European association of urology guidelines on male infertility the 2012 update.pdf

Guidelines European Association of Urology Guidelines on Male Infertility: The 2012 Update Andreas Jungwirth a , *, Aleksander Giwercman b, Herman Tournaye c, Thorsten Diemer d , Zsolt Kopa e, Gert Dohle f, Csilla Krausz g , EAU Working Group on Male Infertility aEMCO Private Clinic, Bad Du ¨rrnberg, Austria; bReproductive Medicine Centre, Skane University Hospital, Lund University, Malmo ¨, Sweden; cCentre for Reproductive Medicine, Free University of Brussels, Belgium; dDepartment of Urology, Paediatric Urology and Andrology, University Hospital Giessen and Marburg GmbH, Campus Giessen, Justus-Liebig-University, Giessen, Germany; eAndrology Centre, Department of Urology, Semmelweis University, Budapest, Hungary; fErasmus University Medical Centre, Rotterdam, herlands; gSexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy 1. Definition ‘‘Infertility is the inability of a sexually active, non- contracepting couple to achieve pregnancy in one year’’(World anisation [WHO], 2000) [1] . 2. Epidemiology and aetiology About 15% of couples do not achieve pregnancy within 1 yr; almost 50% of them do so spontaneously in the second year of unprotected intercourse, and another 14% in the third year. Ultimately, <5% remain childless [2] . No cause of infertility can be found using routine diagnostic work-up in 10–