Couples are unnecessarily undergoing IVF because male infertility is under-researched, with the NHS often failing to diagnose treatable causes, leading experts have said.
Poor understanding among GPs and specialists and a lack of NHS testing means that couples struggling to conceive often go untreated for male infertility, despite 50% of all infertility cases being male.
Many causes of male infertility are treatable. One of the most common, varicocele – a dilated vein in the scrotum that increases testicular temperature, damaging sperm – can be treated through surgery, while lifestyle adjustments and supplements can also help.
Vaibhav Moudgil, honorary clinical professor and consultant urological surgeon and andrologist at the University of Manchester, said there is a lack of awareness about male infertility, which affects 5% to 10% of men in the UK.
She said women who go to the doctor after struggling to conceive often have to undergo “every test you can think of”, while it can take years for men to get even basic tests.
“I don’t think this issue has ever gone away or been given as much attention as it should have been,” he said.
“Unfortunately I can’t see evidence of that happening yet.”
He said that most couples struggling to conceive were seen by gynecologists who specialized primarily in women’s health, and most areas had only one or two dedicated andrologists specializing 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 like Australia’s, but were disappointed by its omission. It is thought that improving women’s health strategies could solve male infertility.
Dr. Michael Carroll, a researcher Manchester Metropolitan University said the strategy was a great initiative, but it missed the opportunity to consider the impact on mental health and how infertile men have shorter lifespans.
Carroll is writing a book on male infertility to bridge the awareness gap compared to women, who are generally well educated on their reproductive health. Many men don’t know how to keep their testicles cool, avoid tight underwear and taking very hot baths, or how lifestyle factors like smoking, alcohol, diet, sleep and exercise can cause sperm quality to decline, he said.
“Historically, fertility has been viewed as a women’s health issue. It’s always been thought of as the ‘infertile woman’ because men think they’re fertile if they’re producing semen,” she said.
“Men should be treated as equals to women. We should do more rigorous testing, more lifestyle and medical history, we should physically examine the testicles – not just give a semen analysis.”
Raj Mathur, a consultant in reproductive medicine and former president of the British Fertility Society, said male infertility has been under-researched.
“Male reproductive issues have been neglected,” he said. “At the moment the number of evidence-based trials for men is relatively small. We really need more funding to research what are the appropriate trials for men, through randomized control 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 guidelines to recommend more testing for men.
Tim Shand, founder of campaign group Men’s Sexual and Reproductive Health Matters, said the draft proposal is a “positive step” but does not go far enough.
Recent research from Fertility Action found that 80.6% of GPs had received no education on male fertility, and 97% would not be able to accurately diagnose varicocele.
Shand said there could be “significant cost benefits to the NHS in providing appropriate and full assessment of men before undertaking the standard IVF procedure”, as well as reducing the mental health burden on couples.
A spokesperson for the Department of Health and Social Care said: “For too long, there has been a reluctance to acknowledge that men face specific inequalities and difficulties when it comes to their health. This includes male infertility.”
“The Men’s Health Strategy sets a strong foundation for improving the way we think and act on men’s health. It’s a bold first step, and we will learn and adapt as challenges arise.”
<a href