For the partner: the evaluation that gets skipped
In couples already diagnosed with male factor infertility, more than a quarter of the men had never seen a specialist.
A survey asked 969 US couples in fertility treatment with a diagnosed male factor about their care. Among the men, 98% reported at least one abnormal semen parameter.
Read the last one again. Among the 248 men whom nobody recommended for specialist evaluation, roughly one in thirteen had azoospermia. Note that this group and the 28% who were never evaluated are counted slightly differently: one is about who was recommended, the other about who actually went.
Of the referrals that did happen, most came from the gynecologist of the female partner. That is a care pathway organised entirely around her, and the authors said what follows from it: insufficient evaluation could lead to missed opportunities for identifying reversible causes of infertility/medical comorbidities and places an unfair burden on the female partner.
The second is the unfair burden. She carries the investigation, and every procedure in it, for a problem that is at least half his.
"My result is abnormal. What specifically, and by how much?"
"Should I see a reproductive urologist? If not, why not?"
One limitation on the numbers above: this was a self-selected online survey of couples already in treatment with a known male factor, not a population sample. It cannot tell you what share of all couples have the man evaluated. It can tell you that among couples who already knew there was a male factor, more than a quarter of the men had still not been seen.