Many men undergo ART procedures without full workup

San Francisco-A new study is suggesting that many couples with male factor infertility are being treated with intrauterine insemination (IUI) or in vitro fertilization (IVF) even though the men are not being fully investigated.

The large, broad North American patient survey found that many potentially reversible causes for male infertility are overlooked in men. Investigators from the University of Toronto reported at the AUA annual meeting in San Francisco that a significant number of men were using finasteride (Propecia) and taking testosterone even though these agents are known to harm fertility.

“We got information on how frequently men were using testosterone, and testosterone is known to cause infertility in men. So, you would think most men would be off testosterone by the time they actually make it to us, but in fact we found 5% were taking testosterone,” said study first author Keith Jarvi, MD, professor of surgery at the University of Toronto. “It was incredibly surprising. It is shocking that it is happening still. People should know.”

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Dr. Jarvi and his co-authors looked at men in The Andrology Research Consortium, which includes men presenting for infertility investigation at 24 North American subspecialty male infertility centers. A total of 4,335 men completed a standardized male infertility questionnaire between May 2015 and September 2017. Mean age of the men was 37 years, and their female partners’ mean age was 34 years. In this cohort, 74% had not been previously assessed by a male fertility specialist.

Dr. Jarvi and his colleagues turned up some rather interesting findings. They discovered that IUI and IVF had been used to treat some of the couples even though they had never had a male factor infertility investigation. There were several potentially reversible causes for the male infertility, including a previous vasectomy and medication and lifestyle factors.

The survey showed that cigarettes were used by 11% and marijuana was used by 9.5% of the men. Limited alcohol consumption (two or fewer drinks/day) was common and only 6.4% reportedly had more than two drinks daily. Cocaine use was reported by 2% of the men.

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Dr. Jarvi, who presented the study findings at the meeting, said it was surprising how many men were on finasteride for baldness.

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“Propecia is used to prevent hair loss and we know Propecia may also cause infertility and almost 4.5% of these guys were on Propecia,” Dr. Jarvi said in an interview with Urology Times. “They are coming to our offices. So, they were on it and they should have been off it.”

The survey showed that the testosterone had been prescribed by urologists, endocrinologists, and primary care physicians in almost equal numbers to manage low energy (31%), diminished libido (20%), improved athletics and strength (15%), and other reasons.