00:00Well, male infertility is a very common problem, but there hasn't been great consistency in
00:08care delivery, partly because people present to different sorts of doctors.
00:13They may present to their local doctor, to a urologist, to a fertility specialist, gynaecologist,
00:19or to an endocrinologist for hormone disorders.
00:21So we're looking to try and bring together the best evidence we can for all those different
00:27parts of the profession to inform them and make sure we have consistent and high quality
00:32care.
00:33So how have these guidelines been devised before we get into what they actually are?
00:37Well, we took advice from the European and the American guidelines, but then with the
00:44assistance of members of all those societies I mentioned a moment ago, brought together
00:48those most relevant and particularly tweaked them, if you like, for the Australian environment.
00:54So they are bespoke Australian guidelines, the very first, and we're aiming to get more
00:58consistent and better quality care through their use.
01:02Okay.
01:03Let's have a look at some of those guidelines.
01:04If we can start maybe with the three mandatory steps that these guidelines are suggesting.
01:09So the first three things that you do before you look at anything else.
01:13Well, it's important that both partners in infertile relationship are seen and reviewed because with
01:21up to half of infertility being related to the male, there's clearly gender equity, if you like,
01:25in the causation and so it's equally important that the male undergo a thorough investigation.
01:30So that's mandatory.
01:32It's essential, obviously, a semen analysis is done of the highest quality and that's something
01:39that's mainly available through specialist programs.
01:43And then we have to ensure that the testing that's done in response to those results is appropriate
01:51because there may be remediable or fixable problems, right?
01:55So it might be possible to restore the man's fertility.
01:58Now, that's important both for the couple, but particularly for his partner, because if you
02:03end up having to have IVF for a condition that could have been addressed in the male, that's inappropriate.
02:09We're trying to reduce the burden. So there are many reasons to have a systematic approach.
02:15Is there a misperception or a bias up until now that usually the women are investigated
02:23first for any infertility issues?
02:26Well, historically, absolutely correct. But for the last 20 years, we've been working
02:31towards getting past that. And we've undertaken many initiatives through the Fertility Society and
02:37also the GPs to ensure that's not the case. Men certainly are aware of it. Couples are aware
02:43of it. There's plenty of discussion in the press, such as yourself. So the community is now aware
02:48of this problem. And so that bias is a historical one, I think. Now, we really are taking it
02:55even-handedly into the future.
02:57Under the guidelines, there are more recommended ones that are there. But when you look at them
03:03holistically, just how invasive are some of these tests for the blokes?
03:09Well, blood testing and semen testing is invasive to a degree. But it could be that ultrasound is
03:15required. It could be that particular, on occasion, a biopsy is required. And I can assure
03:22you that mental couples in whom the male has a serious infertility problem, they are willing to
03:28undergo any of those testings or assessments because they really want to have a family. But
03:34again, you need to do, if you're going to do something invasive like a testicular biopsy,
03:38you have to have a proper basis for undertaking that test. So that's why I think it's important
03:43that something that's systematic like this is something that people will appreciate.
03:48What are some of the common forms of male infertility and just how treatable are they?
03:53Well, the common cause of all is just poor production of sperm within the very fine tubules
04:00that make up the testis. And unfortunately, for many of those people, we don't know or we know,
04:06but can't fix the underlying problem. It could be genetic, it could have been an infection,
04:11it could have been traumatic. So in those men, we are really struggling to get whatever sperm we can
04:17from semen and occasionally from a biopsy. And that's the most common group. The next one is
04:23obstruction. Obviously, if there's a blockage to sperm flow, such as after a vasectomy or some
04:30other surgery, then we have to get around that problem. But there are other problems. Obviously,
04:35if you have erectile or sexual function issues, you can't have regular intercourse. So again,
04:40that's a discrete cause. Rarely, it's due to hormone deficiency from the brain, in which case,
04:47we can give hormone replacement therapy for those missing hormones and get the guy to make sperm
04:53again, which is a tremendous achievement. And so that is clearly remedial. That's one of the major
05:00reasons I think that it's important that the testing, including the hormonal testing is done properly,
05:05but it's really tragic to miss a situation where medical intervention for the male, like hormone
05:11replacement for pituitary problems, will restore his fertility. Problem solved.
05:16Yeah, problem solved, indeed. And then happy family, hopefully, if then all goes to plan.
05:21Oh, yeah. It's very, very exciting.
05:23Yeah. Just finally and briefly, Robert, we know how important it is to understand your body and notice
05:29any changes, etc. How important is self-evaluation of testicles in this? What can men be doing at home
05:37to look after themselves? Well, the general advice is if you ever notice any lump or anything that's
05:44different about your testes or anything else in the scrotum, that you go and see your local doctor.
05:50An ultrasound in 99% of cases will resolve whether it's anything to be concerned about or not.
05:55It's not a terribly onerous thing to every few months or whatever, just make sure that nothing's
06:01changed. It would take about two seconds. So being active in that regard is a very minor intrusion into
06:09your daily routine.
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