The missing piece in management of infertile couple—clinical andrology

Ashok Agarwal, Chak-Lam Cho, Ahmad Majzoub, Sandro C. Esteves


Dr. Kovac, in his commentary (1), highlighted the often more complicated real-world practice than the clinical scenarios discussed in the practice recommendations by Agarwal et al. (2). The author further commented by providing an excellent example: the choice between varicocele repair or testicular sperm retrieval in a patient with failed in vitro fertilization (IVF), high sperm DNA fragmentation (SDF), and grade 3 varicocele. We would like to elaborate on some of the points by Dr. Kovacs such as: (I) the role of practice guidelines; (II) the process of management decision; and (III) the overuse of ART in treating male infertility.