Introduction: While male factor infertility is present in up to half of infertile couples, studies have demonstrated that many male partners do not undergo evaluation by a reproductive urologist. We examined the geographic distribution of reproductive urologists relative to population density throughout the United States to determine whether restricted access to reproductive urologists could contribute to underutilization of male fertility evaluation.
Methods: We compiled a database of reproductive urologists using the Society for the Study of Male Reproduction (SSMR) membership directory and targeted Google searches, as these are the primary means through which patients can find a provider online. All practice locations and the male fertility procedures offered by each provider were recorded. Population data was abstracted from US Census Data (2010) and the American Community Survey 5-year estimates (2017).
Results: 255 reproductive urologists were identified of whom 131 (51%) were registered in the SSMR membership directory. Among all providers, 165 (65%) completed a fellowship in male infertility, andrology, and/or microsurgery. Fellowship-trained providers were more likely to mention sperm extraction, varicocelectomy, or vasectomy reversal on their website compared to non-fellowship trained providers (all p < 0.001) and more likely to practice exclusively at an academic medical center (p < 0.001). Among 3220 counties in the US, only 195 (6.1%) had a practicing reproductive urologist. Counties with a male infertility provider were more populous, had younger residents, higher mean household income and higher rate of college education (all p < 0.001). There was a dearth of reproductive urologists in rural areas (population < 50,000) with 2206 (99%) rural counties lacking a reproductive urologist.
Conclusions: There are a small number of fellowship-trained reproductive urologists in the United States, and the majority of counties do not have a local reproductive urologist, regardless of fellowship training. These factors may contribute to the low rates of male partner evaluation, suggesting a potential role for telemedicine or other novel approaches to improve patient access. Source of
