European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility
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 co...
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| Veröffentlicht in: | European urology Jg. 80; H. 5; S. 603 - 620 |
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| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
Switzerland
Elsevier B.V
01.11.2021
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| ISSN: | 0302-2838, 1873-7560, 1873-7560 |
| Online-Zugang: | Volltext |
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| Abstract | 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.
All infertile men require urological assessment and are at risk of cardiovascular mortality and several cancers. There is low-quality evidence supporting several empirical fertility treatments and the efficacy of these therapies needs to be validated in large-scale randomised controlled trials. |
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| AbstractList | 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.
All infertile men require urological assessment and are at risk of cardiovascular mortality and several cancers. There is low-quality evidence supporting several empirical fertility treatments and the efficacy of these therapies needs to be validated in large-scale randomised controlled trials. 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. The European Association of Urology (EAU) has updated its guidelines on sexual and reproductive health for 2021.CONTEXTThe 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.OBJECTIVETo 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.EVIDENCE ACQUISITIONThe 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.EVIDENCE SYNTHESISThe 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.CONCLUSIONSAll 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.PATIENT SUMMARYApproximately 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. |
| Author | Russo, Giorgio Ivan Tharakan, Tharu Cilesiz, Nusret Can Capogrosso, Paolo Corona, Giovanni Jones, Thomas Hugh Gül, Murat Bettocchi, Carlo Modgil, Vaibhav Verze, Paolo Martínez Salamanca, Juan Ignatio Salonia, Andrea Minhas, Suks Kadioglu, Ates Boeri, Luca Cocci, Andrea Dimitropoulos, Konstantinos Milenkovic, Uros Serefoglu, Ege Can Carvalho, Joana Hatzichristodoulou, Georgios |
| Author_xml | – sequence: 1 givenname: Suks surname: Minhas fullname: Minhas, Suks email: suks.minhas@nhs.net organization: Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK – sequence: 2 givenname: Carlo surname: Bettocchi fullname: Bettocchi, Carlo organization: Department of Urology, University of Foggia, Foggia, Italy – sequence: 3 givenname: Luca surname: Boeri fullname: Boeri, Luca organization: Department of Urology, Foundation IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, University of Milan, Milan, Italy – sequence: 4 givenname: Paolo surname: Capogrosso fullname: Capogrosso, Paolo organization: Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy – sequence: 5 givenname: Joana surname: Carvalho fullname: Carvalho, Joana organization: CPUP: Center for Psychology of Porto University, Faculty of Psychology and Educational Sciences, Porto University, Porto, Portugal – sequence: 6 givenname: Nusret Can surname: Cilesiz fullname: Cilesiz, Nusret Can organization: Department of Urology, Taksim Training & Research Hospital, Istanbul, Turkey – sequence: 7 givenname: Andrea surname: Cocci fullname: Cocci, Andrea organization: Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy – sequence: 8 givenname: Giovanni surname: Corona fullname: Corona, Giovanni organization: Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy – sequence: 9 givenname: Konstantinos surname: Dimitropoulos fullname: Dimitropoulos, Konstantinos organization: Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK – sequence: 10 givenname: Murat surname: Gül fullname: Gül, Murat organization: School of Medicine, Department of Urology, Selcuk University, Konya, Turkey – sequence: 11 givenname: Georgios surname: Hatzichristodoulou fullname: Hatzichristodoulou, Georgios organization: Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany – sequence: 12 givenname: Thomas Hugh surname: Jones fullname: Jones, Thomas Hugh organization: Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Trust, Barnsley, UK – sequence: 13 givenname: Ates surname: Kadioglu fullname: Kadioglu, Ates organization: Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey – sequence: 14 givenname: Juan Ignatio surname: Martínez Salamanca fullname: Martínez Salamanca, Juan Ignatio organization: Department of Urology, Hospital Universitario Puerta del Hierro Majadahonda, Madrid, Spain – sequence: 15 givenname: Uros surname: Milenkovic fullname: Milenkovic, Uros organization: Department of Urology, University Hospitals Leuven, Leuven, Belgium – sequence: 16 givenname: Vaibhav surname: Modgil fullname: Modgil, Vaibhav organization: Manchester Andrology Centre, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, UK – sequence: 17 givenname: Giorgio Ivan surname: Russo fullname: Russo, Giorgio Ivan organization: Urology Section, Department of Surgery, University of Catania, Catania, Italy – sequence: 18 givenname: Ege Can surname: Serefoglu fullname: Serefoglu, Ege Can organization: Department of Urology, Biruni University School of Medicine, Istanbul, Turkey – sequence: 19 givenname: Tharu surname: Tharakan fullname: Tharakan, Tharu organization: Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK – sequence: 20 givenname: Paolo surname: Verze fullname: Verze, Paolo organization: Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy – sequence: 21 givenname: Andrea surname: Salonia fullname: Salonia, Andrea organization: Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34511305$$D View this record in MEDLINE/PubMed |
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| PublicationCentury | 2000 |
| PublicationDate | 2021-11-01 |
| PublicationDateYYYYMMDD | 2021-11-01 |
| PublicationDate_xml | – month: 11 year: 2021 text: 2021-11-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | Switzerland |
| PublicationPlace_xml | – name: Switzerland |
| PublicationTitle | European urology |
| PublicationTitleAlternate | Eur Urol |
| PublicationYear | 2021 |
| Publisher | Elsevier B.V |
| Publisher_xml | – name: Elsevier B.V |
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| Title | European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility |
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