Male infertility

PURPOSE: We assessed male infertility and its treatment in the United States by identifying trends in the use of health care resources and estimating the economic impact of such care. MATERIALS AND METHODS: The analytical methods used to generate these results were previously described. RESULTS: Inpatient hospitalizations for male infertility were relatively few with an overall rate of 0.9/100,000 population. Of these stays 55% were associated with inpatient management of varicocele and 749 of 797 occurred in a rural setting. Between 1994 and 1996 there were 55,411 ambulatory surgery visits with men 25 to 34 years old having the highest use rate of 61/100,000. Men living in the West had the lowest rate of ambulatory surgical visits, which was significantly lower than that for men living in the Northeast and Midwest (29/100,000 vs 104/100,000 and 72/100,000, respectively). The Veterans Affairs health system showed no geographic trend in infertility diagnosis and Hispanic men had the highest frequency of treatment for male infertility, followed by black and then white men. The National Survey for Ambulatory Surgery estimated that 67% of patients undergoing ambulatory surgery for male infertility had a diagnosis of varicocele. In 2000 total expenditures for treating primary male infertility were approximately $17 million. However, adding the cost for assisted reproduction technology cycles placed total cost at about $18 billion. CONCLUSIONS: Infertile males generally seek infertility care outside of traditional reimbursement patterns. For this reason obtaining accurate data regarding the costs associated with male fertility care has proved to be challenging. Given the expense of in vitro fertilization and its attendant technologies, emphasis should be placed on addressing the underlying causes of male infertility. Further systematic examination of the demographics and management of male reproductive dysfunction is warranted.