In a recent episode of Speaking of Urology, Dr. Robert E. Brannigan engages with Dr. Juan J. Andino to delve into the recent amendments to the American Urological Association (AUA) and American Society for Reproductive Medicine (ASRM) guidelines regarding male infertility. Dr. Brannigan serves as the vice chair of clinical urology and the chief of male reproductive medicine and men’s health at Northwestern University in Chicago, Illinois, and is one of the Guideline Amendment Chairs for the AUA male infertility guidelines. Dr. Andino is an assistant professor of urology at UCLA Health.
This insightful dialogue occurred during a live event on X (formerly Twitter) Spaces, hosted by Urology Times.
Brannigan and Andino outlined three significant updates to the male infertility guidelines:
Lower Sperm Concentration Threshold for Testing: The guidelines now recommend reducing the sperm concentration threshold for conducting Y chromosome microdeletion testing.
Pelvic MRI for Ejaculatory Duct Obstruction: The addition of pelvic MRI imaging has been proposed as an option for men suspected of having ejaculatory duct obstruction, supplementing the previously established approach of TRUS/Seminal Vesicle aspiration.
Testicular Sperm Use for Infertility: The guidelines now suggest utilizing testicular sperm in cases where men exhibit elevated sperm DNA fragmentation testing and experience infertility.
The discussion also covered several other important changes, including expanded criteria for when a male should undergo evaluation, even if his semen analysis returns normal. The experts emphasized the need to avoid exogenous therapy if a patient is considering current or imminent fertility. Furthermore, they discussed scenarios in which a scrotal ultrasound might be beneficial, despite it not being a routine requirement.
Brannigan and Andino also addressed the potential role of seminal vesiculoscopy, which remains outside the current guidelines, and touched upon the ASRM’s expanded definition of infertility. These updates aim to enhance clinical practice and improve patient outcomes in the field of male reproductive health.
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