be screened and counseled accordingly. Currently, there is insufficient evidence to support the plethora of empirical treatments and interventions being used in clinical practice and these therapies need to be validated in large-scale RCTs. For more detailed information and a full list of references, refer to the full-text version available on the EAU website (Uroweb - European Association of Urology (EAU) guideline/sexual-and-reproductive-health/)
