Sandro C. Esteves
Faculty of Health, Aarhus University
Male subfertility/infertility may be idiopathic, congenital or acquired but lifestyle, genetic, and psychological factors, and environmental stressors and pollutants, are implicated in the majority of cases. Clinicians have long recognised the need to improve the assessment and management of male infertility, especially in real-world settings.
Although many cases of male infertility can be corrected through lifestyle or clinical interventions, in the past treatment often centered on the female. As knowledge of spermatogenesis has increased, the potential role of exogenous gonadotropins in the management of selected cases of male infertility has emerged; there is a growing pool of evidence for this approach in humans. It is now essential that the clinician thoroughly investigates and accurately diagnoses the cause of male subfertility/infertility so that the patient’s prognosis is appropriately calculated and communicated. In alignment with this approach, the recent introduction of the APHRODITE criteria for male infertility management aims to improve the diagnosis, classification and management of infertile men.
This workshop and its complementary online activities have been developed by Professor Sandro Esteves, first author of the APHRODITE guideline publication [Esteves, in press 2024]. These guidelines explain recent biological and physiological knowledge relating to spermatogenesis, present the concept of the APHRODITE criteria and describe the application of these criteria in specific case-based scenarios.
After participating in both webinars, attendees will be able to:
The program is intended for clinicians, embryologists, andrologists, scientists, and managers working in ART who wish to update their knowledge of advanced techniques and scientific innovations and understand best practices using evidence-based models of care.
This programme will be submitted for CME accreditation from the European Accreditation Council for Continuing Medical Education (EACCME®) and for Continuing Professional Development (CPD) credits.
Introducing the APHRODITE criteria for male infertility diagnosis, prognosis and management
13.00 Med.E.A. Medical Education Academy welcome, introduction, objectives
Sandro Esteves, Brazil; Peter Humaidan, Denmark
Chair: Sandro C. Esteves, Brazil
13.10 Biology of spermatogenesis and pathophysiology of infertility and hypogonadism
Manuela Simoni, Italy
13.30 Q&A: Faculty and Participants
13.40 Introduction to APHRODITE: rationale and group classification
Sandro C. Esteves, Brazil
14.00 Q&A: Faculty and Participants
14.10 Gonadotropin therapy in male infertility management: an overview
Daniele Santi, Italy
14.30 Q&A: Faculty and Participants
Chair: Peter Humaidan, Denmark
14.40 Aphrodite Group 1 with discussion
Leen Antonio, Belgium
14.55 Aphrodite Groups 2 and 3 with discussion
Daniele Santi, Italy
15.10 Aphrodite Groups 2 and 3 with discussion
Sandro Esteves, Brazil
15.25 ART after/during male infertility treatment
Peter Humaidan, Denmark
15.45 Q&A: Faculty and Participants
Sandro Esteves, Brazil & Peter Humaidan, Denmark
Sandro C. Esteves, MD., PhD. is a reproductive urologist who specializes in treating male infertility, particularly its connection with assisted reproductive technology (ART). He is the founder and medical director of ANDROFERT, a Fertility Center based in Campinas, Brazil, dedicated to male reproductive health. He is also a Collaborating Professor of Urology at the State University of Campinas (UNICAMP), Brazil, and an Honorary Professor of Reproductive Medicine at Aarhus University, Denmark.
He obtained his MD. degree in 1990 from the Faculty of Medical Sciences of UNICAMP, Brazil. Subsequently, he completed his Urology residency at the same institution and a postdoctoral fellowship program at the Glickman’s Urological Institute at the Cleveland Clinic Foundation in the United States. He earned a master’s in Surgery from UNICAMP and a Ph.D. in Urology from the Federal University of S o Paulo (EPM-UNIFESP). Dr. Esteves has contributed to our understanding of male infertility with over 25 years of experience in clinical and academic settings. He has emphasized the limitations of basic semen analysis, the importance of assessing sperm DNA fragmentation in male infertility evaluations, and highlighted the relevance of varicocele and its treatment in enhancing male fertility prospects. He has also published extensively on his clinical experience with microsurgical treatment of infertile men, as well as on hormonal therapy for improving sperm retrieval success of men with non-obstructive azoospermia. Dr. Esteves has helped design novel stratification systems for infertile men with testicular dysfunction, for whom fertility prospects may improve after hormonal therapy, and for low prognosis infertile women undergoing ART. Dr. Esteves is a prolific author, and his research comprises over 350 published papers, numerous book chapters, and textbooks. With a Hirsch index of 71 and a citation count of around 17K, he is ranked among the top 1% of global researchers by the Science-Wide Author Databases of Standard Citation Indicators (Elsevier). Prof. Esteves plays an active role in the scientific community as a member of the Faculty Opinions in reproductive endocrinology and infertility and as a founding member of the POSEIDON group for reproductive medicine. Additionally, he holds positions as Associate Editor/Section Editor in several journals, including Human Reproduction, Andrology, Reproductive Biomedicine Online, Frontiers in Endocrinology, and the International Brazilian Journal of Urology. He also serves on the editorial boards of many scientific journals, including Nature Reviews Urology. Dr. Esteves’ clinic has been at the forefront of implementing cleanroom technology in the ART laboratory and adhering to ISO 9001 quality standards in Brazil. The ANDROFERT team is renowned for its strict quality standards and remarkable success rates in treating couples with male factor infertility. As a seasoned speaker, Dr. Esteves delivers over 50 lectures annually in Brazil and internationally. He has received multiple research grants and awards from national and international societies and currently holds the position of head of the Department of Andrology at the Brazilian Society of Human Reproduction.
Professor Peter Humaidan is a specialist in reproductive endocrinology, professor at The Fertility Clinic Skive Regional Hospital, Aarhus University, Denmark and Honorary professor at Odense University, Denmark. During his scientific work he has primarily focused on developing individualized treatment protocols for the infertile patient. His doctoral thesis (DMSc) explored the role of LH during the follicular and luteal phases in controlled ovarian stimulation. His main fields of interest are triggering of ovulation with GnRH agonist, role of LH during the follicular and luteal phases, role of the female genital tract microbiota for reproductive outcomes, OHSS prevention, and role of sperm DNA fragmentation for spontaneous and assisted reproduction. He is the founder of the international society “The Copenhagen GnRHa Triggering Workshop Group” who introduced the GnRHa trigger in modern IVF, changing trigger policies worldwide. Moreover, he is co-founder of the POSEIDON group which suggested a new stratification of the poor responder patient, and a past board member of the ESHRE SIG Endocrinology Group. He is in the Elsevier, Stanford global list of 2% top scientists, and he authored and co-authored 250 + articles (H-index 67, Google Scholar) in international peer reviewed journals as well as chapters in textbooks and the Danish guidelines for OHSS prevention. Peter Humaidan has a wide international scientific network and is frequently invited as a speaker at international conferences.
Martin Savage is Emeritus Professor of Paediatric Endocrinology at William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary, University of London. He was head of the Paediatric Endocrine Unit at Barts and the London School of Medicine from 1982 to 2007. He has interests in growth disorders, specifically those with abnormalities in the GH-IGF-1 axis and in phenotype-genotype relationships of GH-IGF-1 axis defects, notably GH resistance. He published the first human case of an IGF-1 gene defect in the New England Journal of Medicine in 1996. His other interests are Cushing’s syndrome and growth in chronic inflammatory diseases. He was General Secretary of the European Society for Paediatric Endocrinology (ESPE) from 1997 to 2004. He has lectured in 61 countries and has published 472 original articles, reviews, textbook chapters and books. In 2007, he was awarded the ESPE Andrea Prader Prize for contributions to paediatric endocrinology and in 2018 he received a Visionary Award from the American Human Growth Foundation. In 2022, he received a Research Excellence Award from the Dr Sulaiman Al Habib Medical Journal in Riyadh, and the British Society of Paediatric Endocrinology & Diabetes James M. Tanner Lifetime Achievement Award. He continues to lecture nationally and internationally.