Simultaneous Workup
In 2008, after two years of failing to make a child organically, we learned the doom Kathy had already been feeling for more than a year was justified: I was diagnosed with male-factor infertility. Our only real chance to move forward would be in vitro fertilization. We couldn’t afford it; we couldn’t afford not to do it. One way we tried to work through that diagnosis, our anger, and our options was to start a secret infertility blog, “Less Than a Million.” This post and what comments from 2008 that are attached to it come from that blog.—gb
The Los Angeles Times had a story last week that with the incredulous headline “Men can be infertile too,” which shouldn’t be a surprise to anyone who spends any time thinking about infertility. In addition to surveying the common causes of MFI, the story also cites an IntegraMed survey of fertility centers. Unsurprisingly, the survey reveals that many doctors still ignore men when beginning infertility diagnoses.
Sixty-seven percent of those responding to the survey said that the female partner sought initial treatment for infertility.
“Both the male and female partner should be worked up simultaneously,” [Dr. Thomas] Walsh says. “Men are just as deserving of a comprehensive evaluation.” …
Unfortunately, men often resist being tested. Nearly half of all women responding to the IntegraMed survey said that it was only after pressure that their male partners were willing to seek medical consultation.
The reasons for this reluctance have not been well studied. Some fertility experts suggest it’s purely a macho thing—that a man’s sense of masculinity tends to be strongly tied to his ability to reproduce, making him afraid to acknowledge that he might have a fertility problem.
Of course, it’s almost certainly more complicated than that and likely involves a broad range of issues and concerns. It may simply reflect men’s general tendency to utilize healthcare less than women. But regardless of the reason, “When men feel responsible for infertility, it has a profound impact on them,” Walsh says.
I still am astounded by the reported reluctance by men to submit to something as basic as a sperm analysis. That women must undergo the discomfort of something as invasive as an HSG is only one reason to insist that men get over their embarrassment (if embarrassment it is that holds them back)—it’s simple fairness. But on another level, I suspect this is one very real consequence of the fact that infertility treatments are primarily paid out of pocket. Insurance companies are shrewd. They look for many ways to eliminate treatment costs (besides deferring costs to patients, though they do much too much of that). If more companies paid infertility coverage and it were discovered that early diagnosis of MFI save money in treatment in the long run, then they would leverage that knowledge to change doctors’ and patients’ behavior. As it stands, however, infertility clinics have captive audiences of desperate, cash-paying women who are willing to blame themselves for the fact that they cannot get pregnant. That the diagnostic tests for women cost so much more than for men is to their benefit. Why in the world would they want to rock that boat?
