Best Practice Guidelines for Male Infertility Diagnosis and Management

Abstract

Infertility is commonly defined as the inability to conceive a natural pregnancy within 1 year in a sexually active couple. Estimates suggest that between 8 and 15% of couples will have problems with fertility and nearly half of those involve male factor infertility. Three predominant organizations have provided routinely updated, evidence-based guidelines for the diagnosis and treatment of men with male factor infertility. Guidelines from the American Society for Reproductive Medicine (ASRM), the American Urological Association (AUA), and the European Association of Urology (EAU) are presented, compared, and appraised. While many similarities exist between the three guidelines, several significant discrepancies exist. Of note, the AUA and ASRM recommend comprehensive medical history, physical examination, and presence of a single abnormal semen analysis prior to andrological evaluation. Conversely, the EAU recommends two sequential abnormal semen analyses prior to proceeding with further evaluation. Despite these differences, all three provide a reasonable framework for the diagnosis and management of the infertile male.