Is Male Infertility Being Ignored?

Now this is shocking: A survey of more than 2,000 couples seen at U.S. fertility clinics showed that three-fourths of the men had not undergone a fertility workup, even though male infertility contributes to half of all infertility cases. In the subgroup of 1,537 couples without a workup of the male partner, 17% had a history of assisted reproduction procedures, including intrauterine insemination (IUI) and in vitro fertilization (IVF).

Lifestyle factors play a major role in male infertility, and addressing those factors could restore a man’s fertility, allowing many couples to avoid costly procedures that might be doomed to failure from the beginning, andrology specialists said at the American Urological Association meeting. Use of testosterone supplements and topical finasteride (Propecia) are among major contributors to the problem.

“Many infertile couples in North America are being treated with IUI or IVF prior to a male factor infertility investigation,” said Keith Jarvi, MD, of the University of Toronto. “Testosterone is being used very widely … but the downside of testosterone is that it can make almost all men infertile. Among couples coming to U.S. fertility clinics, 5% of the men were on testosterone. They knew they were infertile but the men were still on testosterone. That tells me there is a lot of misinformation out there.”

The survey provided some insights to the question. The data showed a 4.9% prevalence of testosterone use among men seen at the U.S. centers but only 0.8% of those in Toronto. The 4.9% represented an average; testosterone use ranged as high as 10% at some clinics. Similarly, 4.2% of the U.S. men reported using Propecia, which is associated with reduced sperm count, compared with 0.1% of the men from Toronto.

The survey identified other potential lifestyle contributors to male infertility:
Smoking: 470 of 4,335
Marijuana use: 411
Alcohol consumption: 280
Cocaine use: 85
Additionally, 387 men had undergone vasectomy.

While I cannot believe that three-fourths of men did not get a basic evaluation, the useful information here are the lifestyle issues which are much more common in men whose wives are trying to conceive than I would have ever imagined.

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