Article Abstract

Practice patterns for the treatment of idiopathic infertility: is there a role for advanced semen testing?

Authors: Vishal N. Patel, Kevin B. Ginsburg, Erika Etnyre, Felix Shun, Aram Loeb, Stephen A. Krawetz, Amarnath Rambhatla


Background: For idiopathic infertile couples, normal semen parameters do not rule out infertility from a male factor. RNA sequencing of spermatozoa can provide additional measures of male fecundity, distinguishing couples likely to achieve live birth with timed intercourse (TI) or intrauterine insemination (IUI) versus more aggressive assisted reproductive technology [in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI)]. This survey study evaluates treatment patterns of urologists for men with idiopathic infertility (IDF) and investigates attitudes regarding the utility of a novel test of sperm RNA in guiding treatment paradigms.
Methods: A 12-question, web-based survey was emailed to members of two male infertility societies, the Society for the Study of Male Reproduction and The American Society of Andrology. Follow-up email prompts were sent two and four weeks after initial contact.
Results: Of 291 invited participants, 33 (11%) completed the online survey. A majority (58%) were fellowship trained in male infertility. Respondents reported their typical treatment algorithm for most couples with IDF was: TI first line (73%), followed by IUI second line (80%), IVF third line (80%), and ICSI fourth line (85%). Most, 71%, of respondents reported a test that could identify which couples were likely to conceive with TI or IUI vs. proceeding directly to assist reproductive techniques beneficial. Furthermore, 52% report that knowing the results of such a test would change their practice patterns.
Conclusions: Variability exists in the evaluation and treatment of couples with IDF. A majority of physicians surveyed asserted that the development of a test in this space to further characterize male-factor infertility would both be helpful clinically and change practice patterns.