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

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:10.1016/j.fertnstert.2020.11.016

Cited by 93 publications

(70 citation statements)

References 27 publications

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“… 70 71 72 American Urological Association and American Society for Reproductive Medicine (AUA/ASRM) guidelines suggested surgical varicocelectomy in infertile men with palpable varicocele and abnormal semen parameters; however, azoospermic men are an exception to this statement; these patients should be informed of the absence of definitive evidence supporting varicocele repair improvements on the condition before ART. 73 …”

Section: Therapeutic Approachesmentioning

confidence: 99%

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Severe male factor in in vitro fertilization: definition, prevalence, and treatment. An update

et al. 2022

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Infertility affects 10%–15% of couples worldwide. Of all infertility cases, 20%–70% are due to male factors. In the past, men with severe male factor (SMF) were considered sterile. Nevertheless, the development of intracytoplasmic sperm injection (ICSI) drastically modified this scenario. The advances in assisted reproductive technology (ART), specifically regarding surgical sperm retrieval procedures, allowed the efficacious treatment of these conditions. Yet, before undergoing ICSI, male factor infertility requires careful evaluation of clinical and lifestyle behavior together with medical treatment. Epidemiologically speaking, women whose male partner is azoospermic tend to be younger and with a better ovarian reserve. These couples, in fact, are proposed ART earlier in their life, and for this reason, their ovarian response after stimulation is generally good. Furthermore, in younger couples, azoospermia can be partially compensated by the efficient ovarian response, resulting in an acceptable fertility rate following in vitro fertilization (IVF) techniques. Conversely, when azoospermia is associated with a reduced ovarian reserve and/or advanced maternal age, the treatment becomes more challenging, with a consequent reduction in IVF outcomes. Nonetheless, azoospermia seems to impair neither the euploidy rate at the blastocyst stage nor the implantation of euploid blastocysts. Based on the current knowledge, the assessment of male infertility factors should involve: (1) evaluation – to diagnose and quantify seminologic alterations; (2) potentiality – to determine the real possibilities to improve sperm parameters and/or retrieve spermatozoa; (3) time – to consider the available “treatment window”, based on maternal age and ovarian reserve. This review represents an update of the definition, prevalence, causes, and treatment of SMF in a modern ART clinic.

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Section: Therapeutic Approachesmentioning

confidence: 99%

“…Subsequently to these techniques, the retrieved sperm can either be directly used for ICSI or can be cryopreserved. 9 17 73 74 …”

Section: Therapeutic Approachesmentioning

confidence: 99%

Severe male factor in in vitro fertilization: definition, prevalence, and treatment. An update

et al. 2022

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“…The results of the available studies, although promising, are insufficient to recommend the hormonal treatment for every patient with NOA before surgery. Therefore, as stated by the recent AUA/ASRM guidelines on the diagnosis and management of infertility in men [60], patients with NOA should be informed of the limited data supporting pharmacologic prior to surgical intervention (Conditional Recommendation; Evidence Level; Grade C).…”

Section: Hormonal Treatment Before Micro-tesementioning

confidence: 99%

Hormonal Treatment of Men with Nonobstructive Azoospermia: What Does the Evidence Suggest?

Caroppo

Colpi²

2021

JCM

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Hormonal stimulation of spermatogenesis prior to surgery has been tested by some authors to maximize the sperm retrieval yield in patients with nonobstructive azoospermia. Although the rationale of such an approach is theoretically sound, studies have provided conflicting results, and there are unmet questions that need to be addressed. In the present narrative review, we reviewed the current knowledge about the hormonal control of spermatogenesis, the relationship between presurgical serum hormones levels and sperm retrieval rates, and the results of studies investigating the effect of hormonal treatments prior to microdissection testicular sperm extraction. We pooled the available data about sperm retrieval rate in patients with low vs. normal testosterone levels, and found that patients with normal testosterone levels had a significantly higher chance of successful sperm retrieval compared to those with subnormal T levels (OR 1.63, 95% CI 1.08–2.45, p = 0.02). These data suggest that hormonal treatment may be justified in patients with hypogonadism; on the other hand, the available evidence is insufficient to recommend hormonal therapy as standard clinical practice to improve the sperm retrieval rate in patients with nonobstructive azoospermia.

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“…The utility of the hormonal treatment of patients with NOA has been evaluated by a few studies, yet with conflicting results [8]. The recent AUA/ASRM guidelines on the diagnosis and management of male infertility recommend informing patients with NOA about the limited data supporting pharmacologic treatments prior to surgical intervention [9].…”

Section: Preoperative Patient Optimizationmentioning

confidence: 99%

Performing Microdissection Testicular Sperm Extraction: Surgical Pearls from a High-Volume Infertility Center

Colpi¹,

Caroppo

2021

JCM

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Microdissection testicular sperm extraction (mTESE) has been demonstrated to be the gold-standard surgical technique for retrieving testicular sperm in patients with non-obstructive azoospermia (NOA) as it enables the exploration of the whole testicular parenchyma at a high magnification, allowing the identification of the rare dilated seminipherous tubules that may contain sperm, usually surrounded by thinner or atrophic tubules. MTESE requires a skilled and experienced surgeon whose learning curve may greatly affect the sperm retrieval rate, as demonstrated in previous reports. The present review is intended to offer a precise and detailed description of the mTESE surgical procedure, accompanied by an extensive iconography, to provide urologists with valuable information to be translated into clinical practice. Advice about the pre-surgical and post-surgical management of patients is also offered.

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

Cited by 93 publications

References 27 publications

Severe male factor in in vitro fertilization: definition, prevalence, and treatment. An update

Severe male factor in in vitro fertilization: definition, prevalence, and treatment. An update

Hormonal Treatment of Men with Nonobstructive Azoospermia: What Does the Evidence Suggest?

Performing Microdissection Testicular Sperm Extraction: Surgical Pearls from a High-Volume Infertility Center

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