Context

The European Association of Urology (EAU) has updated its guidelines on sexual and reproductive health for 2021.

Objective

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.

Evidence acquisition

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 synthesis

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.

Conclusions

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.

Patient summary

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.

中文翻译：

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欧洲泌尿外科协会男性性与生殖健康指南：2021 年男性不育症更新

语境

欧洲泌尿外科协会 (EAU) 更新了 2021 年性与生殖健康指南。

客观的

概述 2021 年版 EAU 性和生殖健康指南，包括男性不育症的进展和争议领域。

取证

专家组对截至 2021 年 1 月的新数据进行了全面的文献回顾。指南已更新，并根据对文献的系统回顾或专家小组的共识意见（如适用）纳入了每项建议的强度等级。

证据综合

不育夫妇的男性伴侣应接受全面的泌尿科评估，以识别和治疗任何可改变的导致生育障碍的风险因素。不育男性患其他疾病的风险更高，包括恶性肿瘤和心血管疾病，应筛查潜在的可改变风险因素，如性腺机能减退。精子 DNA 片段化测试已成为一种新的生物标志物，可以识别不育男性并提供有关辅助生殖技术结果的信息。激素刺激治疗在高促性腺激素性性腺功能减退或性腺功能正常的患者中的作用是有争议的，不建议在临床试验之外进行。此外，没有足够的证据支持在临床实践中广泛使用其他经验性治疗和手术干预（例如抗氧化剂和无精​​子症男性的手术取精）。有低质量证据支持常规使用睾丸细针测绘作为非梗阻性无精子症 (NOA) 男性睾丸精子提取 (TESE) 前的替代诊断和预测工具，传统或显微解剖 TESE 仍然是手术方式NOA 男性的首选。

结论

所有不育男性都应接受全面的泌尿系统评估，以识别和治疗任何可改变的风险因素。越来越多的数据表明，不育男性心血管死亡和癌症的风险较高，应进行相应的筛查和咨询。低质量的证据支持目前在临床实践中使用的经验性治疗和干预措施；这些疗法的疗效需要在大规模随机对照试验中得到验证。

患者总结

大约 50% 的不孕症是由于男性伴侣的问题。因此，所有不育男性都应由具有专业知识的专家进行评估，这不仅有助于优化他们的生育能力，而且因为他们长期患心血管疾病和癌症的风险更高，因此需要适当的咨询和管理。男性不育症的许多治疗和干预措施尚未在高质量研究中得到验证，在常规临床实践中应谨慎使用。