The Male Room

You’d think that missing the diagnosis of a testicular cancer in a young, healthy male would scare the living daylights out of any doctor. But there exists in today’s modern medicine a situation that continues to baffle me,where some bright doctors ignore the facts. Study after study has proven what urologists have known for years: that a significant number of men seeking evaluation for male infertility have a testicular cancer as the cause of their infertility!

Young men with fertility problems (poor or zero sperm counts) usually go to a fertility center. Almost always this is an OB/GYN that specializes in female reproductive issues or an OB/GYN that has done additional training after residency in female reproduction and is called a reproductive endocrinologist (RE). Because so many advances have been made in assisted reproductive techniques for the female, the cause of the husband’s infertility is considered irrelevant. Sperm can be retrieved blindly and used to create a baby through the magic of ICSI with IVF. This technique is an amazing advance in helping infertile couples create a baby of their own. However, in the doctor’s zeal to move ahead with the “baby making,” the cause of the male’s infertility is often of little concern . They can get sperm, so what difference does it make whatever the cause?

This is where the facts should help define “standard of care.” There are two reasons why a urologist with special interest or training in male fertility should be an integral part of the fertility medical team.

1. There is a real risk that some of these men have a testicular cancer as the cause of their infertility. Without a urologic exam and appropriate studies, he may be able to father a child through IVF, while the undiagnosed cancer continues to grow until it becomes much larger or shows signs of being advanced (as with Lance Armstrong). This is obviously not good for the man, or his new family. Missing an opportunity for an early diagnosis may mean chemotherapy, radical surgery and increased chances for death.
2. Sometimes the urologist is able to diagnose and correct the cause of infertility, such as a varicocele, ejaculatory duct obstruction, or blockage of the vas. This could allow some couples to conceive naturally or without the risks and expense of ICSI with IVF.

So what can be done? First and foremost, couples need to be informed about the causes and treatment options of infertility in the male and female. Second, urologists need to be more involved in their community when it comes to fertility issues. Urologists should also work with the female fertility experts, reminding them of the importance of being included whenever there are male fertility questions. Lastly, doctors that prefer to ignore the potential risks to their infertile male patients need to refer these patients to urologists. This is not rocket science. It is good patient care. If the doctors themselves won’t initiate it, then informed patients must demand it!

Related Topics: Infertility Treatment and Support, Fertility Tests for Men