Male factor infertility: Initial workup and diagnosis in primary care

To present a case-based discussion on the workup of male factor infertility and review currently available treatments.

This discussion is based on the current Canadian Urological Association and American Urological Association guidelines, with reference to landmark papers as appropriate from 2010 onward. All articles were retrieved through PubMed.

Approximately 15% of Canadian couples experience infertility, making it a commonly encountered condition in the primary care setting. Among couples suffering from infertility, male factors can be identified as the sole cause in 30% of cases and as a contributing issue in 20% of cases. Although many of the treatments described aim to improve a couple's chances of naturally conceiving a child via intercourse, many patients ultimately require medical or surgical intervention to achieve pregnancy. This can be a long, protracted course for patients, with important roles for primary care providers and fertility specialists alike.

Male fertility assessment and treatment has historically been left in the hands of fertility specialists, creating a bottleneck for patients to receive fertility care. However, with increased understanding of the underlying causes of male factor infertility, the workup and initial management can occur in the primary care setting, helping to streamline care.