Approaching treatment of male infertility: the APHRODITE criteria

Abstract

The Need for Improved ClassificationMale infertility is a complex clinical condition, and thus far, the clinical management of men with reduced fertility and impaired spermatogenesis has been fraught with difficulties and limited advancement (2). This has led to frustration among both clinicians and patients, perpetuating the belief that intracytoplasmic sperm injection (ICSI) is the only solution to provide the couple with a baby without the need to explore the nature or cause of the underlying male infertility (3, 4). The APHRODITE criteria aim to address this gap by providing a structured approach to characterize male infertility in men seeking paternity, particularly those who may benefit from hormonal treatment (1). Importantly, these criteria are not designed for men with established infertility diagnoses, such as varicocele, infection, or obstruction, who would not benefit from hormonal treatment (3). The Role of Hormones in SpermatogenesisUnderstanding the APHRODITE criteria begins with a brief review of human spermatogenesis, a complex process that takes approximately 75 days and is primarily controlled by follicle-stimulating hormone (FSH) and luteinizing hormone (LH)-driven testosterone (5). These hormones are crucial in regulating spermatogenesis, making them central to our approach.