ASRM 2024 Abstract Submission is Open!

Menu
Close Close Icon

Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility: a committee opinion (2023)


Sexual dysfunction is a common condition among men of reproductive age. It can significantly worsen because of the stress of conception efforts or a diagnosis of infertility. It is important to elicit this sensitive information and provide the appropriate referral. This document presents the diagnostic evaluation and treatment of the most common sexual dysfunction issues seen by fertility providers. These issues drive patients to seek care and offer healthcare providers an opportunity to improve male health.

ERECTILE DYSFUNCTION

Detection

Male sexual dysfunction in the setting of infertility often presents with erectile dysfunction (ED). Erectile dysfunction is defined as the consistent inability to attain or maintain a penile erection of sufficient quality to permit satisfactory sexual intercourse (1). Erectile dysfunction is prevalent and increases with age. Severe and moderate-severity ED occur in 5% and 17%, respectively, of men aged 40–49 years. More than 152 million men worldwide were reported to have ED in 1995, and this number is projected to increase to 322 million in 2025 (2). It is present in 18%–89% of men with infertility (3–6). The prevalence of ED in infertile men is significantly higher than in fertile controls (6). Having an erection is a necessary component of unassisted conception and, often, of intrauterine insemination (IUI) or in vitro fertilization (IVF).

Erectile dysfunction may be indicative of serious health comorbidities.Men with ED without a history of cardiovascular disease have a 45% increased risk of having a subsequent cardiovascular event within 5 years compared with those without ED (7, 8). Erectile dysfunction is associated with a number of other treatable underlying factors or conditions, including smoking, diabetes, depression, hypertension, and heart disease (9, 10). Thus, it is important to inquire about multiple issues that affect aman’s general health in men of all ages  who present with ED, regardless of fertility status.

In the setting of infertility, ED can present in two main forms: psychogenic and organic. Psychogenic ED occurs when a man has normal penile blood flow and nerve function and may achieve an erection under some circumstances but, typically, not with his partner when trying to conceive. Typically, any form of situational ED, particularly that which presents or worsens after a couple begins trying to conceive, is psychogenic. Organic ED is commonly a result of diminished penile blood flow or nerve dysfunction and results in the inability to achieve or maintain an erection regardless of the situation (11). It is often associated with cardiovascular disease and, more commonly, presents in older men. Regardless of the origin, ED can have deleterious effects on psychosocial and relationship issues (12). The severity of ED may be initially determined through a careful history or a validated questionnaire, such as the International Index of Erectile Function (IIEF) or the Sexual Health Inventory for Men (13, 14).

A comprehensive history with a focus on risk factors for cardiovascular disease is a critical component of the ED evaluation. Specifically, the man should be queried about whether he obtains regular primary care; has any comorbidity such as diabetes, hypertension, coronary artery disease, or other cardiac conditions; reports a history of penile, prostate, or spine surgery; uses cigarettes, tobacco, or other recreational drugs; or has a family history of cardiovascular disease. Medication use such as beta blockers, hydrochlorothiazide, other antihypertensives, exogenous testosterone use, use of phosphodiesterase type-5 inhibitors (PDE5i) (such as sildenafil, tadalafil, avanafil, or vardenafil), or use of penile injection therapy should also be documented (15). Evaluation of psychogenic ED involves a thorough sexual history eliciting the onset and exact nature of the problem, with emphasis on whether the man has morning erections, ED with self-stimulation, a history of ED with prior partners, and the timing of the onset of the disease (11). A physical examination should include blood pressure and the calculation of body mass index, as well as an assessment for signs of testosterone deficiency. Morning serum testosterone should be assayed, as should glucose and hemoglobin A1c levels, as well as lipid profile measurements, as indicated (16).

Treatment

The cornerstone of ED treatment for either psychogenic or organic ED is reassurance to the patient that, in most cases, ultimately, the problem can be resolved. Further, it should be made clear to both the patient and his partner that a man's ED is not a function of his attraction or devotion to his partner. Referral to a mental health professional can be considered, as needed. For psychogenic ED, a trial of PDE5i may help restore a man's confidence and improve his chances of maintaining an erection (17). In cases of organic ED, the identification of comorbid conditions such as diabetes can be lifesaving. Lifestyle modification, including weight optimization, a healthy diet, and moderate exercise, may improve erectile function (18). In all cases, these men should have adequate follow-up with a primary care physician. The shared decision-making model can be used to begin a care pathway starting with lifestyle modification, substituting alternative medications in place of those that can exacerbate ED, and a trial of PDE5i in patients who have organic causes of ED such as spinal cord injuries (SCIs), radical pelvic surgery, severe atherosclerosis, or those who fail lifestyle therapy or desire rapid improvement in their ED.

Typically, these men may be started on a PDE5i trial with appropriate counseling about the risk of priapism (defined as an erection lasting >4 hours). Contraindications for PDE5i use include the use of nitrates and inadequate cardiac reserve for sexual activity, requiring clearance by a cardiologist. Further, these medications should be used with caution in men on an alpha blocker, as they can cause an unsafe drop in blood pressure. Side effects of PDE5i agents include headaches, facial flushing, muscle aches, nasal congestion, a blue tinge in vision, dizziness, dyspepsia, and priapism. Typical doses of PDE5i are sildenafil 50–100 mg, tadalafil 5–20 mg, vardenafil 10–20 mg, and avanafil 50–200 mg. When PDE5i therapy is not effective, patients can be transitioned to intracavernosal injection therapy under the care of a urologist (11). Should this fail, surgery to place a penile prosthesis may be indicated.

Patients with SCIs represent a unique population of men with ED. With normal physiologic function, the S2-4 nerve roots cause vasodilation of vessels in the corpora cavernosa, enabling erections. In general, a complete upper-motor neuron injury above T11 can result in reflex erections in the absence of psychogenic erections, although men with an injury impacting the sacral pathways have psychogenic erections but no reflex erections. Phosphodiesterase type-5 inhibitor therapy is the first-line treatment for men with SCI. Another option for ED treatment in men with SCI is intracavernosal injections, which should be started at a lower dose than for men with vasculogenic impotence; these men should be monitored for autonomic dysreflexia.

The evaluation and treatment of psychogenic ED, because it is more likely to present in infertile men, bears particular relevance to reproductive medicine specialists. Certainly, a reported history of diabetes mellitus and a prior history of prostate or penile surgery may obviate the need for any further testing because these conditions are reliably associated with organic ED (19). For less clear-cut circumstances, objective endpoints to discriminate between psychogenic and organic ED include nocturnal penile tumescence testing or penile duplex Doppler ultrasonography (19, 20). Questionnaires, including the frequently employed IIEF, may not always successfully differentiate between psychogenic and organic causes (20, 21). Indeed, in two studies each with 36 and 44 patients, 20%–37% of patients who scored severe ED on the basis of IIEF were found to have normal penile ultrasound dynamics, underscoring the necessity of further testing to differentiate between organic and psychogenic ED (20, 22). In patients with psychogenic ED, empirical psychotherapy with or without PDE5i therapy under the supervision of an appropriate specialist with the requisite expertise should be offered. The importance of an accurate diagnosis is underscored by the finding that up to 32% of 285 men with psychogenic ED in one study experienced resolution of symptoms immediately after a definitive diagnosis (23). This problem is particularly relevant among men who are unable to provide an ejaculated specimen on the day of oocyte retrieval. Therefore, early identification and treatment of this condition are of paramount importance. Additionally, patients with ED (or ejaculatory dysfunction) may warrant counseling and information about sperm banking before treatment in the event they cannot produce a semen sample on the day of planned fertility treatments.

PSYCHOLOGICAL STRESS

The effects of infertility-related stress are not as well studied in the male partner as they are in the female (24). A longitudinal study of infertility-related stress found that women experienced greater anxiety symptoms than men.

Importantly, high levels of sexual infertility stress, defined as loss of enjoyment of sexual relations, feelings of pressure to schedule sexual relations, and loss of sexual self-esteem, were noted among 21% of the 295 men studied (25). Increased sexual dissatisfaction in both partners after IVF failure highlights the need to approach the complaint of ED holistically and consider referral to a specialized mental health professional for appropriate counseling (26). Interestingly, longterm follow-up of patients treated with assisted reproductive therapy found similar sexual satisfaction regardless of whether they were able to conceive a child (27).

EJACULATORY DYSFUNCTION

Ejaculatory dysfunction may have a substantial impact on fertility potential. Aspermia is the absence of antegrade ejaculation with orgasm. This may be because of the lack of seminal emission or because of retrograde ejaculation, which is the backward flow of the ejaculate into the bladder instead of antegrade expulsion out of the urethral meatus. In both circumstances, men will have a ‘‘dry orgasm’’ (28). Patients who undergo a retroperitoneal lymph node dissection for testicular cancer may have a loss of emission because of damage to the hypogastric plexus. For this reason, it is important to counsel these men about sperm banking before surgery when they desire future fertility. There is no available treatment for restoring seminal emission in these patients. In addition, men with ejaculatory duct obstruction may have absent or significantly reduced seminal emission; these patients may benefit from transurethral resection of the ejaculatory ducts to relieve the obstruction. Additional etiologies for lack of seminal emission can include SCI, radical prostatectomy, pelvic trauma, diabetes mellitus, multiple sclerosis, and Parkinson's disease. Testicular sperm extraction may be considered in those patients with failure of emission. 

Retrograde ejaculation can be secondary to medications inhibiting bladder neck closure (i.e., alpha blockers) or because of surgical procedures on the prostate and/or bladder neck. Other etiologies include various neuropathies affecting bladder neck closure, which can be secondary to diabetes mellitus, SCI, neurologic disorders, or retroperitoneal lymph node dissection (29). When retrograde ejaculation is caused by an alpha blocker, stopping the medication will restore antegrade ejaculation. Otherwise, medical therapies aimed at treating retrograde ejaculation include alpha agonists and tricyclic antidepressants such as imipramine, which have been used with variable results (30, 31). When medical therapies are not successful or are not attempted, sperm can be collected from men with retrograde ejaculation using postejaculatory urine specimens and used for either IUI or IVF. Conventional protocols include urine alkalinization for a period of 24 hours, followed by a postorgasm urinalysis. This is essential for ensuring sperm viability so that it can be effectively used for IUI or IVF, depending on the amount and quality of sperm recovered.

Men with SCIs may present with aspermia secondary to either the absence of seminal emission or retrograde ejaculation. Many of these men also have anorgasmia, which is the inability to achieve an orgasm. There has been encouraging success with the use of penile vibratory stimulation to enable these patients to reach climax and produce an ejaculate (32). This is a minimally invasive method to potentially harvest sperm for either IUI or IVF. When there is no ejaculation, then the postejaculatory urine can be analyzed to assess retrograde ejaculation (29). When this is ineffective and an ejaculation is desired for fertility purposes, there have been promising results also with the use of electroejaculation in
these patients (33). 

Premature ejaculation (PE) refers to the triad of short ejaculatory latency, a lack of control over the ability to delay ejaculation, and personal distress as a result of this condition. Although the definition of PE is still evolving, ‘‘lifelong PE’’ is characterized by ejaculation that occurs within 1 minute of vaginal penetration (34). In patients with ‘‘acquired PE,’’ this latency time may be up to 3 minutes (34). Certainly, there are imperfections with this strict definition in that it does not take into account homosexual relationships or early ejaculations before vaginal penetration. However, using this definition, the prevalence of PE has been estimated to be between 5% and 20% (35). Organic causes of PE have been identified because of penile hypersensitivity and 5-hydroxytryptamine receptor hypersensitivity; however, psychogenic influences such as anxiety, depression, and stress may further exacerbate PE. There are several over-the-counter lidocaine-based topical agents aimed at treating penile hypersensitivity (36). These are readily available to all men and are used commonly to delay ejaculation, even without a formal diagnosis of PE. Additionally, selective serotonin reuptake inhibitors have been successful in treating PE by activating the 5-hydroxytryptamine 2C receptor and, consequently, readjusting the ejaculatory threshold set point (37). It is important to emphasize also the role of sexual therapy, employing cognitive and behavioral techniques, as part of the treatment algorithm for PE. Involving the partner in the treatment process and encouraging open communication about sexuality may yield greater relationship benefits as well.

DECREASED LIBIDO

Hormonal dysfunction is frequently associated with sexual complaints among infertile men, most commonly related to diminished libido. Evaluation of these symptoms may include straightforward questions during the medical interview or employing a validated questionnaire, such as the androgen deficiency in aging male’s test (38). Indeed, 43% of 94 men presenting to an infertility clinic with normozoospermia provided a positive response to a validated questionnaire of symptoms consistent with testosterone deficiency (37). Men presenting with oligozoospermia have concomitant hypoandrogenism in 42%–50% of cases (37). Correction of testosterone deficiency in the setting of ED should be approached with modest expectations (39, 40). However, men with complaints related specifically to diminished libido in the setting of testosterone deficiency may achieve good symptomatic benefit from hormonal therapy (41).

Exogenous testosterone replacement therapy should be avoided in men attempting conception because of disruption of normal spermatogenesis. Exogenous testosterone leads to iatrogenic suppression of hypothalamic gonadotropin-releasing hormone secretion, with resultant decreases in pituitary gonadotropin secretion. In turn, this results in decreased intratesticular testosterone concentrations and reduced spermatogenesis, often to the point of azoospermia. Higher doses of testosterone are more likely to suppress the hypothalamic-pituitary-testis axis (42). Alternative therapies for testosterone optimization in men with symptomatic testosterone deficiency who are attempting to conceive include selective estrogen receptor modulators, aromatase inhibitors, and human chorionic gonadotropin (41).

CONCLUSION

  • Psychological distress from infertility contributes to male sexual dysfunction.
  • Studies show that significant, but treatable, medical comorbidities may be identified during evaluation.
  • Aspermia caused by retrograde ejaculation may be treated medically, or sperm can be collected from postejaculatory urine samples.
  • Aspermia caused by failure of emission can be circumvented by a testicular sperm extraction attempt.
  • Exogenous testosterone has the potential to suppress spermatogenesis.
  • Erectile dysfunction is a common, correctable problem that may occur in infertile men.
  • Evaluation and treatment of male sexual dysfunction serve as an opportunity to improve a man’s somatic health.
  • For men with symptomatic testosterone deficiency who are attempting to conceive, exogenous testosterone use should be avoided.

Acknowledgments: This report was developed under the direction of the Practice Committee of the American Society for Reproductive Medicine as a service to its members and other practicing clinicians. Although this document reflects appropriate management of a problem encountered in the practice of reproductive medicine, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Other plans of management may be appropriate, taking into account the needs of the individual patient, available resources, and institutional or clinical practice limitations. The Practice Committee and the Board of Directors of the American Society for Reproductive Medicine have approved this report.

This document was reviewed by ASRM members and their input was considered in the preparation of the final document. The following members of the ASRM Practice Committee participated in the development of this document: Clarisa Gracia, M.D., M.S.C.E.; Alan Penzias, M.D.; Jacob Anderson; Paula Amato, M.D.; Kristin Bendikson, M.D.; Clarisa Gracia, M.D., M.S.C.E.; Tommaso Falcone, M.D.; Rebecca Flyckt, M.D.; Karl Hansen, M.D., Ph.D.; Micah Hill, D.O.; Sangita Jindal, Ph.D.; Suleena Kalra, M.D., M.S.C.E.; Tarun Jain, M.D.; Bruce Pier, M.D.; Michael Thomas, M.D.; Richard Reindollar, M.D.; Jared Robins, M.D.; Chevis N Shannon, Dr.Ph., M.B.A., M.P.H.; Anne Steiner, M.D., M.P.H.; Cigdem Tanrikut, M.D.; and Belinda Yauger, M.D. The Practice Committee acknowledges the special contribution of Cigdem Tanrikut, M.D. in the preparation of this document. All committee members disclosed commercial and financial relationships with manufacturers or distributors of goods or services used to treat patients. Members of the committee who were found to have conflicts of interest on the basis of the relationships disclosed did not participate in the discussion or development of this document.

REFERENCES

  1. NIH Consensus Development Panel on Impotence. NIH consensus conference. Impotence. JAMA 1993;270:83–90.
  2. Ayta IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int 1999;84:50–6.
  3. Song SH, Kim DS, Yoon TK, Hong JY, Shim SH. Sexual function and stress level of male partners of infertile couples during the fertile period. BJU Int 2016;117:173–6.
  4. Ozkan B, Orhan E, Aktas N, Coskuner ER. Depression and sexual dysfunction in Turkish men diagnosed with infertility. Urology 2015;85:1389–93.
  5. Satkunasivam R, Ordon M, Hu B, Mullen B, Lo K, Grober E, et al. Hormone abnormalities are not related to the erectile dysfunction and decreased libido found in many men with infertility. Fertil Steril 2014;101:1594–8.
  6. Shindel AW, Nelson CJ, Naughton CK, Ohebshalom M, Mulhall JP. Sexual function and quality of life in the male partner of infertile couples: prevalence and correlates of dysfunction. J Urol 2008;179:1056–9.
  7. Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA. Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005;294:2996–3002.
  8. Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc 2012;87:766–78.
  9. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994;151:54–61.
  10. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. A prospective study of risk factors for erectile dysfunction. J Urol 2006;176: 217.
  11. American Urological Association. AUA Guideline. Management of erectile dysfunction. Arch Esp Urol 2011;64:4.
  12. O'Leary MP, Althof SE, Cappelleri JC, Crowley A, Sherman N, Duttagupta S, et al. Self-esteem, confidence and relationship satisfaction of men with erectile dysfunction treated with sildenafil citrate: a multicenter, randomized, parallel group, double-blind, placebo-controlled study in the United States. J Urol 2006;175:1058–62.
  13. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49:822–30.
  14. Rosen RC, Cappelleri JC, Gendrano N 3rd. The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res 2002;14:226–44.
  15. Kupelian V, Araujo AB, Chiu GR, Rosen RC, McKinlay JB. Relative contributions of modifiable risk factors to erectile dysfunction: results from the Boston Area Community Health (BACH) Survey. Prev Med 2010;50:19–25.
  16. Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, et al. Erectile dysfunction: AUA guideline. J Urol 2018;200:633.
  17. Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA. Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med 1998;338: 1397–404.
  18. Esposito K, Ciotola M, Giugliano F, Maiorino MI, Autorino R, De Sio M, et al. Effects of intensive lifestyle changes on erectile dysfunction in men. J Sex Med 2009;6:243.
  19. Vickers MA Jr, De Nobrega AM, Dluhy RG. Diagnosis and treatment of psychogenic erectile dysfunction in a urological setting: outcomes of 18 consecutive patients. J Urol 1993;149:1258–61.
  20. Deveci S, O'Brien K, Ahmed A, Parker M, Guhring P, Mulhall JP. Can the International Index of Erectile Function distinguish between organic and psychogenic erectile function? BJU Int 2008;102:354–6. 
  21. Jefferson TW, Glaros A, Spevack M, Boaz TL, Murray FT. An evaluation of the Minnesota Multiphasic Personality Inventory as a discriminator of primary organic and primary psychogenic impotence in diabetic males. Arch Sex Behav 1989;18:117–26.
  22. Kassouf W, Carrier S. A comparison of the International Index of Erectile Function and erectile dysfunction studies. BJU Int 2003;91:667–9.
  23. Cavallini G. Resolution of erectile dysfunction after an andrological visit in a selected population of patients affected by psychogenic erectile dysfunction. Asian J Androl 2017;19:219–22.
  24. Lynch CD, Sundaram R, Maisog JM, Sweeney AM, Buck Louis GM. Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study–the LIFE study. Hum Reprod 2014;29:1067–75.
  25. Peterson BD, Newton CR, Feingold T. Anxiety and sexual stress in men and women undergoing infertility treatment. Fertil Steril 2007;88:911–4.
  26. Slade P, Emery J, Lieberman BA. A prospective, longitudinal study of emotions and relationships in in-vitro fertilization treatment. Hum Reprod 1997;12:183–90.
  27. Wischmann T, Korge K, Scherg H, Strowitzki T, Verres R. A 10-year follow-up study of psychosocial factors affecting couples after infertility treatment. Hum Reprod 2012;27:3226–32.
  28. Sigman M. Introduction: ejaculatory problems and male infertility. Fertil Steril 2015;104:1049–50.
  29. Mehta A, Sigman M. Management of the dry ejaculate: a systematic review of aspermia and retrograde ejaculation. Fertil Steril 2015;104:1074–81.
  30. Proctor KG, Howards SS. The effect of sympathomimetic drugs on postlymphadenectomy aspermia. J Urol 1983;129:837–8.
  31. Ochsenkuhn R, Kamischke A, Nieschlag E. Imipramine for successful treatment of retrograde ejaculation caused by retroperitoneal surgery. Int J Androl 1999;22:173–7.
  32. Brackett NL, LynneCM, Ibrahim E, Ohl DA, Sønksen J. Treatment of infertility in men with spinal cord injury. Nat Rev Urol 2010;7:162–72.
  33. Schatte EC, Orejuela FJ, Lipshultz LI, Kim ED, Lamb DJ. Treatment of infertility due to anejaculation in the male with electroejaculation and intracytoplasmic sperm injection. J Urol 2000;163:1717–20.
  34. McMahon CG, Althof SE, Waldinger MD, Porst H, Dean J, Sharlip ID, et al. An evidence-based definition of lifelong premature ejaculation: report of the International Society for Sexual Medicine (ISSM) ad hoc committee for the definition of premature ejaculation. J Sex Med 2008l;5:1590–606.
  35. Jannini EA, Ciocca G, Limoncin E, Mollaioli D, Di Sante S, Gianfrilli D, et al. Premature ejaculation: old story, new insights. Fertil Steril 2015;104:1061–73.
  36. Rowland D, McMahon CG, Abdo C, Chen J, Jannini E, Waldinger MD, et al. Disorders of orgasm and ejaculation in men. J Sex Med 2010;7:1668–86.
  37. Patel DP, Brant WO, Myers JB, Zhang C, Presson AP, Johnstone EB, et al. Sperm concentration is poorly associated with hypoandrogenism in infertile men. Urology 2015;85:1062–7.
  38. Morley JE, Charlton E, Patrick P, Kaiser FE, Cadeau P, McCready D, et al. Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism 2000;49:1239–42.
  39. Buvat J,Montorsi F,MaggiM, Porst H, Kaipia A, ColsonMH, et al. Hypogonadal men nonresponders to the PDE5 inhibitor tadalafil benefit fromnormalization of testosterone levels with a 1%hydroalcoholic testosterone gel in the treatment of erectile dysfunction (TADTEST study). J Sex Med 2011;8:284–93.
  40. Spitzer M, Basaria S, Travison TG, Davda MN, DeRogatis L, Bhasin S. The effect of testosterone on mood and well-being in men with erectile dysfunction in a randomized, placebo-controlled trial. Andrology 2013;1:475–82.
  41. Mulhall JP, Trost LW, Brannigan RE, Kurtz EG, Redmon JB, Chiles KA, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol 2018;200:423–32.
  42. Grimes DA, Lopez LM, Gallo MF, Halpern V, Nanda K, Schulz KF. Steroid hormones for contraception in men. Cochrane Database Syst Rev 2012;3: CD004316.

Practice Documents

ASRM Practice Documents have been developed to assist physicians with clinical decisions regarding the care of their patients.
Practice

Definition of infertility: a committee opinion (2023)

‘‘Infertility’’ is a disease, condition, or status characterized by several factors.
Practice

Clinical management of mosaic results from preimplantation genetic testing for aneuploidy of blastocysts: a committee opinion (2023)

This document incorporates studies about mosaic embryo transfer and provides evidence-based considerations for embryos with mosaic results on PGT-A.

More Resources

MAC 2021 teaser
ASRM Academy on the Go

ASRM MAC Tool 2021

The ASRM Müllerian Anomaly Classification 2021 (MAC2021) includes cervical and vaginal anomalies and standardize terminology within an interactive tool format.

View the MAC Tool
EMR Phrases teaser
Practice Guidance

EMR Shared Phrases/Template Library

This resource includes phrases shared by ASRM physician members to provide a template for individuals to create their own EMR phrases.

View the library
Practice Committee Documents teaser

ASRM Practice Documents

These guidelines have been developed by the ASRM Practice Committee to assist physicians with clinical decisions regarding the care of their patients.

View ASRM Practice Documents
Ethics Committee teaser

ASRM Ethics Opinions

Ethics Committee Reports are drafted by the members of the ASRM Ethics Committee on the tough ethical dilemmas of reproductive medicine.

View ASRM Ethics Opinions
Coding Corner general teaser
Practice Guidance

Coding Corner Q & A

The Coding Corner Q & A is a list of previously submitted and answered questions from ASRM members about coding. Answers are available to ASRM Members only.

View the Q & A
Covid-19 teaser
Practice Guidance

COVID-19 Resources

A compendium of ASRM resources concerning the Novel Corona virus (SARS-COV-2) and COVID-19.

View the resources
Couple looking at laptop for online patient education materials

Patient Resources

ReproductiveFacts.org provides a wide range of information related to reproductive health and infertility through patient education fact sheets, infographics, videos, and other resources.

View Website

Topic Resources

View more on the topic of sexual dysfunction
Podcast Icon

ASRM Today: 2023 Conference Preview with Dr. Maria Uloko

I'm talking with Dr. Maria Uloko about the upcoming 2023 ASRM PG course in New Orleans titled Sexual Health Identification, Support and Treatment. Listen to the Episode