Overview and methods

Overview

Male infertility contributes to one in four cases of assisted reproductive treatment in Australia but could be a factor in up to 50% of all infertile couples. It is also a biomarker for reproductive and overall health and thus its assessment presents an opportunity for remedial and/or preventative health interventions in men. 

In Australia, male infertility is managed by a range of medical specialists, including general practitioners, urologists, endocrinologists and obstetricians/gynaecologists during ART. 

Previously, no Australian-based clinical guidelines existed for the management of male infertility. To address this knowledge gap, a panel of experts was developed to assemble the first evidence-based Australian guidelines on male infertility. A series of guideline statements was synthesised after reviewing the American and European evidence-based guidelines for male infertility and refining each guideline statement to reflect Australian based clinical practice.

The aim of these guidelines is to inform and support Australian clinicians in the management of all major aspects of male infertility.

Methods

A panel of experts (PoE) was assembled in 2022. The PoE included representatives from various professional organisations, including a urologist with a special interest in male infertility, reproductive endocrinologists with expertise in andrology, and a reproductive endocrinologist and gynaecologist with expertise in ART. Consumer representation was from Healthy Male.

The PoE utilised two recent, well-established and refined evidence-based guidelines on male infertility from the European Association of Urology and the American Urological Association/American Society of Reproductive Medicine. The European and American guidelines are comprehensive and nuanced for their different populations, cultures and health systems.

The European guidelines used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. The American guidelines were similarly designated grading strengths with the assistance of the Emergency Care Research Institute Evidence-based Practice Centre team.

The PoE analysed and reviewed the European and American guidelines and developed 80 guideline statements for Australian clinicians encompassing the evaluation of male infertility and management and therapeutic considerations.

Each guideline statement (GS) was assigned a strength of recommendation rating of mandatory, recommended or suggested, based on the level of evidence and the PoE’s perceived importance of adhering to the recommendation. Each guideline statement was also assigned a level of evidence rating based on the GRADE evidence rating system (High, Moderate, Low-very Low).

Funding for administrative support in formulating these guidelines was provided by Healthy Male under contract from a grant to the University of New South Wales from the Australian Medical Research Future Fund’s Emerging Priorities and Consumer Driven Research (EPCDR) Initiative #EPCD000007.

Endorsement

These guidelines have been endorsed by Healthy Male, Urological Society of Australia and New Zealand (USANZ), Endocrine Society of Australia (ESA) and Fertility Society of Australia and New Zealand (FSANZ).

Authors

These male infertility guidelines were developed by a multidisciplinary group of Australian clinicians, researchers and subject matter experts with specialised knowledge in male reproductive health. Drawing on the latest scientific evidence and their extensive clinical experience, the authors have developed practical, evidence-based recommendations to support health professionals in delivering consistent, high-quality care for men experiencing infertility.