JAMA: The Journal of the American Medical Association: Published on November, 2022

American Urological Association (AUA) and American Society for Reproductive Medicine (ASRM) provide an overview of current guidelines on the evaluation and treatment of male infertility and is an important tool for providers caring for these patients.

With up to 20% of infertility cases observed in couples caused by male factors alone and with fertility specialists being increasingly difficult to access, understanding how to evaluate male infertility in a primary care clinic is paramount.

Male infertility is a significant contributor to infertility in couples and can arise from a variety of conditions.

TAKE-HOME MESSAGE

The synopsis provides an overview of the evaluation of male infertility and important considerations for both the treatment of this condition and the health of the patient and their offspring after treatment.

MAJOR RECOMMENDATIONS

- Semen analysis should guide management, and clinicians should obtain hormonal evaluation including follicle-stimulating hormone and testosterone for men with impaired libido, erectile dysfunction, oligozoospermia (<15 million sperm/mL) or azoospermia, atrophic testes, or evidence of hormonal abnormality on physical evaluation (expert opinion)

- Infertile men and men with abnormal semen parameters should be advised of the relevant, associated health risks and conditions

- Surgical correction of palpable varicocele(s) should be considered for infertile men with sperm in the ejaculate and abnormal semen parameters

- For men with nonobstructive azoospermia who are undergoing sperm retrieval, microdissection testicular sperm extraction should be performed

- Men should be informed about the adverse effects of cancer treatments (chemotherapy, radiation therapy, surgery) on fertility and offered sperm cryopreservation before initiation of these therapies

- Testosterone monotherapy should not be prescribed for men interested in current or future fertility, but other therapies (aromatase inhibitors, human chorionic gonadotropin, selective estrogen receptor modulators) can be used in these men to treat low testosterone