Urology is a surgical subspecialty field in and of its own right. It is the are of medicine focusing on the urinary system including the kidneys, ureters, bladder, prostate and urethra. It also focusses on the male genital system including scrotum, testes, epididymis, vas deferens, prostate, seminal vesicles and related structures. All urologists receive training in these areas; however, some urologists specialize in the sub-subspecialty area of Male Reproductive Medicine and Surgery, also known as Male Infertility.
Despite their additional focus, interest and training, there is a question as to whether “Reproductive Urologists” (RU’s) offer value to male infertility patients above and beyond their general urology peers. Of course, one could imagine this might be difficult to prove. What metric would provide evidence?
A report in the March edition of Fertility and Sterility by Pham et al addressed this question. This study looked at one aspect of the quality of patient care with respect to the training of the urologist providing that care. Specifically, in a sample of men with abnormal semen analyses who did NOT see an RU, their understanding of their analysis result was correct only about 23% of the time. Furthermore, in a much larger number of patients where abnormal semen analysis results were found on labs ordered by non-urologists, an RU was consulted only about one fifth of the time. The paper concludes with a recommendation on efforts to be made to “ensure that sub-fertile men receive appropriate Reproductive Urologist evaluation”.
Of course, there are important implications of these findings. One can only imagine that if a semen analysis result is not presented to a male patient in a way he can understand or is not correctly presented, one might also anticipate incorrect further evaluation and potentially inappropriate counselling and treatment. The paper notes that the American Society of Reproductive Medicine recommends RU evaluation in men with an abnormal semen analysis or abnormal reproductive history. The authors further note that not only does a finding of male infertility sometimes represent a sign of an underlying medical condition but also that Reproductive Urologists can potentially improve the chances of conception and or reduce the potential expense of evaluation and treatment.
It is this author’s hope that non-urologist who evaluate fertility patients, including reproductive endocrinologists, gynecologists and general practitioners, understand and embrace the recommendation in this journal report.