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    Study: More urologists needed in fertility clinics


    Evaluating content of fertility clinic web sites
    San Francisco—Fertility clinics need more urologists.

    That's the conclusion from a study of male factor infertility information presented on fertility clinic web sites by Daniel Williams IV, MD, assistant professor of urology and director of male reproductive medicine and surgery at the University of Wisconsin School of Medicine and Public Health, Madison.

    Biased or inaccurate information on fertility clinic web sites can hamper infertility treatment and possibly endanger men's health, Dr. Williams said at the American Society for Reproductive Medicine annual meeting in San Francisco. Dr. Williams conducted the study with Josiah D. Nelson, MD.

    The researchers found that male factor infertility is mentioned on less than two-thirds of infertility clinic web sites. Obvious male factors such as vasectomy reversal are seldom mentioned. Urologists who are specifically trained in male infertility are rarely included as part of fertility clinic teams.

    And when male factor infertility is mentioned on fertility clinic web sites, the information presented is either wrong or biased at least 12% of the time. Prior studies suggest that a male factor is present in about half of all infertile couples in the United States.

    Inaccuracies raise risks

    Incorrect or incomplete information on male factor infertility poses multiple problems, Dr. Williams said. Ignoring male factors ignores at least one element contributing to infertility in half of couples, which may reduce the likelihood and timeliness of a successful pregnancy as well as the overall cost-effectiveness of fertility treatments.

    Ignoring male infertility also ignores a variety of potential male health problems, including testicular cancer, melanoma, and prostate cancer. Some of these conditions may be discovered in the course of a routine infertility examination by a urologist. But without appropriate male infertility information, couples are unlikely to recognize the need for a urologist on the infertility treatment team.

    "The underlying message, especially in consideration of the potential health risks that may accompany male factor infertility, is that we need to pay more attention to the role of urologists in infertility evaluations and treatments," Dr. Williams said. "Nearly half of all couples consult the Internet at some point for their reproductive concerns. The lack of online information regarding male factor infertility and the amount of misinformation out there is concerning."

    Dr. Williams consulted the Society for Assisted Reproductive Technology (SART) and found web sites for 350 of the 396 fertility clinics listed in the SART database. Of the total, 72 (21%) were academic clinics and 278 (79%) were private clinics. Among academic clinics, 66% mentioned male factor infertility while 58% of private clinics mentioned it.

    Biased, inaccurate information

    Academic clinics scored better than private clinics when it came to the specifics of male factor infertility, but neither group scored well, Dr. Williams said. Urologists were included on the fertility clinic team by only 13% of academic clinics and 6% of private clinics. Among academic clinics, 14% provided a navigational link to a urologist, compared to 4% of private clinics. Vasectomy reversal was mentioned by 19% of academic clinics and 16% of private clinics.

    Both groups scored unfortunately high for presenting inaccurate information or biased language, which Dr. Williams defined as "language that could dissuade an infertile couple from seeking a male factor evaluation." Among academic fertility clinics, 14% had incorrect or biased statements on their web sites compared to 12% for private fertility clinics.

    One of the alarming statements Dr. Williams found was, "If you are not able to produce testosterone, even with hormonal stimulation, your doctor may recommend that you use a testosterone supplement."

    "Most urologists understand that if you give a man testosterone for low sperm count, you will only reduce his sperm count even further," Dr. Williams said. "It is clear that we need to get better information about male factor infertility on fertility clinic web sites, and we need to get more urologists involved in fertility evaluations and treatments. Urologists generally know that male infertility may represent other underlying medical conditions, while other physicians may not yet be aware of this potential."

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