Couples are needlessly going through IVF because male infertility is under-researched, with the NHS too often failing to diagnose treatable causes, leading experts have said.
Poor understanding among GPs and a lack of specialists and NHS testing means 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 – a dilated vein in the scrotum that increases testicular temperatures, damaging sperm – can be treated through surgery, while lifestyle adjustments and supplements can also help.
Vaibhav Modgil, an honorary clinical professor at the University of Manchester, and consultant urological surgeon and andrologist, said there was a lack of awareness of male infertility, which affects between 5% and 10% of men in the UK.
He said women visiting a doctor after struggling to conceive were often rapidly submitted to “every test you can think of”, whereas it could take years for men to receive even basic testing.
“I don’t think the issue has ever gone away or received the attention it’s deserved,” he said, adding that remedying the situation “will require a top-down approach at a much higher level”.
“Unfortunately I can’t see evidence that’s happened yet.”
He said most couples struggling to conceive were seen by gynaecologists, who predominantly specialise in women’s health, and that most regions had only one or two dedicated andrologists specialising in men’s health.
Experts said they had hoped the government’s first men’s health strategy, which was published this week, would contain a strategic focus on male infertility similar to Australia’s, but were disappointed by its omission. It is understood a refresh of the women’s health strategy may address male infertility.
Dr Michael Carroll, a researcher at Manchester Metropolitan University, said the strategy was a great initiative, but that there was a missed opportunity to consider the toll it took on mental health and how infertile men tended to have shorter lifespans.
Carroll is writing a book on male infertility to close the awareness gap compared with women, who are typically well educated on their reproductive health. Many men do not know to keep their testicles cool, avoid tight underwear and taking very hot baths, or how lifestyle factors such as smoking, drinking, diet, sleep and exercise can cause sperm quality to decline, he said.
“Historically, fertility has been seen as a women’s health issue. It was always considered as ‘the barren woman’ because men think they’re fertile if they’re producing semen,” he said.
“Men should be considered on parity with women. We should do more rigorous testing, more lifestyle and medical history, we should physically examine the testes – not just give a semen analysis.”
Raj Mathur, a consultant in reproductive medicine and the former chair of British Fertility Society, said male infertility was under-researched.
“There’s been a neglect of male fertility issues,” he said. “At the moment the number of tests for men that are evidence-based is relatively small. We really need more money to research what the appropriate tests for men are through randomised control trials looking at different interventions to see if they actually 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.
The draft proposals are a “positive step forward” but do not go far enough, said Tim Shand, the founder of the campaign group Men’s Sexual and Reproductive Health Matters.
Recent research from Fertility Action found that 80.6% of GPs had received no education on male fertility, and that 97% would not be able to examine accurately for varicocele.
Shand said there could be a “significant cost benefit for the NHS in doing a proper and full assessment of men before initiating the standard IVF process”, as well as easing the mental health burden on couples.
A Department of Health and Social Care spokesperson said: “For too long, there has been a reluctance to accept that men suffer specific inequalities and hardships when it comes to their health. This includes male infertility.
“The Men’s Health Strategy sets up a strong foundation for improving how we think and act on men’s health. It is a bold first step, and we will learn and adapt as challenges emerge.”
The Guardian
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