title: Validation of the American Society for Reproductive Medicine guidelines/recommendations in white European men presenting for couple's infertility.
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.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Academic reproductive medicine outpatient clinic.
  
  
  METHODS
  Cohort of 1,056 consecutive infertile men (noninterracial infertile couples).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.affiliation: 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.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Ventimiglia
authors.affiliation: 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.
authors.forename: Paolo
authors.initials: P
authors.lastname: Capogrosso
authors.affiliation: Division of Experimental Oncology/Unit of Urology, Urological Research Institute, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Boeri
authors.affiliation: Division of Experimental Oncology/Unit of Urology, Urological Research Institute, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ippolito
authors.affiliation: Division of Experimental Oncology/Unit of Urology, Urological Research Institute, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Scano
authors.affiliation: Division of Experimental Oncology/Unit of Urology, Urological Research Institute, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Moschini
authors.affiliation: 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.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Infertility Unit, Unit of Obstetrics/Gynecology, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Papaleo
authors.affiliation: 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.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: 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.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D003940:Diagnostic Techniques, Endocrine / Q000592:standards*; D005298:Fertility; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology / Q000503:physiopathology; D007248:Infertility, Male / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology / Q000503:physiopathology; D007558:Italy / Q000453:epidemiology; D008297:Male; D049451:Nomograms; D009929:Organ Size; D017410:Practice Guidelines as Topic / Q000592:standards*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013076:Sperm Count; D013737:Testis / Q000473:pathology; D013739:Testosterone / Q000097:blood; D044465:White People
chemical_list: D015415:Biomarkers; D013739:Testosterone
keywords: Male infertility; guidelines; hormones; semen parameters; testosterone