Male Infertility Management: A Critical Appraisal of Clinical Practice Guidelines With the AGREE II Instrument

To systematically evaluate the quality of both domestic and international clinical practice guidelines for male infertility using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool, identify methodological shortcomings, and propose evidence-based recommendations for improvement, this study was conducted. A systematic search of Chinese and English databases, along with official websites of international organizations, was undertaken to identify relevant guidelines. Four independent reviewers assessed the included guidelines employing the AGREE II tool, focusing on the rigor of development processes and the concordance and divergence among core recommendations. Ten guidelines were included, with only one rated "recommendable" using AGREE II criteria; others were "conditionally recommendable" or "not recommendable." Key shortcomings included deficient rigor of development (Domain III: 34.4%), applicability (Domain V: 48.3%), and editorial independence (Domain VI: 23.5%). Eighteen core recommendations were identified. Domestic guidelines lacked transparent conflict of interest disclosures and multidisciplinary collaboration, whereas international guidelines demonstrated superior methodological rigor through interprofessional integration. Most guidelines failed to validate clinical impacts of recommendations, hindering practical implementation. This study represents the first systematic evaluation of male infertility guidelines at national and international levels, with comparative analysis of their recommendations. Findings reveal widespread deficiencies in methodological rigor, applicability, and editorial independence. Future guideline development should adopt standardized frameworks, enhance multidisciplinary collaboration, ensure editorial independence, and integrate evidence-based medicine to improve quality and clinical utility.