What criteria should I use to refer a patient for specialist assessment in cases of male infertility?

Criteria for referring a male patient for specialist assessment in cases of infertility include:

• Men with abnormal semen analysis results, such as azoospermia or other significant semen abnormalities, should be referred for specialist assessment to determine underlying causes and appropriate management options.
• Men with hypogonadotrophic hypogonadism should be referred as they may benefit from gonadotrophin therapy to improve fertility.
• Men with obstructive azoospermia should be referred to centres with appropriate expertise for possible surgical correction of epididymal blockage as an alternative to surgical sperm recovery and IVF.
• Men with chronic viral infections such as hepatitis B, hepatitis C, or HIV should be referred to specialist centres with expertise in safe risk-reduction investigation and treatment before conception is considered.
• Men with ejaculatory failure or other specific male factor infertility issues should be referred for specialist evaluation and management.

Referral should also be considered earlier if there is a known clinical cause or history of predisposing factors for infertility, or if treatment that may impair fertility (e.g., cancer treatment) is planned.

Routine use of ineffective treatments such as anti-oestrogens, androgens, or surgery for varicoceles is not recommended without specialist assessment.

Overall, referral is indicated when initial assessment including semen analysis suggests male factor infertility or when clinical history indicates a need for specialist input to guide management and treatment options.

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