Eugenio Ventimiglia1, Paolo Capogrosso1, Luca Boeri2, Silvia Ippolito2, Roberta Scano2, Marco Moschini2, Giorgio Gandaglia1, Enrico Papaleo3, Francesco Montorsi1, Andrea Salonia4. 1. Division of Experimental Oncology/Unit of Urology, Urological Research Institute, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy. 2. Division of Experimental Oncology/Unit of Urology, Urological Research Institute, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy. 3. Infertility Unit, Unit of Obstetrics/Gynecology, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy. 4. Division of Experimental Oncology/Unit of Urology, Urological Research Institute, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy. Electronic address: salonia.andrea@hsr.it.
Abstract
OBJECTIVE: To retrospectively validate the American Society for Reproductive Medicine (ASRM) guidelines/recommendations concerning endocrine evaluation in a cohort of white European men presenting for couple's infertility. DESIGN: Retrospective study. SETTING: Academic reproductive medicine outpatient clinic. PATIENT(S): Cohort of 1,056 consecutive infertile men (noninterracial infertile couples). INTERVENTION(S): Testicular volume was assessed with a Prader orchidometer. Serum hormones were measured (8-10 a.m.) in all cases. Hypogonadism was defined as total T < 3 ng/mL, according to the Endocrine Society definition. Semen analysis values were assessed based on the 2010 World Health Organisation reference criteria. MAIN OUTCOME MEASURE(S): ASRM indications for endocrine assessment in infertile men (sperm concentration <10 million/mL, impaired sexual function, and other clinical findings suggesting a specific endocrinopathy) were used to predict hypogonadism in our cohort. Moreover, a clinically user-friendly three-item nomogram was developed to predict hypogonadism and was compared to the ASRM guidelines assessment. RESULT(S): Biochemical hypogonadism was diagnosed in 156 (14.8%) men. Overall, 669 (63.4%) patients would have necessitated total T assessment according to the ASRM criteria; of these, only 119 (17.8%) were actually hypogonadal according to the Endocrine Society classification criteria. Conversely, 37 (23.7%) out of 156 patients with biochemical hypogonadism would have been overlooked. The overall predictive accuracy, sensitivity, and specificity of the ASRM guidelines was 58%, 76%, and 39%, respectively. Our nomogram was not reliable enough to predict hypogonadism, despite demonstrating a significantly higher predictive accuracy (68%) than the ASRM guidelines. CONCLUSION(S): The current findings show that the ASRM guidelines/recommendations for male infertility workup may not be suitable for application in white European infertile men.
OBJECTIVE: To retrospectively validate the American Society for Reproductive Medicine (ASRM) guidelines/recommendations concerning endocrine evaluation in a cohort of white European men presenting for couple's infertility. DESIGN: Retrospective study. SETTING: Academic reproductive medicine outpatient clinic. PATIENT(S): Cohort of 1,056 consecutive infertile men (noninterracial infertile couples). INTERVENTION(S): Testicular volume was assessed with a Prader orchidometer. Serum hormones were measured (8-10 a.m.) in all cases. Hypogonadism was defined as total T < 3 ng/mL, according to the Endocrine Society definition. Semen analysis values were assessed based on the 2010 World Health Organisation reference criteria. MAIN OUTCOME MEASURE(S): ASRM indications for endocrine assessment in infertile men (sperm concentration <10 million/mL, impaired sexual function, and other clinical findings suggesting a specific endocrinopathy) were used to predict hypogonadism in our cohort. Moreover, a clinically user-friendly three-item nomogram was developed to predict hypogonadism and was compared to the ASRM guidelines assessment. RESULT(S): Biochemical hypogonadism was diagnosed in 156 (14.8%) men. Overall, 669 (63.4%) patients would have necessitated total T assessment according to the ASRM criteria; of these, only 119 (17.8%) were actually hypogonadal according to the Endocrine Society classification criteria. Conversely, 37 (23.7%) out of 156 patients with biochemical hypogonadism would have been overlooked. The overall predictive accuracy, sensitivity, and specificity of the ASRM guidelines was 58%, 76%, and 39%, respectively. Our nomogram was not reliable enough to predict hypogonadism, despite demonstrating a significantly higher predictive accuracy (68%) than the ASRM guidelines. CONCLUSION(S): The current findings show that the ASRM guidelines/recommendations for male infertility workup may not be suitable for application in white European infertile men.
Authors: J C Trussell; R Matthew Coward; Nanette Santoro; Christy Stetter; Allen Kunselman; Michael P Diamond; Karl R Hansen; Stephen A Krawetz; Richard S Legro; Dan Heisenleder; James Smith; Anne Steiner; Robert Wild; Peter Casson; Cristos Coutifaris; Reuben R Alvero; R B Robinson; Greg Christman; Pasquale Patrizio; Heping Zhang; Mark C Lindgren Journal: Fertil Steril Date: 2019-04-12 Impact factor: 7.329
Authors: Eugenio Ventimiglia; Paolo Capogrosso; Luca Boeri; Walter Cazzaniga; Rayan Matloob; Edoardo Pozzi; Francesco Chierigo; Costantino Abbate; Paola Viganò; Francesco Montorsi; Andrea Salonia Journal: Hum Reprod Open Date: 2020-09-22
Authors: Christopher L R Barratt; Lars Björndahl; Christopher J De Jonge; Dolores J Lamb; Francisco Osorio Martini; Robert McLachlan; Robert D Oates; Sheryl van der Poel; Bianca St John; Mark Sigman; Rebecca Sokol; Herman Tournaye Journal: Hum Reprod Update Date: 2017-11-01 Impact factor: 15.610