Reproductive endocrinologists are the gatekeepers for male infertility care in North America: results of a North American survey on the referral patterns and characteristics of men presenting to male infertility specialists for infertility investigations

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 (5 alpha-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 5 alpha-reductase inhibitor use. ((C) 2019 by American Society for Reproductive Medicine.)