Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II


      The summary presented herein represents Part II of the two-part series dedicated to the Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. Part II outlines the appropriate management of the male in an infertile couple. Medical therapies, surgical techniques, as well as use of intrauterine insemination (IUI)/in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) are covered to allow for optimal patient management. Please refer to Part I for discussion on evaluation of the infertile male and discussion of relevant health conditions that are associated with male infertility.


      The Emergency Care Research Institute Evidence-based Practice Center team searched PubMed®, Embase®, and Medline from January 2000 through May 2019. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. (Table 1) This summary is being simultaneously published in Fertility and Sterility and The Journal of Urology.


      This Guideline provides updated, evidence-based recommendations regarding management of male infertility. Such recommendations are summarized in the associated algorithm. (Figure 1)


      Male contributions to infertility are prevalent, and specific treatment as well as assisted reproductive techniques are effective at managing male infertility. This document will undergo additional literature reviews and updating as the knowledge regarding current treatments and future treatment options continues to expand.
      Diagnóstico y tratamiento de la infertilidad masculina: guía de AUA/ASRM parte II.


      El resumen que se presenta en este documento representa la Parte II de la serie de dos partes dedicada al diagnóstico y tratamiento de la infertilidad en hombres: guía AUA / ASRM. La Parte II describe el manejo apropiado del hombre en una pareja infértil. Terapias médicas, técnicas quirúrgicas, así como el uso de inseminación intrauterina (IIU) / fertilización in vitro (FIV) / inyección intracitoplasmática espermática (ICSI) están incluidos para permitir un manejo óptimo del paciente. Consulte la Parte I para obtener información sobre la evaluación del varón infértil y la discusión sobre las condiciones de salud relevantes que están asociadas con la infertilidad masculina.


      El equipo del Instituto de investigación de urgencias Centro de práctica Basado en la Evidencia buscó en PubMed®, Embase® y Medline desde enero de 2000 hasta mayo de 2019. Cuando existía evidencia suficiente, se asignaba al cuerpo de evidencia una calificación de fuerza de A (alto), B (moderado) o C (bajo) para el apoyo de recomendaciones fuertes, moderadas o condicionales. En ausencia de suficiente evidencia, se proporcionaba información adicional como Principios Clínicos y Opiniones de expertos (Tabla 1). Este resumen está siendo publicado simultáneamente en Fertility and Sterility y The Journal of Urology.


      esta guía proporciona recomendaciones actualizadas y basadas en la evidencia sobre el manejo de la infertilidad masculina. Tales recomendaciones se resumen en el algoritmo asociado (Figura 1).


      La contribución masculina a la infertilidad son prevalentes, y el tratamiento específico y las técnicas de reproducción asistida son eficaces en el manejo de la infertilidad masculina. Este documento se someterá a revisiones bibliográficas adicionales y se actualizará a medida que se conozcan los tratamientos actuales y las opciones de tratamiento futuras continúen expandiéndose.


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        • Wang J.
        • Xia S.J.
        • Liu Z.H.
        • et al.
        Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: A meta-analysis.
        Asian J Androl. 2015; 17: 74
        • Kim H.J.
        • Seo J.T.
        • Kim K.J.
        • et al.
        Clinical significance of subclinical varicocelectomy in male infertility: Systematic review and meta-analysis.
        Andrologia. 2016; 48: 654
        • Schlegel P.N.
        • Kaufmann J.
        Role of varicocelectomy in men with nonobstructive azoospermia.
        Fertil Steril. 2004; 81: 1585
        • Bernie A.M.
        • Mata D.A.
        • Ramasamy R.
        • et al.
        Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: A systematic review and meta-analysis.
        Fertil Steril. 2015; 104
        • Ramasamy R.
        • Yagan N.
        • Schlegel P.N.
        Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction.
        Urology. 2005; 65: 1190
        • Yu Z.
        • Wei Z.
        • Yang J.
        • et al.
        Comparison of intracytoplasmic sperm injection outcome with fresh versus frozen-thawed testicular sperm in men with nonobstructive azoospermia: A systematic review and meta-analysis.
        J Assist Reprod Genet. 2018; 35: 1247
        • Engin G.
        Transrectal us-guided seminal vesicle aspiration in the diagnosis of partial ejaculatory duct obstruction.
        Diagn Interv Radiol. 2012; 18: 488
        • Avellino G.J.
        • Lipshultz L.I.
        • Sigman M.
        • et al.
        Transurethral resection of the ejaculatory ducts: Etiology of obstruction and surgical treatment options.
        Fertil Steril. 2019; 111: 427
        • Jarow J.P.
        Transrectal ultrasonography of infertile men.
        Fertil Steril. 1993; 60: 1035
        • Finkelstein J.S.
        • Whitcomb R.W.
        • O'Dea L.S.
        • et al.
        Sex steroid control of gonadotropin secretion in the human male. I. Effects of testosterone administration in normal and gonadotropin-releasing hormone-deficient men.
        J Clin Endocrinol Metab. 1991; 73: 609
      1. Contraceptive efficacy of testosterone-induced azoospermia in normal men. World health organization task force on methods for the regulation of male fertility.
        Lancet. 1990; 336: 955
        • Vilar L.
        • Vilar C.F.
        • Lyra R.
        • et al.
        Pitfalls in the diagnostic evaluation of hyperprolactinemia.
        Neuroendocrinology. 2019; 109: 7
        • Famini P.
        • Maya M.M.
        • Melmed S.
        Pituitary magnetic resonance imaging for sellar and parasellar masses: Ten-year experience in 2598 patients.
        J Clin Endocrinol Metab. 2011; 96: 1633
        • Snyder P.J.
        Clinical manifestations and evaluation of hyperprolactinemia.
        • Melmed S.
        • Casanueva F.F.
        • Hoffman A.R.
        • et al.
        Diagnosis and treatment of hyperprolactinemia: An endocrine society clinical practice guideline.
        J Clin Endocrinol Metab. 2011; 96: 273
        • Meistrich M.L.
        Effects of chemotherapy and radiotherapy on spermatogenesis in humans.
        Fertil Steril. 2013; 100: 1180
        • Tomlinson M.
        • Meadows J.
        • Kohut T.
        • et al.
        Review and follow-up of patients using a regional sperm cryopreservation service: Ensuring that resources are targeted to those patients most in need.
        Andrology. 2015; 3: 709
        • Brydoy M.
        • FossA S.D.
        • Klepp O.
        • et al.
        Sperm counts and endocrinological markers of spermatogenesis in long-term survivors of testicular cancer.
        Br J Cancer. 2012; 107: 1833
        • Isaksson S.
        • Eberhard J.
        • StAhl O.
        • et al.
        Inhibin b concentration is predictive for long-term azoospermia in men treated for testicular cancer.
        Andrology. 2014; 2: 252
        • Gandini L.
        • SgrAý P.
        • Lombardo F.
        • et al.
        Effect of chemo- or radiotherapy on sperm parameters of testicular cancer patients.
        Hum Reprod. 2006; 21: 2882
        • Namekawa T.
        • Imamoto T.
        • Kato M.
        • et al.
        Testicular function among testicular cancer survivors treated with cisplatin-based chemotherapy.
        Reprod Med Biol. 2016; 15: 175
        • Bahadur G.
        • Ozturk O.
        • Muneer A.
        • et al.
        Semen quality before and after gonadotoxic treatment.
        Hum Reprod. 2005; 20: 774
        • Spermon J.R.
        • Ramos L.
        • Wetzels A.M.M.
        • et al.
        Sperm integrity pre- and post-chemotherapy in men with testicular germ cell cancer.
        Hum Reprod. 2006; 21: 1781
        • Bohlen D.
        • Burkhard F.C.
        • Mills R.
        • et al.
        Fertility and sexual function following orchiectomy and 2 cycles of chemotherapy for stage i high risk nonseminomatous germ cell cancer.
        J Urol. 2001; 165: 441
        • Schrader M.
        • Muller M.
        • Straub B.
        • et al.
        Testicular sperm extraction in azoospermic patients with gonadal germ cell tumors prior to chemotherapy--a new therapy option.
        Asian J Androl. 2002; 4: 9
        • Meistrich M.L.
        Risks of genetic damage in offspring conceived using sperm produced during chemotherapy or radiotherapy.
        Andrology. 2019;
        • Oktay K.
        • Harvey B.E.
        • Partridge A.H.
        • et al.
        Fertility preservation in patients with cancer: Asco clinical practice guideline update.
        J Clin Oncol. 2018; 36: 1994
      2. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: A committee opinion.
        Fertil Steril. 2019; 112: 1022
        • Grover N.S.
        • Deal A.M.
        • Wood W.A.
        • et al.
        Young men with cancer experience low referral rates for fertility counseling and sperm banking.
        J Oncol Pract. 2016; 12: 465
        • Klosky J.L.
        • Wang F.
        • Russell K.M.
        • et al.
        Prevalence and predictors of sperm banking in adolescents newly diagnosed with cancer: Examination of adolescent, parent, and provider factors influencing fertility preservation outcomes.
        J Clin Oncol. 2017; 35: 3830
        • Sonnenburg D.W.
        • Brames M.J.
        • Case-Eads S.
        • et al.
        Utilization of sperm banking and barriers to its use in testicular cancer patients.
        Support Care Cancer. 2015; 23: 2763

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      • Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I
        Fertility and SterilityVol. 115Issue 1
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          The summary presented herein represents Part I of the two-part series dedicated to the Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. Part I outlines the appropriate evaluation of the male in an infertile couple. Recommendations proceed from obtaining an appropriate history and physical exam (Appendix I), as well as diagnostic testing, where indicated.
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