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Evidence Library · The male half

The half of the problem that often never gets examined

Four out of five men with an abnormal result were never sent to a specialist.

A large academic health system reviewed every abnormal semen analysis ordered by a non-urologist between 2002 and 2019: 2,283 men.

20.5%
Were seen by a reproductive urologist
Roughly four in five were not
3.7% to 35.8%
Range in referral rate depending on which clinician ordered the test
A tenfold spread
22.7%
Of unevaluated men correctly understood their result was abnormal
Survey of 84 respondents

Even a genuinely low sperm count only tripled the odds of specialist referral (odds ratio 3.08) off that low base. And whether a man was evaluated depended substantially on who ordered his test rather than on what the test showed.

The last figure comes from a small survey arm, 310 men contacted with 84 responding, so treat 22.7% as indicative rather than precise. The 20.5% is solid. Note also its exact denominator: men whose test was ordered by someone other than a urologist, which is to say men who entered fertility care through their partner's doctor.

What to ask
  • "Can we do the semen analysis at the same time as my tests, not after them?"
  • "The result is abnormal. What specifically is abnormal, and by how much?"
  • "Should he see a reproductive urologist? If not, why not?"
There are treatable and occasionally serious causes of an abnormal semen analysis, including some that have nothing to do with fertility. Skipping the evaluation skips those too.
Where this comes from:
28. Pham MN, Ambulkar SS, Fantus RJ, Joshi T, Hudnall MT, Lai JD, et al. Reproductive urologic consultation in subfertile men: predictors of establishing care and patient perceptions after abnormal semen testing. Fertil Steril. 2022;117(3):489-496.
29. Schlegel PN, Sigman M, Collura B, De Jonge CJ, Eisenberg ML, Lamb DJ, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I. Fertil Steril. 2021;115(1):54-61.
10. Practice Committee of the American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertil Steril. 2021;116(5):1255-1265.

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