Cost-effective workup of the infertile male patient
Thorough history/physical, high-quality semen analyses among critical components
Male infertility is a devastating and frequent condition that, in most instances, remains outside the domain of insurance coverage.
Infertility, as defined by the inability to conceive after 12 months of regular unprotected intercourse, impacts 15% to 20% of all couples, with male factor being responsible in 50% (Int J Androl 2006; 29:2-11; Hum Reprod 1991; 6:811-6; Hum Reprod 2001; 16:481-6). Male infertility is significantly more costly to treat than female infertility and, even in states where coverage is mandated for female infertility, it is unlikely to be covered (Urol Clin North Am 2014; 41:205-11; J Urol 2005; 174:1926-31). Finally, all of this is happening in a cost-constrained medical system with a declining number of urologists.
Assessment of the infertile male is also hindered by the inability of bulk seminal parameters to adequately predict pregnancy and live birth rates in the vast majority of men. Although a total motile count (TMC) of less than 5 million does predict a poor chance of success with intrauterine insemination (IUI) and chance of natural pregnancy increases proportionately with sperm TMC of one sperm to approximately 20 million, the only finding that completely precludes natural conception is azoospermia (Hum Reprod March 8, 2015 [epub ahead of print]).
Male infertility is also the only area in medicine, along with female infertility, where the unit of treatment is the couple and not an individual. This makes effective and timely communication between reproductive endocrinologists and urologists vital in delivering high-value, cost-effective care for infertile men and their partners. Further, the presence and severity of female infertility factors will significantly impact the decision for optimal treatment of male infertility.
In this article, I outline the elements that comprise a cost-effective workup of the infertile male patient.
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