Male Fertility as a Marker of Men’s Health: What the New Australian Guidelines and USANZ Are Telling Us
Male fertility has traditionally been a quiet topic — overshadowed by misconceptions, stigma, and the belief that reproductive issues are mainly a “female problem.” But new evidence and strong public statements from the Urological Society of Australia and New Zealand (USANZ) make one thing clear:
Male fertility is an important marker of overall health, not just the ability to conceive.
With the release of both the USANZ media statement and Australia’s first-ever evidence-based National Guidelines on Male Infertility (Medical Journal of Australia, 2025), men now have clearer guidance, better information, and stronger reasons to seek help early.
As a urological surgeon with a special interest in male reproductive and general urological health, I believe this shift is long overdue — and incredibly important for men of all ages.
Male Infertility Is Common - and Increasing
USANZ highlights several key facts:
1 in 20 Australian men are infertile
Global male fertility has been declining for decades
Varicocele affects up to 1 in 7 men
Many men are unaware of fertility issues until they actively try to conceive
Stigma remains a major barrier to help-seeking
Varicocele, the most common reversible cause of male infertility, occurs when the veins that drain the testicles become enlarged. Some men experience aching or heaviness, but many feel no symptoms at all. What is less well known is that varicocele can significantly impair sperm quality — and that treatment (when appropriately indicated) can meaningfully improve natural fertility.
USANZ shared examples of men previously told they could never conceive naturally who went on to father children after straightforward treatment. These stories are not unusual in clinical practice.
Why Male Fertility Matters for More Than Reproduction
One of the strongest messages from USANZ — and an area of growing research — is that male infertility is an early warning sign of broader health issues.
A landmark study from Stanford University demonstrated links between male infertility and:
Cardiovascular disease
Metabolic disease (including diabetes)
Autoimmune conditions
Certain cancers
Higher rates of hospitalisation and mortality
Just as erectile dysfunction can precede a heart attack, infertility can signal underlying hormonal, metabolic, vascular, or systemic abnormalities.
This message has been reinforced in the new Australian national guidelines: evaluating male infertility is not just about identifying sperm issues — it is an opportunity for men to engage with preventive health, uncover undiagnosed conditions, and improve long-term outcomes.
Australia’s First National Male Infertility Guidelines (MJA 2025)
These new guidelines provide much-needed clarity for clinicians and patients.
Link to paper
The first Australian evidence-based guidelines on male infertility
Darren J. Katz, Liza O’Donnell, Robert I. McLachlan, Tim J. Moss, Clare V. Boothroyd, Veena Jayadev, Sarah R. Catford
First published: 10 November 2025
https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70080
Key Messages from the Guidelines
1. Every man with fertility concerns deserves proper evaluation
The guidelines recommend:
Detailed reproductive and general medical history
Physical and scrotal examination
Semen analysis (with repeat testing if abnormal)
Simultaneous assessment of the female partner
Avoiding unnecessary early tests (e.g., sperm antibodies, routine ultrasound)
This prevents delays and ensures the right issues are addressed early.
2. Varicocele must be examined properly — and treated when appropriate
A clinical, palpable varicocele, combined with any of the following, should be considered for treatment:
Abnormal semen parameters
Unexplained infertility
Elevated sperm DNA fragmentation
Recurrent miscarriage or ART failure
Microsurgical varicocelectomy offers the best outcomes and lowest complication rates.
Importantly, subclinical (ultrasound-only) varicoceles should not be treated.
3. Azoospermia: Understanding the cause is essential
The guidelines strongly emphasise distinguishing between:
Obstructive azoospermia (blockage)
Non-obstructive azoospermia (reduced sperm production)
This distinction informs further investigation, genetic testing, hormonal assessment, and sperm retrieval planning. Micro-TESE is the preferred technique for men with non-obstructive azoospermia.
4. Genetic and hormonal evaluation when needed
Depending on the clinical findings, men may require:
Karyotype testing
Y-chromosome microdeletion analysis
CFTR gene testing (when vas deferens abnormalities exist)
FSH, LH, testosterone, SHBG
Possible imaging
These tests have implications not only for fertility but for overall health and future offspring.
5. Lifestyle matters — more than many men expect
Both USANZ and the guidelines highlight the role of modifiable factors:
Weight
Smoking
Alcohol
Exercise
Sleep
Stress
Heat exposure
Cardiometabolic health
Improving these can enhance fertility and reduce long-term health risks.
6. Fertility preservation is critical
Sperm banking is strongly recommended for:
Men undergoing gonadotoxic cancer therapy
Men having orchidectomy
Adolescents and adults with Klinefelter syndrome
Any male patient at risk of losing fertility due to treatment or illness
This proactive approach can make a profound difference in future options.
Male Infertility Is Not a Niche Issue — It’s a Public Health Issue
USANZ stresses that we need to stop treating male infertility as a “rare” or “specialised” concern. It affects tens of thousands of Australian men, carries long-term health implications, and should be recognised as an opportunity for early intervention.
The AIHW’s 2023 Health of Australia’s Males report noted a significant gap in national data on male infertility — highlighting the need for increased awareness and investment.
By normalising conversations, reducing stigma, and encouraging early assessment, we can significantly improve not only fertility outcomes but men’s overall health and life expectancy.
When Men Should Seek Help
Men should consider assessment if:
They’ve been trying to conceive for 6–12 months
They have a known varicocele
There is a history of undescended testes, testicular cancer, chemotherapy, or radiation
Semen analysis has shown abnormal results
There are symptoms of hormonal imbalance (low libido, fatigue, reduced strength)
There is testicular discomfort, asymmetry, or change in size
They simply want a clear picture of their reproductive and general health
A timely, thorough evaluation can identify reversible conditions, guide appropriate treatment, and provide reassurance or early detection of other medical issues.
Final Thoughts
Male fertility is a critical part of men’s health — not just an isolated issue of reproduction. The combination of the recent USANZ media release and the new national guidelines marks a major step forward in recognising and addressing this.
Infertility is medical, common, treatable in many cases, and deeply informative about long-term health.
If you have concerns about fertility, testicular health, or hormonal symptoms, seeking early assessment is one of the most impactful decisions you can make for both your reproductive and overall wellbeing.