Dr Kola Tytler MBBS CertHE MBA MSt MRCGPClinical Lead • iatroX
Assessment of Male Factor Infertility in Primary Care:
- Take a detailed history including previous genital pathology, urogenital surgery, sexually transmitted infections, varicocele, systemic illness, and any known causes of infertility such as prior cancer treatment.
- Perform a physical examination focusing on the genitalia to identify abnormalities such as varicoceles or signs of obstruction.
- Order an initial semen analysis following WHO guidelines: ensure the sample is complete, collected properly, and delivered to the lab within 30-50 minutes, with results interpreted against WHO reference values.
- If the first semen analysis is abnormal, repeat the test ideally after 3 months to confirm findings; if two abnormal results occur, refer to secondary care for further assessment.
- Screen for Chlamydia trachomatis infection as part of the assessment.
Management in Primary Care:
- Provide general advice on lifestyle factors affecting fertility such as smoking cessation, reducing excessive alcohol intake, weight management, and stress reduction.
- Inform men that treatments like anti-oestrogens, gonadotrophins, androgens, bromocriptine, or antibiotics for leucocytes in semen without infection are not effective and should not be offered.
- Refer men with hypogonadotrophic hypogonadism to specialists for gonadotrophin therapy.
- Do not offer surgery for varicoceles as it does not improve pregnancy rates; however, men with obstructive azoospermia may be referred for surgical correction if expertise is available.
- Offer counselling and psychological support to men and couples as infertility and its investigation can cause significant stress.