Currently, most men with infertility cannot be given an aetiology, which reflects a lack of knowledge around gamete production and how it is affected by genetics and the environment. A failure to recognize the burden of male infertility and its potential as a biomarker for systemic illness exists. The absence of such knowledge results in patients generally being treated as a uniform group, for whom the strategy is to bypass the causality using medically assisted reproduction (MAR) techniques. In doing so, opportunities to prevent co-morbidity are missed and the burden of MAR is shifted to the woman. To advance understanding of men's reproductive health, longitudinal and multi-national centres for data and sample collection are essential. Such programmes must enable an integrated view of the consequences of genetics, epigenetics and environmental factors on fertility and offspring health. Definition and possible amelioration of the consequences of MAR for conceived children are needed. Inherent in this statement is the necessity to promote fertility restoration and/or use the least invasive MAR strategy available. To achieve this aim, protocols must be rigorously tested and the move towards personalized medicine encouraged. Equally, education of the public, governments and clinicians on the frequency and consequences of infertility is needed. Health options, including male contraceptives, must be expanded, and the opportunities encompassed in such investment understood. The pressing questions related to male reproductive health, spanning the spectrum of andrology are identified in the Expert Recommendation.
Nature reviews. Urology. 2023 Oct 12 [Epub ahead of print]
Sarah Kimmins, Richard A Anderson, Christopher L R Barratt, Hermann M Behre, Sarah R Catford, Christopher J De Jonge, Geraldine Delbes, Michael L Eisenberg, Nicolas Garrido, Brendan J Houston, Niels Jørgensen, Csilla Krausz, Ariane Lismer, Robert I McLachlan, Suks Minhas, Tim Moss, Allan Pacey, Lærke Priskorn, Stefan Schlatt, Jacquetta Trasler, Leonardo Trasande, Frank Tüttelmann, Mónica Hebe Vazquez-Levin, Joris A Veltman, Feng Zhang, Moira K O'Bryan
Department of Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada., MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK., Division of Systems Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK., Center for Reproductive Medicine and Andrology, University Hospital, Martin Luther University Halle-Wittenberg, Halle, Germany., Hudson Institute of Medical Research, Melbourne, Victoria, Australia., Department of Urology, University of Minnesota, Minneapolis, MN, USA., Institut National de la Recherche Scientifique, Centre Armand-Frappier Sante Biotechnologie, Laval, Quebec, Canada., Department of Urology and Obstetrics and Gynecology, Stanford University, Stanford, CA, USA., IVI Foundation, Instituto de Investigación Sanitaria La Fe, Valencia, Spain., School of BioSciences and Bio21 Institute, The University of Melbourne, Parkville, Melbourne, Australia., Department of Growth and Reproduction, International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Department of Experimental and Clinical Biomedical Sciences, 'Mario Serio', University of Florence, University Hospital of Careggi Florence, Florence, Italy., Hudson Institute of Medical Research and the Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia., Department of Surgery and Cancer Imperial, London, UK., Healthy Male and the Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia., Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK., Centre for Reproductive Medicine and Andrology, University of Münster, Münster, Germany., Departments of Paediatrics, Human Genetics and Pharmacology & Therapeutics, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada., Center for the Investigation of Environmental Hazards, Department of Paediatrics, NYU Grossman School of Medicine, New York, NY, USA., Institute of Reproductive Genetics, University of Münster, Münster, Germany., Instituto de Biología y Medicina Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina, Fundación IBYME, Buenos Aires, Argentina., Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK., Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China., School of BioSciences and Bio21 Institute, The University of Melbourne, Parkville, Melbourne, Australia. .