UPJ INSIGHT: Referral Patterns for Infertile Men: Predictors of Continued Treatment by Reproductive Endocrinologist versus Referral to a Nearby Urologist

By: Julie M. Shabto, MD, MBA; Dattatraya Patil, MBBS, MPH; Katherine Poulose, BA; Mackenzie P. Bennett, BS; Angel X. Xiao, BSE, MSE; Heather S. Hipp, MD; Jennifer F. Kawwass, MD; Akanksha Mehta, MD, MS | Posted on: 01 Jul 2022

Shabto JM, Patil D, Poulose K et al: Referral patterns for infertile men: predictors of continued treatment by reproductive endocrinologist versus referral to a nearby urologist. Urol Pract 2022; 9: 321

Study Need and Importance

The American Urological Association and American Society for Reproductive Medicine national guidelines for the management of male infertility state that men at risk for subfertility should be further evaluated by a urologist, ideally with specialization in male reproduction. The adherence of U.S. fertility clinics to these guidelines is not well known. In this study, we aimed to investigate management practices of U.S. fertility clinics with regard to male infertility, including website educational information, continued treatment by reproductive endocrinologists (REIs) and referral to a urologist located within 5 miles of the fertility clinic.

Table. Multivariable logistic regression model predicting management of male factor infertility by REIs

		REI Does Not Manage Male Infertility Treatment
Variable	No. (%)	OR (95% CI)	OR p Value
Referral to a urologist:			<0.001*
No	30 (6.3)	Referent
Yes	447 (93.7)	12.11 (5.12–28.66)
Practice affiliation:			0.046*
Nonacademic	423 (88.7)	Referent
Academic	54 (11.3)	3.39 (1.02–11.25)
Embryo laboratory accreditation status:†
No	29 (6.1)	Referent
Unknown	34 (7.1)	1.63 (0.53–5.00)	0.397
Yes	414 (86.8)	3.02 (1.30–7.03)	0.010*

Number of observations in the original data set was 477.

*Statistical significance at alpha <0.05 by chi-square test.

†As reported in the 2018 Centers for Disease Control and Prevention Fertility Clinic Success Rates Report.

What We Found

We found that the majority of fertility clinic websites discussed male infertility evaluation, while less than half discussed treatment options. Clinics that were academically affiliated, had an accredited embryo laboratory and referred patients to a urologist were less likely to have the REI physician manage male infertility (see Table). Practice affiliation, practice size and website discussion of surgical sperm retrieval were the strongest predictors of nearby urological referral.

“We found that the majority of fertility clinic websites discussed male infertility evaluation, while less than half discussed treatment options.”

Limitations

Intrinsic to phone interviews, responses may vary depending on the respondent’s role, or responses may be inaccurate. Also, the data analysis is reliant on the accuracy of data reported to the Centers for Disease Control and Prevention and Society for Assisted Reproductive Technology for the 2015–2018 Fertility Clinic Success Rates Reports. Finally, the distance between a fertility clinic and urologist is not a perfect variable for evaluating barriers to access because a patient may need to travel a long distance to both the assisted reproductive technology clinic and the referred urologist.

Interpretation for Patient Care

The results of this study highlight characteristics of U.S. fertility clinics that may predict whether male patients of infertile couples are managed by REIs or by a nearby outside urologist. Our findings reveal that the management of couples who present to assisted reproductive technology clinics with male factor infertility is dependent upon clinic size and practice setting.