Diagnosis and Treatment of Infertility in Men: AUA/ ASRM Guideline

Flashcards about the diagnosis and treatment of infertility in men.

What is the purpose of this guideline?

To outline the appropriate evaluation and management of the male in an infertile couple.

What should the initial evaluation of the male for fertility include?

A reproductive history and one or more semen analyses (SAs).

Infertile men or men with abnormal semen parameters should be counseled of the health risks associated with what?

Abnormal sperm production

What should clinicians advise couples with advanced paternal age (≥40) about?

Increased risk of adverse health outcomes for their offspring

What are the specific goals of the evaluation of the infertile male?

Potentially correctable conditions, irreversible conditions amenable to ART, irreversible conditions not amenable to ART, life- or health-threatening conditions, and genetic abnormalities.

Infertility is defined as the failure to achieve a clinical pregnancy after how long?

12 months or more of regular unprotected sexual intercourse

What should the endpoint for fertility trials ideally be?

Live birth or cumulative live birth

What is the single most important factor when predicting the chances of conception for a couple?

Age of the female partner

How is recurrent pregnancy loss (RPL) defined?

Two or more failed pregnancies

What specialties were included in the Male Infertility Panel?

Urology, andrology, endocrinology, and obstetrics & gynecology

For initial infertility evaluation, both male and female partners should undergo what?

Concurrent assessment

The SA should include measures of what?

total sperm number, sperm concentration/sperm count, sperm motility, and sperm morphology

A reproductive Evaluation will lead to what of an individual and future offspring?

Maximizing the Reproductive Health

In couples with failed ART cycles or recurrent pregnancy losses, what evaluations of the male should be considered?

sperm DNA fragmentation and karyotype testing

Male infertility or abnormal SA may be a harbinger of medical diseases in men. While abnormal SA is not synonymous with male infertility, most specific male infertility diagnoses are associated with what?

abnormal SA.

What condition is associated with testosterone deficiency, abnormal muscle mass, and impaired spermatogenesis?

Klinefelter syndrome

What condition is associated with male infertility as well as pulmonary problems and pancreatic deficiency?

Cystic Fibrosis (CF)

What condition is associated with infertility as well as a higher risk of testis cancer?

Cryptorchidism

The systematic review by Johnson et al. examined correlations between age and what seven semen parameters?

Semen volume, sperm concentration, total sperm count, sperm motility, progressive motility, % with normal morphology, and sperm DNA fragmentation

A clinician may advocate for what in sedentary, infertile men with abnormal semen parameters in order to improve pregnancy and live birth rates?

regular resistance and/or high-intensity exercise

What medication has been associated with decreased semen volume and appears to be dose-dependent?

finasteride

Evaluation of the impact of environmental factors on male fertility was determined to be conclusive for some what?

heavy metals and pesticides

The OR for infertility as the number of abnormal parameters increases.

increase

Testosterone levels should be defined based upon a blood sample drawn during what part of the day?

morning

What is defined as absence of sperm in the ejaculate?

Azoospermia

What are the most common known genetic abnormalities that cause male infertility?

Karyotype abnormalities

Y chromosome microdeletions can result from what?

errors that occur during homologous recombination during meiosis due to the palindromic structure of the chromosome

What is the goal of genetic testing for a CFTR mutation?

To help identify the etiology as well as provide counseling on potential offspring transmission.

There are no prospective studies that have directly evaluated the impact of DNA fragmentation testing on the clinical management of infertile couples; meaning what?

The fertility outcomes of those who had testing are different from those who did not

Increased levels of round cells in the semen may result from a spermatogenic problem or fromwhat?

white blood cells in the semen (pyospermia)

White blood cells in the semen may result from what in the proximal or distal male genital tract?

Infection or inflammation

ASA can result from events such as trauma, mumps orchitis, testis malignancy, vasal obstruction, vasectomy that does what?

disrupts the blood-testis barrier

Clinicians should recommend renal ultrasonography for patients with vasal agenesis to what?

evaluate for renal abnormalities.

Surgical varicocelectomy should be considered in men attempting to conceive who have what?

palpable varicocele(s), infertility, and abnormal semen parameters

For men with clinical varicocele and NOA, couples should be informed of what?

The absence of definitive evidence supporting varicocele repair prior to ART

For men with NOA undergoing sperm retrieval, what should be performed?

Microdissection testicular sperm extraction (TESE)

In men undergoing surgical sperm retrieval, either what sperm may be used for ICSI.

fresh or cryopreserved

In men with azoospermia due to obstruction undergoing surgical sperm retrieval, sperm may be extracted from either where?

the testis or the epididymis.

The patient presenting with what should be evaluated to determine the etiology of the disorder and treated based on diagnosis.

hypogonadotropic hypogonadism (HH)

For the male interested in current or future fertility, what should not be prescribed.

testosterone monotherapy