Reproductive urologic consultation in subfertile men: predictors of establishing care and patient perceptions after abnormal semen testing

Objective: To evaluate the predictors of establishing care with a reproductive urologist (RU) among men with abnormal semen analyses (SAs) ordered by nonurologists and examine patient perceptions of abnormal SAs in the absence of RU consultation. Design: Retrospective cohort study with cross-sectional survey. Setting: Large, integrated academic healthcare system during 2002–2019. Patient(s): We identified adult men undergoing initial SAs with nonurologists who had abnormalities. Patients with index SAs during 2002–2018 were included for the analysis of RU consultation. Men tested in 2019 were recruited for cross-sectional survey. Intervention(s): Cross-sectional survey. Main Outcome Measure(s): RU consultation and accurate perception of abnormal SAs. Result(s): A total of 2,283 men had abnormal SAs ordered by nonurologists, among whom 20.5% underwent RU consultation. Mixed-effect logistic regression modeling identified oligospermia as the strongest predictor of RU care (odds ratio, 3.08; 95% confidence interval, 2.43–3.90) with a significant provider-level random intercept. We observed substantial provider-level heterogeneity among nonurologists with provider-specific rates of RU evaluation ranging from 3.7% to 35.8%. We contacted 310 men who did not undergo RU consultation with a 27.2% survey response rate. Of respondents, 6.7% reported receiving an RU referral. Among men with abnormal SAs not evaluated by RU, 22.7% appropriately perceived an abnormal SA. Conclusion(s): In men with abnormal SAs diagnosed by nonurologists, the rate of RU consultation was low and associated with substantial provider-level variation among ordering providers. Patients without RU consultation reported inaccurate perceptions of their SA. Multidisciplinary efforts are needed to ensure that subfertile men receive appropriate RU evaluation.