A Chance Meeting on The Future of Male Infertility

It was about as spontaneous as meetings get. The academic equivalent of a “pick up” ball game. But it was attended by a who’s who in andrology in England and Ireland. And the topic was one that we never seem to think about in our busy lives as infertility care specialists: What is the future of male infertility?

A July Crowd

In attendance at the meeting, held at the famed Durrants Hotel in London, were urologists, gynecologists, endocrinologists, Ph.D. researchers, nutritionists, embryologists, psychologists, and industry experts. The meeting was organized by Dr. Jonathan Ramsay, a prominent London male fertility specialist, and we were also graced by the presence of a member of the British Parliament, Lord Robert Winston, who also happens to be a gynecology professor at Imperial College in London and a pioneering IVF clinician (IVF was invented in England). Surely a king’s table event loaded with a heavy-hitting brain trust in male infertility and sperm biology.

30,000-Foot Thoughts

At the meeting we discussed the current status of male infertility care in Europe and the US, and also where it’s headed. Although disagreements were common, what struck me most was how much, and how often, we agreed on things. A summary of the current state of male infertility:

• In the UK and the US, the vast majority of women but only a minority of infertile men receive medical care for their diagnosis.
• For a variety of reasons, men have difficulty accessing infertility care.
• Whether men admit it or not, the psychological impact of being infertile is great and likely on par with having cancer or other life-threatening illness.
• Given that infertility is a “biomarker” of overall health, it is more important than ever that men receive proper medical care (and not just a semen analysis) when diagnosed with infertility.
• Neither the public nor the rest of medicine fully appreciates the fact that evaluating male infertility provides a “window” into men’s overall health.
• Although commonly used for 50 years, the semen analysis is a “blunt instrument” in the infertility evaluation. A “deeper dive” into sperm quality is essential to an improved understanding of male infertility.
• We have not pursued “root cause” analyses of male infertility as diligently as we should. Research in this field is essential, as a better understanding of causes leads to more effective treatments.
• IVF is now a big business in both countries and is used liberally as a “catch all” treatment in many cases of male infertility. But, unfortunately, it appears that the IVF sons of infertile men will also need IVF because the infertility is not “cured” but simply bypassed. This is not great news for the future of male infertility care.

The Crystal Ball

Moving forward, we all agreed that nothing beats good scientific research and well-performed randomized clinical trials to ensure that we offer the best possible solutions to male infertility. In addition, we felt that there is a great need to increase awareness of infertility as a life-altering and health-related disease amongst the public and within medicine. A driving sentiment felt throughout the meeting was that we must keep moving the needle and get infertile men the care that they not only need but also deserve. Good, better, best; never let it rest!