more_vert
Australia’s first evidence-based guidelines for male infertility will serve as a long overdue clinical aid to practitioners who provide fertility care to men.
About one in six Australian couples are impacted by infertility, and male infertility may be a factor in 50% of those cases.
While male infertility care has been guided by international guidelines for decades, Australian-based guidelines have not existed.
Now, a panel of experts has formulated Australia’s first evidence-based guidelines on male infertility, and a summary of the recommendations has been published in the Medical Journal of Australia.
Lead author, Clinical Associate Professor Darren J Katz, said the inspiration came to him for Australian guidelines more than a decade ago when he was having sub-speciality training in New York.
“Whilst I was there, I realised that there are just so many advancements in male infertility that I didn’t even know about or come across during my training here in Australia,” A/Prof Katz said.
“So I brought some of these techniques, these operations and these approaches back to Australia for the treatment of male infertility back here in Australia and I slowly began to try and change the way that male infertility was managed in Australia but the truth is trying to change entrenched practises of doctors in medicine, no matter what the area of medicine is notoriously difficult.”
About three years ago a panel of male infertility experts got together with A/Prof Katz and decided as a team to develop the first guidelines on managing male 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,” A/Prof Katz said.
80 recommendations to support clinicians
The guidelines were formulated by a multidisciplinary panel of experts, who reviewed each statement from the European and American guidelines and discussed whether the statements were applicable in an Australian setting.
Ultimately, 80 guidelines statements were produced to assist in the assessment and management of male infertility, encompassing initial evaluation, management and therapeutic considerations.
The main recommendations are:
- 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.
The guidelines have been endorsed the Urological Society of Australia and New Zealand, the Endocrinological Society of Australia and New Zealand, the Fertility Society of Australia and New Zealand and Healthy Male — funded by the Department of Health.
“I really think this is going to be a game changer in male infertility and how male infertility is managed in our country,” A/Prof Katz said.
“Male infertility can cause a lot of mental stress but it’s a common stress and makes you feel you’ve lost part of your manhood.”
Giving men hope about conceiving and fulfilling their dreams of being a biological father is another main aim of the guidelines.
“I’ve lost count of the number of men who’ve come to see me in my clinic who have been told that there was no hope, but after treatment they’re dreams of becoming a father have been realised.”
“I really think these guidelines are about hope, hope for men and giving them the best chance that they to being a biological father.
A/Prof Katz describes the joy of seeing his patients who’ve been successfully treated.
“A year or two down the track they walk in with a baby and they’re just beaming.”
“And they’ve come from being told it’s impossible and then it’s just happened and I can tell you on both sides of the consultation desk there’s emotions … I invest a lot in my patients, I know how important this is for patients to have children.”
“To be able to help patients achieve their dreams and their goals, I really do feel privileged.”
Read the guideline summary in the Medical Journal of Australia.
Listen to the MJA podcast with A/Prof Katz.
Sally Block is the editor of the MJA’s InSight+. She is a former ABC Journalist.
Annika Howells is the sub-editor of the MJA’s InSight+.
Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.