Survey: Patients are uninformed about male infertility

April 1, 2008

Men who present with infertility issues and their partners are relatively uninformed about the causes and treatments of male infertility, a fact that may be attributable to urologists' failure to properly market their capabilities in this area of clinical practice.

Key Points

Stanton C. Honig, MD, reported the results of a patient and partner questionnaire-based study at the AUA annual meeting in Anaheim, CA. Generally speaking, both groups' understanding of urologic abnormalities associated with male infertility prior to consultation was limited.

"Urologists and the AUA have not done a great job of promoting the concept of direct treatment of male-factor infertility, even though the success rates of those treatments are actually quite good in terms of treating blockages and repairing varicoceles," said Dr. Honig, associate clinical professor of urology/surgery at the University of Connecticut School of Medicine, Farmington, and a staff urologist at Yale-New Haven Hospital, New Haven, CT.

The study data came from 85 questionnaires completed by patients and their partners. Dr. Honig and David J. Rosenberg, MD, a urology resident at Yale University School of Medicine, administered the questionnaires through Dr. Honig's clinic at the University of Connecticut and at a separate outpatient private practice.

Knowledge gaps

There were significant gaps between patients' and partners' knowledge of male infertility and real-world clinical experience. For example, 55% of respondents identified "tight underwear" as a cause of infertility, although the only published study on the topic found no significant difference in fertility between men who wore boxer shorts and those who wore briefs (J Urol 1998; 160:1329-33).

On the other end of the spectrum, few of those completing the questionnaire (13%) identified varicoceles as a potential cause of infertility, and only 10% felt varicocele repair was "highly successful" in treating it.

"And yet the literature suggests that approximately 70% of patients see improvement in semen quality and a doubling of pregnancy rates 6 to 12 months after varicocele repair," Dr. Honig said.

Referral patterns suggest a potential bias in the types of treatments of which respondents were aware. OB-GYNs were responsible for most of the referrals in the study (43%), followed by reproductive endocrinologists (24%). Urologists referred just 10% of the patients, while 23% were referred from other sources.

As one might expect, a full two-thirds (66%) of those referred by reproductive endocrinologists and 59% of those referred by OB-GYNs were aware of in vitro fertilization, versus just 23% of those who came from urologists or other sources.

"My sense is that there is much more awareness of treatment options such as IVF and insemination and much less awareness of, for instance, testicular cancers and varicoceles that can cause infertility but may be treatable or reversible," Dr. Honig said. "What is more concerning is that many of these patients are not even examined or evaluated for life-threatening conditions that may cause infertility, such as testicular cancer and pituitary tumors."

While Dr. Honig did not assess knowledge differences among males and females who responded, he and Dr. Rosenberg are in the process of breaking down responses by patient and partner findings.

"Wives tend to read a lot more than the men do about infertility," said Dr. Honig. "A lot of the marketing that is done for the understanding and treatment of male infertility is actually geared toward the partner. In general, the partner tends to be more well-informed, though the accuracy of the information they receive is sometimes suspect."