In 1988, a poignant advertisement for an article to appear in the Ladies’ Home Journal filled a full page in the Wall Street Journal. Above a drawing of an infant was the following headline: “Will this be the status symbol of the 90s?” Below the drawing the text said:”In the 80s, it was anything that was expensive. In the 90s, however, will having a baby be infinitely more impressive than any hood ornament or designer name?”Now in the new millennium, and looking back at the last decade of the 20th century, we can ask whether this question was answered affirmatively.
We see in data accumulated by the American Society for Reproductive Medicine (ASRM) in 1998 that one million women made new visits to their gynecologists to address the subject of infertility. Despite this apparent desire for babies, however, only 250,000, or roughly 20%, of the male partners of these women were ever seen for an evaluation. Why is there this disparity?One could theorize that since women do have gynecologists whom they see regularly, a couple’s first means of addressing the subject of infertility would be by the wife’s mentioning this at her yearly examination. However, this does not explain why more husbands were not seen.
Lack of male factor evaluation in infertile couples can be blamed, it would seem, on two problems:(1) The perception held by gynecologists that urologists are not interested in infertility.(2) The beliefs of the public that little can be done to treat the male factor and that the initial step should be confrontation of the female factor.Both of these perceptions are inaccurate. Most urologists today are interested in and trained to varying degrees in addressing the subject of male infertility. We now know that much can be done in solving the problem of male infertility once an accurate diagnosis is made. The key is having the patient see an interested urologist who can initiate a cost-effective, goal-oriented evaluation that results in the most accurate diagnosis possible and offers the best possible options for cure.
The fact that the males are not being seen is indeed a problem. Roughly 30% of the time, the male accounts solely for a couple’s infertility, and another 20% of the time the male factor is a contributing factor. Consequently, in approximately 50% of couples, the male requires treatment of some form if the couple’s fertility potential is to be optimized.The evaluation of the male patient is much like the evaluation of any patient with a health complaint. That is, a visit with the physician and a detailed history are required. A physical examination is needed with, in this instance, a focus on the male reproductive organs. And finally, appropriate testing is performed, in this case a semen analysis.
However, fertility is best achieved when a man and his partner openly communicate their questions regarding each other’s health issues, both between themselves and with their respective treating physicians. Individual blame should not become part of the infertility workup, since infertility itself is a couple-related phenomenon and can only be solved when the couple is treated as a reproductive unit. It is hoped that this brochure will promote dialogue and encourage couples to seek out a knowledgeable and caring urologist to make the best possible initial diagnosis for the male and to discuss treatment options not only for the male but also for the couple in an effort to allow them to achieve a natural pregnancy.