December 2025
Australia’s first male infertility guidelines available
By Rebecca Jenkins
Australia’s first evidence-based guidelines on male infertility have been published to inform and support clinicians managing the condition.
A multidisciplinary panel of experts formulated 80 evidence-based statements around the management of the most common areas of male infertility, spanning initial evaluation and investigation to surgical management and hormone therapy.
Writing in the Medical Journal of Australia, the seven experts said infertility affected about one in six couples and a male factor might contribute in 50% of cases.
‘The male contribution to couple infertility has been recognised by international practice guidelines for more than two decades but, until recently, Australian-based guidelines did not exist,’ they wrote.
‘These first Australian evidence-based guidelines will serve as a long overdue clinical aid to the large number of practitioners who provide services to men with infertility.’
Guideline lead author, Associate Professor Darren Katz, Urologist and Male Fertility Microsurgeon, at the University of Melbourne’s Department of Surgery, and Medical Director at Men’s Health Melbourne, said a key recommendation was the need to concurrently investigate the male and female partner of a couple presenting with infertility to avoid delays in accessing appropriate and timely fertility care.
‘Most of the time, there is still a significant delay before the male is assessed, usually only after the female has gone through her series of testing,’ he told Medicine Today.
An initial evaluation for male infertility should include a reproductive and medical history, physical examination (including the scrotum) and semen analysis. If the semen analysis was abnormal, a second analysis should be repeated about six weeks later, Professor Katz said.
The guidelines also highlighted the importance of identifying clinically significant varicocele, using the Valsalva manoeuvre.
‘Even though only a minority of varicoceles can cause problems – usually the bigger palpable ones – given that 15% of men have them, they are a significant cause of both primary and secondary infertility,’ Professor Katz said.
Varicocele treatment should be considered in men with infertility who have a clinical varicocele in addition to either abnormal sperm parameters, unexplained infertility or raised sperm DNA fragmentation, and in couples who have experienced failed assisted reproductive technology.
Specific recommendations were also included in the guidelines for men with cryptorchidism and Klinefelter syndrome, as well as managing cancer and male infertility.
Professor Katz said it was hoped that the guidelines would help raise awareness about male infertility and reduce the stigma around it for affected men.
‘The psychological effect of male infertility is perhaps less well appreciated,’ he said.
‘When a male is diagnosed with infertility, there can be a sense of a "hit" to his masculinity. It is imperative to acknowledge that this can occur for the male partner and indeed encourage support as necessary.’
The recommendations were endorsed by key stakeholder organisations including Healthy Male, the Urological Society of Australia and New Zealand, the Endocrine Society of Australia and the Fertility Society of Australia and New Zealand. The guidelines are available online at: https://healthymale.org.au/projects/male-infertility-guidelines.