Changes in practice patterns in male infertility cases in the United States - the trend toward subspecialization

Abstract

OBJECTIVE: Very few studies have addressed attitudes on posthumous sperm retrieval due to the ethical and legal ramifications of the use of gametes after death. We evaluated the presence and content of a policy on posthumous sperm retrieval at the 50 major academic medical centers.DESIGN: Questionnaire based telephone study / web survey. MATERIALS AND METHODS: We surveyed the 50 major academic medical centers as ranked for research in 2016 by U.S. News & World Report. We gathered data on presence and content of posthumous sperm retrieval policies. If not published, we contacted the legal counsel for the medical center, the ethics and compliance offices, as well as the Urology Department for each center.RESULTS: Out of the 50 major academic medical centers, we gathered data on posthumous sperm retrieval from 14 (28%). Of the 14 institutions, five (35.7%) had policies regarding posthumous sperm retrieval and the remaining nine (64.3%) did not have a policy. Four of the nine medical centers without policies have discussed development of a policy but did not formalize it due to lack of legal guidance as a barrier to policy adoption. Out of the five centers that had a policy, one required prior written consent, while four allowed for verbal or inferred consent from the surviving life partner.CONCLUSIONS: Very few, less than 1/3, of the surveyed academic medical centers have policies on posthumous sperm retrieval. Medical centers can adopt individualized policies based on guidelines published by the American Society for Reproductive Medicine.

The quality of systematic reviews and meta‐analyses assessing the treatment and management of male infertility

“…Infertility is an overlapping area of treatment for urologists, andrologists, gynecologists, obstetricians, endocrinologists, embryologists, and general practitioners. However, analysis of practice patterns among urologists, and specifically andrologists, shows that treatment of male infertility has become increasingly subspecialized 21 . Therefore, it is important for infertility specialists to be familiar with journals specific to their patient population.…”

Barriers, potential solutions, and alternatives to randomized clinical trials in male reproductive medicine

“…While infertility is widely prevalent, and a male factor is present in up to 50% of couples, the clinical volume and prevalence of male reproductive specialists does not necessarily reflect this epidemiology. Though the number of andrology fellowships has increased over time, there remain a small number of training programs across the country, and just 2.3% of all urologists identify as andrology specialists (2). Most academic institutions and private practices employ, at most, one andrologist, rendering single-site trials difficult to execute and, generally, underpowered.…”