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

Schlegel, Peter N.; Sigman, Mark; Collura, B.; Jonge, Christopher J. De; Eisenberg, Michael L.; Lamb, Dolores J.; Mulhall, John P.; Niederberger, Craig S.; Sandlow, Jay; Sokol, Rebecca Z.; Spandorfer, Steven D.; Tanrikut, Cigdem; Treadwell, Jonathan; Oristaglio, Jeffrey T.; Zini, Armand

doi:10.1097/ju.0000000000001521

Cited by 140 publications

(199 citation statements)

References 0 publications

Supporting

Mentioning

197

Contrasting

Order By: Relevance

“…Existing data are inadequate to provide recommendation for specific agents to use for this purpose. (Conditional Recommendation; Evidence Level: Grade B)” [ 60 ]. However, the extensive research that has been published on the study of AOX certainly warrants the formulation of new specific guidelines on the topic that would consider the utility of OS diagnostic testing, AOX type, dose and duration, and the clinical indications for AOX therapy.…”

Section: Discussionmentioning

confidence: 99%

“…This survey reports the opinions of 1,327 healthcare practitioners from around the world regarding the utility of AOX therapy for male infertility in clinical practice. Despite the recently published recommendations from international societies, including ASRM and EAU [ 60 ], 85.4% of respondents believe that AOX are a useful treatment option for men with infertility, with 69.1% of them basing their decision on scientific evidence in support for AOX use ( Table 6 ). Indeed, such evidence exists, although the studies supporting the use of AOX are small and heterogeneous.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Global Survey of Reproductive Specialists to Determine the Clinical Utility of Oxidative Stress Testing and Antioxidant Use in Male Infertility

Agarwal

Finelli

Selvam

et al. 2021

World J Mens Health

Self Cite

View full text Add to dashboard Cite

Purpose The use of antioxidants is common practice in the management of infertile patients. However, there are no established guidelines by professional societies on antioxidant use for male infertility. Materials and Methods Using an online survey, this study aimed to evaluate the practice pattern of reproductive specialists to determine the clinical utility of oxidative stress (OS) testing and antioxidant prescriptions to treat male infertility. Results Responses from 1,327 participants representing 6 continents, showed the largest participant representation being from Asia (46.8%). The majority of participants were attending physicians (59.6%), with 61.3% having more than 10 years of experience in the field of male infertility. Approximately two-thirds of clinicians (65.7%) participated in this survey did not order any diagnostic tests for OS. Sperm DNA fragmentation was the most common infertility test beyond a semen analysis that was prescribed to study oxidative stress-related dysfunctions (53.4%). OS was mainly tested in the presence of lifestyle risk factors (24.6%) or sperm abnormalities (16.3%). Interestingly, antioxidants were prescribed by 85.6% of clinicians, for a duration of 3 (43.7%) or 3–6 months (38.6%). A large variety of antioxidants and dietary supplements were prescribed, and scientific evidence were mostly considered to be modest to support their clinical use. Results were not influenced by the physician's age, geographic origin, experience or training in male infertility. Conclusions This study is the largest online survey performed to date on this topic and demonstrates 1) a worldwide understanding of the importance of this therapeutic option, and 2) a widely prevalent use of antioxidants to treat male infertility. Finally, the necessity of evidence-based clinical practice guidelines from professional societies is highlighted.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Global Survey of Reproductive Specialists to Determine the Clinical Utility of Oxidative Stress Testing and Antioxidant Use in Male Infertility

Agarwal

Finelli

Selvam

et al. 2021

World J Mens Health

Self Cite

View full text Add to dashboard Cite

show abstract

“…A recent AUA/ASRM guideline that is more supportive of DNA fragmentation testing has been published recently. In this guideline, DNA damage is identified as possibly leading to infertility and miscarriage, but it does not recommend routine testing of DNA fragmentation in the initial evaluation of male infertility due to the lack of prospective studies (Schlegel et al ., 2020).…”

Section: Introductionmentioning

confidence: 99%

Clinical implications of sperm DNA damage in IVF and ICSI: updated systematic review and meta‐analysis

et al. 2021

View full text Add to dashboard Cite

The clinical effect of sperm DNA damage in assisted reproduction has been a controversial topic during recent decades, leading to a variety of clinical practice recommendations. While the latest European Society of Human Reproduction and Embryology (ESHRE) position report concluded that DNA damage negatively affects assisted reproduction outcomes, the Practice Committee of the American Society for Reproductive Medicine (ASRM) does not recommend the routine testing of DNA damage for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Herein, our aim was to perform a systematic review and meta‐analysis of studies investigating whether sperm DNA damage affects clinical outcomes in IVF and ICSI, in order to contribute objectively to a consistent clinical recommendation. A comprehensive systematic search was conducted according to PRISMA guidelines from the earliest available online indexing year until March 2020, using the MEDLINE‐PubMed and EMBASE databases. We included studies analysing IVF and/or ICSI treatments performed in infertile couples in which sperm DNA damage was well defined and assessed. Studies also had to include information about pregnancy, implantation or live birth rates as primary outcomes. The NHLBI‐NIH quality assessment tool was used to assess the quality of each study. Meta‐analyses were conducted using the Mantel–Haenszel method with random‐effects models to evaluate the Risk Ratio (RR) between high‐DNA‐damage and control groups, taking into account the 95% confidence intervals. Heterogeneity among studies was evaluated using the I2 statistic. We also conducted sensitivity analyses and post‐hoc subgroup analyses according to different DNA fragmentation assessment techniques. We identified 78 articles that met our inclusion and quality criteria and were included in the qualitative analysis, representing a total of 25639 IVF/ICSI cycles. Of these, 32 articles had sufficient data to be included in the meta‐analysis, comprising 12380 IVF/ICSI cycles. Meta‐analysis revealed that, considering IVF and ICSI results together, implantation rate (RR = 0.74; 95% CI = 0.61–0.91; I2 = 69) and pregnancy rate (RR = 0.83; 0.73–0.94; I2 = 58) are negatively influenced by sperm DNA damage, although after adjustment for publication bias the relationship for pregnancy rate was no longer significant. The results showed a non‐significant but detrimental tendency (RR = 0.78; 0.58–1.06; I2 = 72) on live birth rate. Meta‐analysis also showed that IVF outcomes are negatively influenced by sperm DNA damage, with a statistically significant impact on implantation (RR = 0.68; 0.52–0.89; I2 = 50) and pregnancy rates (RR = 0.72; 0.55–0.95; I2 = 72), although the latter was no longer significant after correction for publication bias. While it did not quite meet our threshold for significance, a negative trend was also observed for live birth rate (RR = 0.48; 0.22–1.02; I2 = 79). In the case of ICSI, non‐significant trends were observed for implantation (RR = 0.79; 0.60–1.04; I2 = 72) or pregnanc...

show abstract

“…While FSH does not need to be used in all men undergoing reconstruction, FSH may provide a useful biomarker in men with a history of impaired spermatogenesis. Elevated FSH greater than 7.6 IU/L in the presence of atrophic and soft testicles is highly suggestive of spermatogenic failure rather than obstructive azoospermia (Schlegel et al., 2020). Combining the history, testicular examination and FSH levels can identify failures of spermatogenesis before proceeding to a surgery resulting in a technical success without improving fertility.…”

Section: Hormonal Evaluationmentioning

confidence: 99%

“…In the United States, vasectomy is the most common cause of obstructive azoospermia, with estimates of 175,000 to 350,000 men undergoing a vasectomy each year (Namekawa et al., 2018). The joint American Society of Reproductive Medicine (ASRM) and American Urological Association (AUA) 2020 male infertility guidelines highlight that couples desiring conception after vasectomy have the option of surgical reconstruction, surgical sperm retrieval, or both reconstruction and simultaneous sperm retrieval for cryopreservation (Schlegel et al., 2020). While vasectomy reversal remains the only method to allow for natural conception, the joint ASRM and AUA 2020 male infertility guidelines fail to mention the situations where a vasectomy reversal would not be able to be performed.…”

Section: Introductionmentioning

confidence: 99%

Challenges in completing a successful vasectomy reversal

et al. 2021

View full text Add to dashboard Cite

Although a wide array of interventions exist for men seeking fertility after vasectomy, up to 6% of them will elect for a vasectomy reversal. While the widespread adoption of telemedicine promises convenience and improved access, lack of ability to do a physical examination may hinder appropriate counselling. Although vasectomy reversal is successfully completed in most of the men either with a vasovasostomy or a vasoepididymostomy, there could be various reasons for the inability to successfully complete the operation. Our commentary outlines the reasons why a vasectomy reversal is not possible or successful. We also discuss a pre‐operative management algorithm in men seeking vasectomy reversal to ensure appropriate counselling with a thorough pre‐operative history, physical examination and on occasion, hormonal evaluation.

show abstract

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

Cited by 140 publications

References 0 publications

A Global Survey of Reproductive Specialists to Determine the Clinical Utility of Oxidative Stress Testing and Antioxidant Use in Male Infertility

A Global Survey of Reproductive Specialists to Determine the Clinical Utility of Oxidative Stress Testing and Antioxidant Use in Male Infertility

Clinical implications of sperm DNA damage in IVF and ICSI: updated systematic review and meta‐analysis

Challenges in completing a successful vasectomy reversal

Contact Info

Product

Resources

About