ABSTRACT
OBJECTIVE: To compare racial differences in male fertility history and treatment. DESIGN: Retrospective review of prospectively collected data. SETTING: North American reproductive urology centers. PATIENT(S): Males undergoing urologist fertility evaluation. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Demographic and reproductive Andrology Research Consortium data. RESULT(S): The racial breakdown of 6,462 men was: 51% White, 20% Asian/Indo-Canadian/Indo-American, 6% Black, 1% Indian/Native, <1% Native Hawaiian/Other Pacific Islander, and 21% "Other". White males sought evaluation sooner (3.5 ± 4.7 vs. 3.8 ± 4.2 years), had older partners (33.3 ± 4.9 vs. 32.9 ± 5.2 years), and more had undergone vasectomy (8.4% vs. 2.9%) vs. all other races. Black males were older (38.0 ± 8.1 vs. 36.5 ± 7.4 years), sought fertility evaluation later (4.8 ± 5.1 vs. 3.6 ± 4.4 years), fewer had undergone vasectomy (3.3% vs. 5.9%), and fewer had partners who underwent intrauterine insemination (8.2% vs. 12.6%) compared with all other races. Asian/Indo-Canadian/Indo-American patients were younger (36.1 ± 7.2 vs. 36.7 ± 7.6 years), fewer had undergone vasectomy (1.2% vs. 6.9%), and more had partners who underwent intrauterine insemination (14.2% vs. 11.9%). Indian/Native males sought evaluation later (5.1 ± 6.8 vs. 3.6 ± 4.4 years) and more had undergone vasectomy (13.4% vs. 5.7%). CONCLUSION(S): Racial differences exist for males undergoing fertility evaluation by a reproductive urologist. Better understanding of these differences in history in conjunction with societal and biologic factors can guide personalized care, as well as help to better understand and address disparities in access to fertility evaluation and treatment.
Subject(s)
Fertility , Health Knowledge, Attitudes, Practice/ethnology , Health Status Disparities , Healthcare Disparities/ethnology , Infertility, Male/ethnology , Infertility, Male/therapy , Patient Acceptance of Health Care/ethnology , Reproductive Techniques, Assisted/trends , Adult , Body Mass Index , Cross-Sectional Studies , Female , Health Care Surveys , Humans , Infertility, Male/diagnosis , Infertility, Male/physiopathology , Life Style/ethnology , Male , Maternal Age , North America/epidemiology , Paternal Age , Race Factors , Retrospective Studies , Risk Assessment , Risk Factors , VasectomyABSTRACT
OBJECTIVE: To characterize the referral patterns and characteristics of men presenting for infertility evaluation using data obtained from the Andrology Research Consortium. DESIGN: Standardized male infertility questionnaire. SETTING: Male infertility centers. PATIENT(S): Men presenting for fertility evaluation. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Demographic, infertility history, and referral data. RESULT(S): The questionnaires were completed by 4,287 men, with a mean male age of 40 years ± 7.4 years and female partners age of 37 years ± 4.9 years. Most were Caucasian (54%) with other races being less commonly represented (Asian 18.6%, and African American 5.5%). The majority (59.7%) were referred by a reproductive gynecologist, 19.4% were referred by their primary care physician, 4.2% were self-referred, and 621 (14.5%) were referred by "other." Before the male infertility investigation, 12.1% of couples had undergone intrauterine insemination, and 4.9% of couples had undergone in vitro fertilization (up to six cycles). Among the male participants, 0.9% reported using finasteride (5α-reductase inhibitor) at a dose used for androgenic alopecia, and 1.6% reported exogenous testosterone use. CONCLUSION(S): This broad North American patient survey shows that reproductive gynecologists are the de facto gateway for most male infertility referrals, with most men being assessed in the male infertility service being referred by reproductive endocrinologists. Some of the couples with apparent male factor infertility are treated with assisted reproductive technologies before a male factor investigation. The survey also identified potentially reversible causes for the male infertility including lifestyle factors such as testosterone and 5α-reductase inhibitor use.
Subject(s)
Endocrinologists , Infertility, Male/therapy , Referral and Consultation , Adult , Female , Humans , Male , Middle Aged , Reproductive Techniques, Assisted , Surveys and QuestionnairesABSTRACT
Urodynamic pressure-flow studies provide an objective means of identifying bladder outlet obstruction. However, standard tests are invasive. This study evaluates a non-invasive method of obtaining pressure-flow data. One hundred men without clinical evidence of urinary obstruction were divided into 5 age groups. Non-invasive "cuff flow" urodynamic studies were obtained in each subject. Initial Pressure (P), initial flow (Q), resistive indices (Req =P/Q(2)) and uroflow patterns were obtained. With increasing age there were higher detrusor pressures, slower flows and greater resistive indices. This is in accordance with the prevalence of asymptomatic bladder outlet obstruction in older men. Statistical analysis revealed that Req is a highly reproducible value. An age specific nomogram for clinically unobstructed men was developed. The cuff flow devices is a new and reliable means of obtaining pressure-flow data in a non-invasive manner. From the values of Req in normal unobstructed men, future trials will assess clinically obstructed subjects prior to and after treatment.
