Failure to diagnose treatable male infertility leading to unnecessary IVF, experts say | Fertility problems

Couples are unnecessarily resorting to in vitro fertilization because male infertility is under-researched and the NHS often fails to diagnose treatable causes, leading experts say.

Poor understanding from GPs and a lack of specialist and NHS testing mean male infertility is often left untreated in couples struggling to conceive, despite men accounting for 50% of all infertility cases.

Many causes of male infertility are treatable. One of the most common, varicocele (an enlarged vein in the scrotum that increases the temperature of the testicles and damages sperm), can be treated with surgery; Lifestyle changes and supplements may also help.

Vaibhav Modgil, consultant urological surgeon and andrologist and honorary clinical professor at the University of Manchester, said there was a lack of awareness of male infertility, which affects 5% to 10% of men in the UK.

Women who go to the doctor after struggling to get pregnant are often quickly put through “every test you can think of,” she said, whereas men can take years to get even basic tests.

“I don’t think the problem ever went away or got the attention it deserved,” he said, adding that fixing the situation “will require a top-down approach at a much higher level.”

“Unfortunately, I don’t see any evidence yet that this is happening.”

He said most couples who have difficulty conceiving are examined by gynecologists who specialize predominantly in women’s health, and in most areas there is only one or two andrologists who specialize in men’s health.

Experts said they had hoped the government’s first men’s health strategy, published this week, would include a strategic focus on male infertility similar to Australia’s, but were disappointed it had been omitted. It is understood that the renewal of the women’s health strategy can provide a solution to male infertility.

Dr Michael Carroll, researcher Manchester Metropolitan University said the strategy was a great initiative but a missed opportunity to consider the impact on mental health and how infertile men have shorter lifespans.

Carroll is writing a book on male infertility to close the awareness gap compared to women, who are generally well-educated about reproductive health. He said many men don’t know that they should keep their testicles cool, avoid tight underwear and avoid taking very hot baths, or that lifestyle factors such as smoking, drinking, diet, sleep and exercise can cause poor sperm quality.

“Historically, fertility has been viewed as a women’s health issue. They have always been considered ‘infertile women’ because men think they are fertile if they produce semen,” he said.

“Men should be considered equal to women. We need to do more rigorous testing, get more lifestyle and medical history, physically examine the testicles — not just semen analysis.”

Raj Mathur, a reproductive medicine consultant and former president of the British Fertility Society, said male infertility was under-researched.

“Male fertility issues are neglected,” he said. “There are relatively few evidence-based tests for men at the moment. We really need more money to research what appropriate tests are for men through randomized controlled trials looking at different interventions to see if they really make a difference.”

The National Institute for Health and Care Excellence is in the process of updating its guidance to recommend more testing for men.

Tim Shand, founder of campaign group Men’s Sexual and Reproductive Health Matters, said the draft proposals were a “positive step forward” but did not go far enough.

A recent survey by Fertility Action found that 80.6% of GPs have received no training in male fertility and 97% cannot properly examine for varicoceles.

As well as easing the mental health burden on couples, Shand said there could be “a significant cost advantage for the NHS to have a proper and full assessment of men before starting the standard IVF process”.

A Department of Health and Social Care spokesman said: “For far too long, there has been a reluctance to acknowledge that men face certain inequalities and challenges when it comes to health. This includes male infertility.

“The Men’s Health Strategy lays a strong foundation for improving the way we think and act about men’s health. This is a bold first step, and we will learn and adapt as challenges arise.”