Male infertility: what on earth is going on? Pilot international questionnaire study regarding clinical evaluation and fertility treatment for men

Infertility is a time-consuming and exhaustive process, which disproportionally affects women. Although concerns have been raised about deficiencies in the clinical evaluation of infertile men, there are currently little published data documenting this. A SurveyMonkey questionnaire was therefore created to capture the current clinical practice of fertility specialists working in in vitro fertilisation clinics. Responses were collected from May to July 2021. A total of 112 clinicians completed the pilot survey with respondents from Europe (n = 49; 43.8%), Africa (n = 39, 34.8%), North America (n = 6; 5.4%), Asia (n = 16; 14.3%), South America (n = 1; 0.9%) and Australasia (n = 1; 0.9%). Forty-one percent of fertility specialists (45/110) reported taking only a brief medical history and 24% reported that they never routinely examined infertile male patients. Fifty-four percent of fertility specialists also reported issues getting men to undertake diagnostic semen analysis. Treatment for male infertility spanned assisted reproductive technology (ART), with themes of individualised medicine influencing treatment recommendations. Of the clinicians, 48.2% clinicians reported using empirical medical therapy for unexplained male infertility. Notably, 3.6% respondents recommended testosterone treatment, despite the likely negative impact on spermatogenesis. However, high levels of opportunistic general health advice were reported, including discussion of life exposures thought to be important for male reproductive health. This study adds novel evidence and highlights current deficiencies in clinical practice relating to male infertility. Evaluation of the infertile male using simple medical tools (detailed history taking and clinical examination) has the potential to identify treatable or reversible conditions and should be an immediate focus for education and improvement in reproductive medicine. Investment in research and development is much needed in the field of andrology to develop effective non-ART treatment options for male infertility. LAY SUMMARY: Poor sperm quality (male infertility) significantly reduces the chance of natural conception and accounts for half of all cases of infertility, yet affected men are frequently overlooked when couples seek fertility investigations and treatment. Despite a growing awareness of men’s issues and a need to improve patient experience, there is very little documented about how fertility specialists (clinicians) routinely assess and treat male infertility. This study used a SurveyMonkey® questionnaire to capture current clinical practice, with 112 respondents from around the world. Forty-one percent of clinicians did not routinely consider male medical history in detail and 24% never routinely examined infertile men. This should be a focus for improvement in clinical care. As expected, fertility treatment recommended for male infertility was mostly in vitro fertilisation and intracytoplasmic sperm injection, where a single sperm is injected into each mature egg. However, 48.2% of clinicians also reported prescribing unproven medical therapy for unexplained male infertility. Of concern, a few clinicians routinely recommended testosterone treatment, which is likely to harm sperm production. However, advice regarding general health was universally delivered.