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MALE INFERTILITY
Treatment Guideline Chart

Infertility is the inability to conceive despite regular unprotected sexual intercourse for one year.

Male infertility as the sole cause accounts for 20% & 30-40% as a contributory factor to infertility in couples.

Causes include: hypothalamic pituitary disease, primary testicular disease, disorders of sperm transport, genetic disorders, idiopathic infertility, infections, immune system disorders, iatrogenic causes, and chronic illness.

Male Infertility References

  1. Barak S, Baker HWG. Clinical management of male infertility. In: Jameson JL. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Saunders, Elsevier Inc; 2016:2431-2455.e4.
  2. Bella AJ, Lee JC, Carrier S, Bénard F, Brock GB. 2015 CUA practice guidelines for erectile dysfunction. Can Urol Assoc J. 2015 Jan;9(1-2):23-29. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336024/pdf/cuaj-1-2-23.pdf. PMID: 25737750
  3. Cooper TG, Noonan E, von Eckardstein S, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010 May;16(3):231-245. http://www.who.int/reproductivehealth/topics/infertility/cooper_et_al_hru.pdf?ua=1. PMID: 19934213
  4. Cocuzza M, Agarwal A. Nonsurgical treatment of male infertility: specific and empiric therapy. Biologics. 2007 Sep;1(3):259-269. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721319/pdf/btt-1-259.pdf. PMID: 19707335
  5. Ferri FF. Infertility. In: Ferri FF. Ferri’s Clinical Advisor. Philadelphia, PA: Elsevier Inc; 2016:701-702.e2.
  6. Garg H, Kumar R. An update on the role of medical treatment including antioxidant therapy in varicocele. Asian J Androl. 2016 Mar;18(2):222-228. http://www.ajandrology.com/temp/AsianJAndrol182222-852012_234001.pdf. PMID: 26763549
  7. Jarrow J, Sigman M, Kolettis PN, et al. The optimal evaluation of the infertile male: AUA best practice statement. American Urological Association website. https://www.auanet.org/common/pdf/education/clinical-guidance/Male-Infertility-d.pdf. 2010.
  8. Jungwirth A, Diemer T, Dohle GR, et al. for the European Association of Urology. Guidelines on male infertility. European Association of Urology website. http://uroweb.org/wp-content/uploads/17-Male-Infertility_LR1.pdf. 2015.
  9. Kamel RM. Management of the infertile couple: an evidence-based protocol. Reprod Biol Endocrinol. 2010 Mar;8:21. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844387/pdf/1477-7827-8-21.pdf. PMID: 20205744
  10. Kliesch S. Diagnosis of male infertility: diagnostic work-up of the infertile man. European Urology Supplements. 2014 Nov;13(4):73-82. http://dx.doi.org/10.1016/j.eursup.2014.08.002.
  11. Loh SF, Agarwal R, Chan JK, et al. Academy of Medicine Singapore-Ministry of Health Clinical Practice Guidelines: assessment and management of infertility at primary healthcare level. Ministry of Health Singapore website. https://www.moh.gov.sg/content/dam/moh_web/HPP/Doctors/cpg_medical/current/2013/Infertility/Infertility_Booklet2013(HiRes).pdf. Dec 2013.
  12. Loh SF, Agarwal R, Chan JK, et al. Academy of Medicine Singapore-Ministry of Health Clinical Practice Guidelines: assessment and management of infertility at primary healthcare level. Singapore Med J. 2014 Feb;55(2):58-65; quiz 66. http://sma.org.sg/UploadedImg/files/SMJ/5502/5502cpg1.pdf. PMID: 24570313
  13. Goldstein M. Surgical management of male infertility. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier Inc; 2016:580-611.e4.
  14. Matsumoto AM, Bremner WJ. Testicular disorders. In: Melmed S, Polonsky KS, Larsen, PR, Kronenberg HM. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier Inc; 2016:694-784.
  15. Melmed S, Casanueva FF, Hoffman AR, et al; Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Feb;96(2):273-288. http://press.endocrine.org/doi/pdf/10.1210/jc.2010-1692. PMID: 21296991
  16. Montague DK, Jarow J, Broderick GA, et al; AUA Erectile Dysfunction Guideline Update Panel. AUA guideline on the pharmacologic management of premature ejaculation. J Urol. 2004 Jul;172(1):290-294. https://www.auanet.org/common/pdf/education/clinical-guidance/Premature-Ejaculation.pdf. PMID: 15201797
  17. National Institute for Health and Care Excellence. Fertility problems (quality standard). NICE website. https://www.nice.org.uk/guidance/qs73/resources/fertility-problems-2098846428613. Oct 2014.
  18. National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. NICE website. https://www.nice.org.uk/guidance/cg156/resources/fertility-problems-assessment-and-treatment-35109634660549. Feb 2013.
  19. Petak SM, Nankin HR, Spark RF, et al; American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients-2002 update. Endocr Pract. 2002 Nov;8(6):440-456. https://www.aace.com/files/hypo-gonadism.pdf. PMID: 15260010
  20. Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile male: a committee opinion. Fertil Steril. 2015 Mar;103(3):e18-e25. https://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Committee_Opinions/optimal_evaluation_of_the_infertile_male(1).pdf. PMID: 25597249
  21. Practice Committee of the American Society for Reproductive Medicine. Effectiveness and treatment for unexplained infertility. Fertil Steril. 2006 Nov;85(5)(Suppl 1):S111-114. https://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Educational_Bulletins/effectiveness_and_treatment_for_unexplained_infertility(1).pdf. PMID: 17055802
  22. Practice Committee of the American Society for Reproductive Medicine; Society for Male Reproduction and Urology. Report on varicocele and infertility: a committee opinion. Fertil Steril. 2014 Dec;102(6):1556-1560. https://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Joint_Reports/Report_on_varicocele(1).pdf. PMID: 25458620
  23. Showell MG, Mackenzie-Proctor R, Brown J, Yazdani A, Stankiewicz MT, Hart RJ. Antioxidants for male subfertility. Cochrane Database Syst Rev. 2014;12:CD007411. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007411.pub3/epdf. PMID: 25504418
  24. Snyder PJ. Induction of fertility in men with secondary hypogonadism. UptoDate website. http://www.uptodate.com/contents/induction-of-fertility-in-men-with-secondary-hypogonadism?source=search_result&search=Induction+of+fertility+in+men+with+secondary+hypogonadism&selectedTitle=1~150. Dec 2015.
  25. Swerdloff RS, Wang C. Causes of male infertility. UptoDate website. http://www.uptodate.com/contents/causes-of-male-infertility?source=related_link. Nov 2015.
  26. Swerdloff RS, Wang C. Evaluation of male infertility. UptoDate website. http://www.uptodate.com/contents/evaluation-of-male-infertility?source=related_link. Nov 2015.
  27. Swerdloff RS, Wang C. The testis and male hypogonadism, infertility and sexual dysfunction. In: Goldman L. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Saunders, Elsevier Inc; 2016.
  28. Wang C, Swerdloff RS. Treatment of male infertility. UptoDate website. http://www.uptodate.com/contents/treatment-of-male-infertility. Nov 2015.
  29. Synder PJ. Cause of primary hypogonadism in males. UpToDate. http://www.uptodate.com/contents/causes-of-primary-hypogonadism-in-males?source=see_link. Jan 2016.
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