The first Australian evidence-based guidelines on male infertility.

introductionInfertility affects about one in six couples and a male factor may contribute to 50% of cases. Until recently, no Australian-based clinical guidelines for the management of male infertility had been published. A panel of experts was assembled to formulate the first Australian evidence-based guidelines on male infertility. MAIN RECOMMENDATIONS: The initial evaluation of male fertility should include a reproductive and medical history, physical (including scrotal) examination and semen analysis, and simultaneous evaluation of the female partner. Further evaluation of men with suspected infertility should be guided by an expert in male reproduction and include hormonal evaluation and an estimate of testicular volume. Extra tests according to clinical indication are sperm DNA testing, somatic genetic testing and imaging. Varicocele treatment should be considered in men with infertility who have a clinical varicocele(s) and associated clinical indications. Men with azoospermia should be evaluated to differentiate between obstructive and non-obstructive azoospermia. Micro testicular sperm extraction is the preferred method of sperm retrieval in men with non-obstructive azoospermia and prior diagnostic biopsy or fine needle aspiration is not required. The management of male infertility should include counselling men regarding potentially modifiable risk factors, associated health conditions, and implications for their future health and offspring. Surgical management of infertility includes retrieval of sperm for use in assisted reproductive technology and treatment of varicocele, and non-surgical management includes management of hormonal disorders. Specific guidelines are included for men with cryptorchidism, varicoceles and Klinefelter syndrome and cancer and male infertility. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES: These first Australian evidence-based guidelines will serve as a long overdue clinical aid to the large number of practitioners who provide services to men with infertility. The broad and comprehensive nature of the guidelines will facilitate evidence-based care for the most common areas of male infertility. The formulation of these guidelines by experts representing key stakeholder organisations should enhance the promotion of the guideline statements and help raise awareness of this common condition.