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• W2891994433 abstract "Since females traditionally drive a couple’s fertility workup, we characterized infertile couples requiring varicocelectomy and their delay in presentation to a male infertility clinic. Descriptive retrospective review of patients who underwent microsurgical varicocelectomy by two surgeons. Patients whose charts included partner histories were assessed for duration of attempting conception, prior workup, and prior use of assisted reproductive technology (ART). A student’s t test was used to compare total motile sperm counts between patients who used ART to those who did not. Time trying for conception was compared between those presenting with primary versus secondary infertility. A total of 376 patients were included in the study population. At presentation, the mean age was 34.6 (range 21 - 63) years for men, and 31.15 (range 19 - 43) years for women. On average, couples were trying for 22 (range 0 to 120) months prior to presenting for male evaluation. 86% (307/356) of couples presented with concerns for primary infertility while 14% (49/356) of couples presented for secondary infertility. Couples with primary infertility were trying for pregnancy for an average of 21 months, while couples with secondary infertility were trying for pregnancy for an average of 29 months prior to presentation for male workup. However this difference did not reach statistical significance (p=0.096). 59% (198/337) of couples were first seen by a gynecologist only, 24% (83/337) a reproductive endocrinologist (REI) only, 15% (50/337) presented without a female workup, and 2% (6) couples saw both a gynecologist and REI prior to presenting to a male infertility clinic. In total, 18% underwent ART prior to presentation [38/345 underwent intrauterine insemination (IUI) (range 1-10 cycles); 30/345 underwent in vitro fertilization (IVF) (1 to 4 cycles); 5/345 underwent both IUI and IVF] Couples who had undergone IUI or IVF had similar total motile sperm counts compared to others. The majority (72.3%) of females had no abnormality in their workup, making varicocele the only correctable factor for infertility. The female conditions diagnosed are in Table 1. Our findings show a significant delay in referral of infertile men requiring varicocelectomy. 18% of couples underwent IUI or IVF, a costly procedure, prior to having an inexpensive (<$1000) male workup (scrotal ultrasound, semen analysis, and hormone levels). In an era of medical cost containment, early referral to a male infertility specialist is imperative.Table 1Comorbidities and Results of Female Workup Prior to Seeing Male Fertility SpecialistComorbidity/Finding on WorkupIncidence (Total n=311)No Abnormality Found225 (72%)Ovulatory Factor/ Polycystic Ovarian Syndrome49 (15.7%)Tubal Factor17 (5.4%)Endometriosis13 (4.2%)Uterine Factor12 (3.9%)Cervical Factor3 (1.0%)Other/Unexplained1 (0.32%) Open table in a new tab" @default.
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• W2891994433 date "2018-09-01" @default.
• W2891994433 modified "2023-10-17" @default.
• W2891994433 title "It takes two to tango: couples’ long and expensive paths to varicocele repair" @default.
• W2891994433 doi "https://doi.org/10.1016/j.fertnstert.2018.07.772" @default.
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