Chosing a Doctor for Male Infertility
Subfertility (the preferred term over “infertility”) is a medical problem that MUST be investigated based on the couple, not either partner in isolation. Subfertility is a result of both the man and the woman at the same time 50% of the time, with ONLY the man or the woman being the issue 25% of the time each.
Fellowship training in reproductive endocrinology (”fertility specialists”) typically takes place in departments of obstetrics & gynecology where there is frequently very limited expertise in examining the man and investigating male factors that cause, subfertility. Also, the great majority of urologists have not received specialized training in subfertility.
EVERY couple that is having troubles conceiving, should have the man evaluated by an individual specifically trained in “andrology” or male reproduction. This could include a urologist with a true speciality in fertility medicine or and andrologist (the male side of a gynaecologist).
Men’s Health Best Life, March, 2006 had a GREAT quote from some of my dancing buddies in American Society of Andrology on how to choose such a doctor. The article states and I quote–
“In other fields (of medicine), fundamental expertise is relatively easy to gauge. A cardiologist can’t treat heart patients unless he is board certified in cardiology; a doctor can’t go by the title “oncologist” unless he’s trained to treat various forms of cancer. But many urologists can and do treat male infertility without ever having received specialized training in reproductive medicine. “Make sure your doctor has that extra fellowship training” says Jon Pryor, MD chair of urology at University of Minnesota School of Medicine. “After all, who’s better at fixing a Volvo- a dealer or the mechanic down the street?”
Ask your doctor what percentage of his practice is infertility related. “It should be at least 1/3″, says Jay Sandlow, MD, vice chair of urology at Medical College of Wisconsin. Also ask him what societies he belongs to. If “andrology” “infertility” or “sexual” isn’t in the title, then he’s not active in the field and probably doesn’t keep up with the latest advances.”
Another alternative to a Urologist is the Clinical Andrologists. These are often PhDs (such as myself) that study sperm physiology and male reproduction. You should always ask if your RE clinic has a Clinical Andrologist on staff, what level of education they have (it should be a PhD) and if they belong to the American Society of Andrology, or Society for Male Reproduction and Urology. Also, confirm that any clinic you work with adheres to World Health Organization guidelines for sperm analysis… if they don’t, ask for a referral specifically for your husband elsewhere, for evaluation.
Finally, since the advent of intra-cytoplasmic sperm injection (”ICSI”), where fertilization can be achieved in the labroatory by injecting a single sperm cell into an egg, many doctors simply look at the man as being a source of sperm, and have the couple undergo assisted reproductive technology treatment (”ART”) without worrying about diagnosing or attempting to treat cases of “male factor subfertility” directly. While this can certainly be seen as a quick way to achieve a pregnancy, it might not be the cheapest, or safest, means of doing so. However, such medical management decisions must always be taken by a physician fully trained in all aspects of subfertility diagnosis and advice cannot be provided outside of such a patient-doctor relationship.
Nonetheless, from a scientific perspective, it is clear that many “infertility doctors” could benefit from more extensive, or more recent, training in male reproductive biology and medicine. This opinion is based on the many patients who have received advice that is contrary to the recommendations of the World Health Organization’s Manual for the Standardized Investigation, Diagnosis and Management of the Infertile Male, which is intended as a “lowest common denominator ” approach to investigating and managing subfertile couples with a male factor, that can be applied everywhere, including Third World countries.
Unfortunately, there is no simple way for a couple to verify that their managing physician has proper expertise in clinical andrology, but patients must never be afraid to ask questions, perhaps especially about the nature of their doctor’s training and expertise in clinical andrology, and about what options other than ICSI have been considered and might be available to them. As a generalization, based on experience from centers where andrology is integrated into their operation, only 35 to 40% of in vitro treatment cycles actually need ICSI.
Dr. E
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