Validation of the American Society for Reproductive Medicine guidelines/recommendations in white European men presenting for couple's infertility.

<bold>Objective: </bold>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.<bold>Design: </bold>Retrospective study.<bold>Setting: </bold>Academic reproductive medicine outpatient clinic.<bold>Patient(s): </bold>Cohort of 1,056 consecutive infertile men (noninterracial infertile couples).<bold>Intervention(s): </bold>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.<bold>Main Outcome Measure(s): </bold>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.<bold>Result(s): </bold>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.<bold>Conclusion(s): </bold>The current findings show that the ASRM guidelines/recommendations for male infertility workup may not be suitable for application in white European infertile men. [ABSTRACT FROM AUTHOR]