[Assessment of the man in the infertile couple]

Abstract

Background: Among couples consulting for infertility, there is a male component, either alone or associated with a female aetiology in around one in 2 cases.

Material and methods: Bibliographic search in PubMed using the keywords "male infertility", "diagnosis", "management" and "evaluation" limited to clinical articles in English and French prior to 1/01/2023.

Results: The AFU recommends: (1) a complete medical history including: family history, patient history affecting fertility, lifestyle habits (toxicity), treatments, symptoms, sexual dysfunctions; (2) a physical examination including: BMI, signs of hypogonadism, secondary sexual characteristics, scrotal examination (volume and consistency of testes, vas deferens, epididymal or testicular nodules, presence of varicocele); (3) two spermograms, if abnormal on the first; (4) a systematic scrotal ultrasound,± an endorectal ultrasound depending on the clinic; (5) a hormonal work-up (testosterone, FSH; if testosterone is low: LH assay to differentiate between central or peripheral hypogonadism); (6) karyotype if sperm concentration≤10 million/mL; (7) evaluation of Y chromosome microdeletions if concentration≤1 million/mL; (8) evaluation of the CFTR gene in cases of suspected bilateral or unilateral agenesis of the vas deferens and seminal vesicles. The role and usefulness of direct and indirect tests to assess the effects of oxidative stress on sperm DNA will also be explained.

Conclusion: This review complements and updates the AFU/SALF 2021 recommendations.

Keywords: Agénésie déférentielle; Azoospermia; Azoospermie; CFTR; Caryotype; Chomosome Y microdeletions; DNA fragmentation; Deferential agenesis; Fragmentation de l’ADN; France genomics 2025 plan; Infertilité masculine; Karyotype; Male infertility; Microdélétions du chomosome Y; Plan France génomique 2025; Varicocele; Varicocèle.