The long overdue clinical recommendations are set to standardise national practice.
Male infertility is managed by a variety of healthcare providers across multiple disciplines, yet there have been no guidelines to standardise patient management across the country.
Until now.
The long overdue guidelines have been created by a multidisciplinary group of Australian clinicians and researchers, and are available as a simple, searchable online document.
The guidelines give clinicians, particularly GPs, a shared reference point and clearer language around investigation and referral, said Dr Genia Rozen, co-director of the Fertility Preservation Service at the Royal Women’s Hospital in Melbourne.
There are European and US guidelines, but these are not consistently applied in Australia.
“While the core content aligns closely with existing international guidance, the Australian version adjusts for local context such as Medicare constraints, workforce gaps, and the limited access to subspecialty services,” Dr Rozen told The Medical Republic.
She said many of the recommendations are already in place in well-resourced areas, but the guidelines standardise referral structure and highlight the importance of avoiding unnecessary testing.
“While first-line steps such as semen analysis and reproductive history are typically undertaken, subsequent management, including consistent interpretation of results and referral thresholds, varies across disciplines,” she said.
“[The guideline] also establishes GPs as the first critical touchpoint for detecting broader male health issues, not just infertility. This aligns fertility care with preventive health, which is powerful.”
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There are 80 guideline statements, categorised as mandatory, recommended or suggested, from which Dr Rozen identified several clinical takeaways:
- GS1: Initial semen analysis, physical exam and history – already common practice, but now clearly mandated.
- GS2: Concurrent evaluation of female partner – prevents delays and unnecessary repeat cycles.
- GS5: Refer to a reproduction specialist if semen parameters are abnormal or azoospermia suspected.
- GS6 and GS8: Avoid unnecessary testing early – DNA fragmentation and ultrasound are not needed in routine workup.
- GS36: GPs should counsel men on lifestyle factors (e.g., weight, smoking, alcohol). Advise men with infertility that lifestyle changes, including maintaining a healthy weight, regular physical activity, smoking cessation and a reduction in alcohol intake, may improve sperm quality and the chances of conception.
- GS37: Men with abnormal semen parameters should be assessed for broader health risks, including cardiovascular and metabolic disease Inform men with abnormal semen parameters of associated health conditions that may require regular review.
- GS38: Inform couples with paternal age greater than 40 years of an increased risk of adverse health outcomes in offspring.
- GS40 and GS41: Varicocele management – emphasises that palpable, not ultrasound-only, varicoceles may warrant repair.
- GS64: Do not prescribe testosterone for men with current or imminent reproductive intent.
- GS70: Supplements and antioxidants may help, but evidence remains weak.
Dr Rozen noted that the clinical significance of the guidelines lay more in consolidation than in innovation.
Most statements likely won’t be news to experienced GPs, but she hopes the guidelines will empower providers to navigate these conversations with clarity.
She said the guidelines were also a reminder that male infertility was a major contributor to reproductive challenges and affected up to half of infertile couples.
The guideline noted that a third of assisted reproductive technology (ART) cycles are used because of male factor infertility in Australia.
“Crucially, [infertility] is also a biomarker for broader male health, flagging risks for cardiovascular disease, metabolic syndrome, testicular cancer, and more,” said Dr Rozen.
Male infertility deserves structured, standardised evaluation and care, she said, and previous inconsistency may have contributed to delayed diagnoses of conditions such as hypogonadism and Klinefelter’s syndrome, as well as missed opportunities to address broader aspects of male health.
