National guidelines published for male fertility testing to identify issues sooner

ABC NEWS (Australia)

A leading team of experts has published new national guidelines for male fertility testing to better support GPs and other specialists evaluating patients. One in 20 Australian men experience infertility, and experts say the guidelines will allow for treatable fertility issues to be identified sooner in men. Professor Robert McLachlan is the medical director at Healthy Male, a national organisation for men's health. He was also chief investigator on this project.

Transcript

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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