Department of Urology and Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA; Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark; Department of Urology, Rigshospitalet.
FertilityIQ, San Francisco, CA.
Urology. 2020 May;139:97-103. doi: 10.1016/j.urology.2019.12.035. Epub 2020 Feb 11.
To characterize the evaluation, treatment, and insurance coverage among couples with male factor infertility in the United States.
A cohort of 969 couples undergoing fertility treatment with a diagnosis of male factor infertility were identified from an online survey. The proportion of men that were seen/not seen by a male were compared. Insurance coverage related to male factor was also assessed.
Overall, 98.0% of the men reported at least one abnormal semen parameter. Of these, 72.0% were referred to a male fertility specialist with the majority being referred by the gynecologist of their female partner. As part of the male evaluation, 72.2% had blood hormone testing. Of the 248 men who were not recommended to see a male fertility specialist, 96.0% had an abnormal semen analysis including 7.6% who had azoospermia. Referral to a male fertility specialist was largely driven by severity of male factor infertility rather than socioeconomic status. Insurance coverage related to male factor infertility was poor with low coverage for sperm extractions (72.9% reported 0-25% coverage) and sperm freezing (83.7% reported 0-25% coverage).
Although this cohort includes couples with abnormal semen parameters, 28% of the men were not evaluated by a male fertility specialist. In addition, insurance coverage for services related to male factor was low. These findings may be of concern as insufficient evaluation and coverage of the infertile man could lead to missed opportunities for identifying reversible causes of infertility/medical comorbidities and places an unfair burden on the female partner.
描述美国男性因素不育症夫妇的评估、治疗和保险覆盖情况。
从一项在线调查中确定了 969 对接受男性因素不育症生育治疗的夫妇的队列。比较了男性接受/未接受男性检查的比例。还评估了与男性因素相关的保险覆盖范围。
总体而言，98.0%的男性报告至少有一个异常精液参数。其中，72.0%被转介给男性生育专家，大多数是由女性伴侣的妇科医生转介的。作为男性评估的一部分，72.2%的人进行了血液激素检测。在未被建议看男性生育专家的 248 名男性中，96.0%的人精液分析异常，包括 7.6%的无精子症。男性生育专家的转介主要取决于男性因素不育症的严重程度，而不是社会经济地位。与男性因素不育症相关的保险覆盖范围较差，精子提取（72.9%报告覆盖范围为 0-25%）和精子冷冻（83.7%报告覆盖范围为 0-25%）的覆盖范围较低。
尽管本队列包括精液参数异常的夫妇，但仍有 28%的男性未接受男性生育专家的评估。此外，与男性因素相关的服务保险覆盖范围较低。这些发现可能令人担忧，因为对不育男性的评估和覆盖不足可能导致错过识别不育/医学合并症的可逆原因的机会，并给女性伴侣带来不公平的负担。
