JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):13
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263533

P-01. A Novel Approach to Male Infertility: A Scoping Review on the Stratification, Sustainability, and Cost-effectiveness of the APHRODITE Criteria

Julia Roverso Correa Silveira¹, Katherine Ann Reimão Miller¹, Melanie May Chow¹, Gabriel Monteiro Pinheiro¹

¹Universidade Santo Amaro - São Paulo - SP - Brasil

Objective: This scoping review aims to exam how the APHRODITE criteria stratified men with idiopathic testicular dysfunction into hormone and semen based subgroups to guide personalized FSH, hCG, or combined therapies, evaluating associated clinical outcomes, including improvements in semen parameters, sperm retrieval rates, total testosterone levels, time to conception and sperm DNA fragmentation.
Methods: This scoping review followed the PRISMA-Scr guideline and was prospectively registered in Open Science Framework (ID: osf.io/3g6qy). We conducted a systematic search strategy up to June 2025 in PubMed, Cochrane Library, SciELO, ScienceDirect and Google Scholar, combining the descriptors “Male Infertility” AND “APHRODITE Criteria” with boolean operators. Articles were eligible if they presented original data on the diagnostic application or clinical utility of the APHRODITE criteria in male infertility, or if they evaluated resource rationalization or cost effectiveness of APHRODITE implementation in assisted reproduction settings. We excluded studies that addressed only female infertility, publications without full text access or applicable clinical data (including conference abstracts), and any duplicate or retracted reports. Two reviewers independently screened titles, abstracts and full texts, extracting information on study design, setting, population characteristics, interventions, outcomes, key findings and limitations. Discrepancies were resolved by consensus. The extracted data were synthesized thematically across five domains: (1) clinical stratification; (2) hormone therapy selection; (3) semen and hormonal outcomes; (4) diagnostic and resource optimization; and (5) economic impact and sustainability. A critical appraisal was performed to identify methodological gaps and inform future validation studies.
Results: The database searches retrieved 163 records, of which 154 were excluded after title/abstract and full text screening, leaving nine primary studies for analysis; additional articles provided epidemiological context and definitions of male infertility. The APHRODITE framework reproducibly separated men with idiopathic testicular dysfunction into five functional phenotypes, establishing clear criteria for assigning FSH, hCG, or combined regimens. Tailoring therapy by phenotype enhanced treatment accuracy, combined FSH + hCG consistently restored spermatogenesis in hypogonadotropic profiles, while monotherapy approaches delivered subgroup specific improvements. When applied within the correct phenotypes, hormone guided interventions produces significant increases in sperm concentration and progressive motility, raises serum testosterone levels, accelerates time to conception and reduces sperm DNA fragmentation. The early use of APHRODITE reduced both invasive diagnostics and redundant hormonal assays, focusing resources on patients most likely to benefit. Phenotype driven management decreased the number of repeated assisted reproduction cycles and low yield diagnostic tests.
Conclusion: The APHRODITE criteria provide a validated, phenotype driven framework that enhances the precision of hormonal therapy selection in idiopathic male infertility, leading to demonstrable improvements in semen quality, androgen status, conception rates, and sperm DNA integrity. Their early application streamlines the diagnostic process by reducing unnecessary invasive procedures and redundant testing, while phenotype guided management decreases reliance on repeated assisted reproduction cycles and low yield diagnostics, yielding significant cost savings and promoting sustainability in fertility care. These findings support the integration of APHRODITE into clinical practice and underscore the need for prospective, multicenter studies to further confirm its utility across diverse patient populations and healthcare settings.