Underutilization of primary medical care among men presenting for fertility evaluation

Abstract

A growing body of evidence demonstrates an association between male infertility and significant medical comorbidities including cardiovascular disease, cancer, and even mortality. As such, it is essential that men with subfertility establish and maintain a relationship with a primary care physician (PCP). We sought to determine the proportion of young men presenting for fertility evaluation who reported an established relationship with a PCP. Retrospective, cross-sectional study. We retrospectively examined all men presenting for initial male infertility consultation at a tertiary care center with a single reproductive urologist between 2000 and 2018. All men were asked to provide the name of their PCP at the time of initial visit. Descriptive statistics and multivariable regression were utilized to characterize the proportion of men with a PCP at the time of evaluation and associations between PCP status, patient age, and comorbidity. Among 4,127 men presenting for initial fertility consultation, 1,324 had PCP data recorded. Of these, 480 (36.3%) did not have an established PCP at the time of evaluation. Men with a PCP were older than those without - median age 35 years (interquartile range [IQR] 23-40) versus 34 years (IQR 31-38), p<0.001. A smaller proportion of men with a PCP had elevated blood pressure (46.2% versus 56.8%, p=0.03), however a similar proportion of men in both groups were obese (21.7% versus 24.6%, p=0.31). Among 513 men who had a documented visit with an internal medicine physician within our tertiary care network prior to initial fertility consultation, 184 (35.9%) had not seen an internal medicine physician in over a year. Over one-third of men presenting for fertility evaluation did not have an established PCP, and among those who did, a sizable proportion had not seen their PCP in the previous year. Given the strong link between male infertility and medical comorbidities, reproductive urologists are uniquely positioned to encourage and facilitate the critical relationship between men with subfertility and primary care physicians.