The American Urological Association (AUA) and the American Society of Reproductive Medicine (ASRM) have combined to release new guidelines for the evaluation and treatment of male infertility. This updates the guidelines that were last reviewed about eight years ago, and provides a much more detailed approach to men who have fertility problems. Here, we will review some of the important new concepts and why it is important for men to be evaluated.
One of the new guidelines stresses the importance of doctors to review the health risks associated with infertile men and men with abnormal sperm production. It has been known for years that men with fertility abnormalities may have underlying medical conditions such as testicular cancer, genetic abnormalities, abnormal growth in the pituitary gland, and other abnormalities, which may be responsible for their low sperm production. This is important because as one of the guidelines says, “Men with one or more abnormal semen markers should be evaluated by a male reproductive expert with a complete history and physical exam.”
There is also growing evidence that men who have abnormal semen parameters may have a slightly higher mortality rate. This is based on preliminary data from one study, and is certainly concerning. More studies are necessary to confirm whether this is true or not.
Another new and important guideline involves advising couples that “men who are older are at increased risk of adverse health outcomes for their offspring.” This has been noted previously with women age 35 and older, but now there is evidence that this is true for men as well, including a higher incidence of schizophrenia, autism, and chondrodysplasia (genetically-caused bony and cartilage disorders). While there is no clear definition for advanced paternal age, the risk starts to increase over the age of 40 and is significantly higher above the age of 50.
The guidelines also stress the importance that doctors discuss risk factors such as lifestyle, medication usage, and environmental exposures associated with male infertility. However, the guidelines note that the current data on the majority of these risk factors is limited. It is clear to most reproductive urology specialists that a healthy lifestyle will most likely result in healthier sperm. Eating healthy, not smoking, minimizing the use of alcohol and marijuana, and generally living a healthy lifestyle is going to provide a better outcome in terms of getting your partner pregnant.
The benefits of supplements such as antioxidants and vitamins in the treatment of male infertility are highlighted in the new guidelines as well. At the present time, existing data is inadequate to provide specific recommendations for men regarding dietary supplements, but supplements that have thought to be valuable for men include vitamin C, vitamin E, carnitine, and Coenzyme Q.
It is important for patients and their partners to understand the new guidelines developed by the American Urological Association and the American Society of Reproductive Medicine. Much of this is based on scientific data, but it also includes the expert opinions of many reproductive urologists and has been ‘peer reviewed’ by multiple physicians and scientists from around the country. In part 2 of my review, which I will release in a few months, I will focus on the new guidelines regarding medical and surgical treatment of male factor infertility.