Men are just as likely as women to struggle with infertility, yet the focus of medical intervention in Australia and Aotearoa New Zealand has typically centred on women.

In most cases, women are referred for in vitro fertilization (IVF), with surgical options for men to improve their fertility potential seldom explored—lagging years behind other parts of the world.

While international guidelines for male infertility patient care have existed for decades—Australia and Aotearoa New Zealand didn’t have any.

That gap has now been addressed through the publication of Australia’s first evidence-based Male Infertility Guidelines. The guidelines, three years in the making, were led by Melbourne urologist Clinical Associate Professor Darren Katz—the only RACS representative on the multidisciplinary guideline panel.

Published in the Medical Journal of Australia, the guidelines mark a significant advance for surgeons, Trainees and researchers across the region.

Making male infertility mainstream
Associate Professor Katz says the guidelines fundamentally reposition the surgical dimension of male infertility as a key consideration of male infertility, to improve the couple’s chances of having a baby.

Surgeons may not be the first specialists to assess men with fertility concerns but involvement of a surgeon early during the infertility journey can reshape the entire clinical pathway. Their decisions influence diagnosis, investigation, referral timing and treatment options.

As lead author, Associate Professor Katz ensured the document reflected surgical realities.

“The reason why this is such a game-changer for surgeons is that given I was the lead author for the manuscript, I made sure that the surgical viewpoint was always considered where appropriate,” he says.

“For many years in the USA and Europe, male infertility has been managed by urologists who were sub-specialised in male infertility,” he says.

“But in Australia, male infertility has traditionally been managed by IVF specialists who mainly have a training background in managing female fertility as their background training is in obstetrics and gynaecology.

“These new 80 guidelines statements now place male infertility specialists (such as urologists specialising in male infertility) at the forefront of managing men who suffer from infertility with the aim of improving outcomes for patients.”

Broader benefit
Although developed in Australia, the principles and evidence apply equally to Aotearoa New Zealand, where referral patterns, training pathways and clinical challenges closely mirror those across the Tasman.

For surgeons practising in both public and private systems, the guidelines offer clarity on when to investigate male infertility, when surgery is indicated, when referral is required and when intervention should be avoided.

They also support contemporary education for Trainees, junior doctors and specialist international medical graduates navigating Australian and New Zealand standards of care.

Correcting outdated assumptions
The new guidelines outline evidence-based indications for several specialised procedures that were previously underutilised in Australia.

These include microsurgical testicular sperm extraction (micro-TESE) for men with non-obstructive azoospermia, who were often told biological fatherhood was impossible.

Associate Professor Katz says that after surgery, informing a man that sperm has been found can be transformative.

For men who have undergone vasectomy, the guidelines also reinforce the evidence supporting vasectomy reversal, even many years after the original procedure.

Associate Professor Katz notes that many men were seldom offered this option and were instead funnelled directly into IVF pathways.

Professionalism and stigma
Beyond procedures, the guidelines emphasise communication, professionalism and stigma reduction as core elements of surgical practice.

Male infertility, Associate Professor Katz says, is “a real hit to man’s masculinity”, and that impact is visible in consultations. Tears are not uncommon on both sides of the desk, particularly when men have carried the diagnosis for years.

Normalising male infertility and addressing it with clarity and evidence helps reduce shame and supports better engagement with care.

Multidisciplinary care
While the guidelines place male infertility specialists at the forefront of managing male factors, collaboration remains essential.

Optimal outcomes depend on multidisciplinary care involving surgeons, IVF specialists, reproductive endocrinologists and embryologists. Assessing both partners simultaneously avoids unnecessary interventions and can prevent years of lost fertility potential.

These guidelines have been endorsed by Urological Society of Australia and New Zealand, The Fertility Society of Australia and New Zealand, The Endocrinology Society of Australia and Healthy Male. Associate Professor Katz acknowledges the tremendous support from every member of the esteemed panel representing these societies in the formation of the guidelines.

Future directions
Looking ahead, Associate Professor Katz believes male infertility will increasingly influence surgical training, research and service delivery.

There is growing demand for fertility-literate surgeons across all career stages—from Trainees to senior consultants. Emerging technologies, including artificial intelligence, may soon routinely assist sperm identification and improve outcomes in complex procedures.

For the surgical community, the guidelines advance RACS’ social contract by improving patient outcomes, strengthening professional standards and ensuring equitable access to contemporary care.