The European Association of Urology (EAU) has updated its guidelines on sexual and reproductive health for 2021.
To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health, including advances and areas of controversy in male infertility.
The panel performed a comprehensive literature review of novel data up to January 2021. The guidelines were updated and a strength rating for each recommendation was included that was based either on a systematic review of the literature or consensus opinion from the expert panel, where applicable.
The male partner in infertile couples should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors causing fertility impairment. Infertile men are at a higher risk of harbouring and developing other diseases including malignancy and cardiovascular disease and should be screened for potential modifiable risk factors, such as hypogonadism. Sperm DNA fragmentation testing has emerged as a novel biomarker that can identify infertile men and provide information on the outcomes from assisted reproductive techniques. The role of hormone stimulation therapy in hypergonadotropic hypogonadal or eugonadal patients is controversial and is not recommended outside of clinical trials. Furthermore, there is insufficient evidence to support the widespread use of other empirical treatments and surgical interventions in clinical practice (such as antioxidants and surgical sperm retrieval in men without azoospermia). There is low-quality evidence to support the routine use of testicular fine-needle mapping as an alternative diagnostic and predictive tool before testicular sperm extraction (TESE) in men with nonobstructive azoospermia (NOA), and either conventional or microdissection TESE remains the surgical modality of choice for men with NOA.
All infertile men should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors. Increasing data indicate that infertile men are at higher risk of cardiovascular mortality and of developing cancers and should be screened and counselled accordingly. There is low-quality evidence supporting the use of empirical treatments and interventions currently used in clinical practice; the efficacy of these therapies needs to be validated in large-scale randomised controlled trials.
Approximately 50% of infertility will be due to problems with the male partner. Therefore, all infertile men should be assessed by a specialist with the expertise to not only help optimise their fertility but also because they are at higher risk of developing cardiovascular disease and cancer long term and therefore require appropriate counselling and management. There are many treatments and interventions for male infertility that have not been validated in high-quality studies and caution should be applied to their use in routine clinical practice.
European urology. 2021 Sep 09 [Epub ahead of print]
Suks Minhas, Carlo Bettocchi, Luca Boeri, Paolo Capogrosso, Joana Carvalho, Nusret Can Cilesiz, Andrea Cocci, Giovanni Corona, Konstantinos Dimitropoulos, Murat Gül, Georgios Hatzichristodoulou, Thomas Hugh Jones, Ates Kadioglu, Juan Ignatio Martínez Salamanca, Uros Milenkovic, Vaibhav Modgil, Giorgio Ivan Russo, Ege Can Serefoglu, Tharu Tharakan, Paolo Verze, Andrea Salonia, EAU Working Group on Male Sexual and Reproductive Health
Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK. Electronic address: ., Department of Urology, University of Foggia, Foggia, Italy., Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy., Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy., CPUP: Center for Psychology of Porto University, Faculty of Psychology and Educational Sciences, Porto University, Porto, Portugal., Department of Urology, Taksim Training & Research Hospital, Istanbul, Turkey., Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy., Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy., Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK., School of Medicine, Department of Urology, Selcuk University, Konya, Turkey., Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany., Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Trust, Barnsley, UK., Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey., Department of Urology, Hospital Universitario Puerta del Hierro Majadahonda, Madrid, Spain., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Manchester Andrology Centre, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, UK., Urology Section, Department of Surgery, University of Catania, Catania, Italy., Department of Urology, Biruni University School of Medicine, Istanbul, Turkey., Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK., Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy., Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.