The aim of these Association Française d'Urologie (AFU) and Société d'Andrologie de Langue Française (SALF) common recommendations are to provide practice guidelines for the French Urological and Andrological community regarding the evaluation of infertile men.
Literature search in PubMed using the keywords "male infertility", "diagnosis", "management" and "evaluation" limited to clinical articles in English and French prior to 1/01/2020. To inform the level of evidence, the HAS grading system (2013) was applied.
Concerning the evaluation of infertile men, the AFU and the SALF recommend : (1) a systematic interview exploring the family history, the fertility history of the man outside the couple, the patient's personal history that may have an impact on his fertility, lifestyle habits, treatments, symptoms and possible sexual difficulties of the couple; (2) a general physical examination to assess signs of hypogonadism and secondary sexual characters; (3) a scrotal physical examination performed by an urologist or andrologist to assess (i) the testes for volume and consistency, (ii) vas deferens and epididymes for total or partial absence or nodules, and (iii) presence of varicoceles; (4) Performing two semen analyses, according to World Health Organization guidelines, if the first one has at least one abnormaly; (5) a scrotal ultrasound as part of routine investigation, that can be completed with an endorectal pelvic ultrasound according to the clinic; (6) an endocrine evaluation with at least a Testosterone and FSH serum determination; (7) Karyotype analysis in infertile men with a sperm concentration ≤10 106/mL; (8) assessment of Yq microdeletions in infertile men with a sperm concentration ≤1 106/mL; (9) Cystic fibrosis transmembrane conductance regulator gene evaluation in case of suspicion for bilateral or unilateral congenital agenesis of vas deferens and seminal vesicles. The interest of tests analyzing DNA fragmentation (TUNEL, SCSA) is still under investigation.
These guidelines can be applied in routine clinical practice in all infertile men.
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2020 Dec 09 [Epub ahead of print]
Eric Huyghe, Florence Boitrelle, Charlotte Methorst, Roger Mieusset, Pierre F Ray, William Akakpo, Isabelle Koscinski, Céline Chalas, Nathalie Rives, Ingrid Plotton, Geoffroy Robin, Rabi El Osta, Sylviane Hennebicq, Florence Eustache, François Marcelli, Hervé Lejeune
Département d'Urologie, Transplantation Rénale et Andrologie, CHU de Toulouse, site de Rangueil, Toulouse, France; Médecine de la Reproduction, CHU de Toulouse, site de Paule de Viguier, Toulouse, France. Electronic address: ., Service de gynécologie-obstétrique, CHI Poissy/Saint-Germain-en-Laye, Poissy, France., Service d'Urologie, CH des quatre villes, Saint-Cloud, France., Médecine de la Reproduction, CHU de Toulouse, site de Paule de Viguier, Toulouse, France., Service de Biologie, Génétique de la reproduction, CHU de Grenoble, France., Service d'Urologie, Hôpital universitaire de la Pitié Salpêtrière, APHP, Paris, France., Service de Biologie de la Reproduction, CECOS, CHRU de Nancy, France., Service d'Histologie, embryologie, cytologie, Hôpital Cochin, APHP, Paris, France., Laboratoire de Biologie de la Reproduction, CECOS, CHU de Rouen, France., Service de médecine de la reproduction, Hôpital Femme Mère Enfant, HCL, Bron, France., Service de gynécologie, Médecine de la reproduction, Hôpital Jeanne de Flandres, CHRU de Lille, France., Service d'Urologie, CHRU de Nancy, France., Laboratoire d'aide à la procréation, CECOS, CHU de Grenoble, France., Biologie de la reproduction, Hôpital Jean Verdier, Bondy, France., Service d'Urologie, CHRU de Lille, France.