Underutilization of primary medical care among men presenting for fertility evaluation

Objective: To determine the proportion of men presenting for fertility evaluation who reported having an established primary care physician (PCP). Design: Retrospective, observational study. Setting: Academic health center. Patient(s): All men presenting for initial male factor infertility consultation with a single reproductive urologist between 2002 and 2018. Intervention(s): Men were asked to provide the name of their PCP at the time of initial visit. Main Outcome Measure(s): Descriptive statistics characterized the proportion of men with a PCP at the time of evaluation and associations between PCP status and clinical characteristics. Result(s): Among 4,127 men presenting for initial fertility consultation, 844 (20.5%) reported having an established PCP, 480 (11.6%) reported no PCP, and 2,803 (67.9%) did not have data available. Among 1,302 men who had a prior primary care visit within our healthcare system, 414 (31.8%) had been seen within 1 year before their fertility evaluation. Men with an established PCP were slightly older than those without a PCP, with higher body mass index, and lower systolic blood pressure. Hormonal profiles were similar across groups, but men with an established PCP had a significantly higher total motile sperm count than those without a PCP, median 53 (interquartile range, 11–109) versus 35 (interquartile range, 8–98). Conclusion(s): More than one third of men presenting for fertility evaluation did not have an established PCP. Reproductive urologists are uniquely positioned to facilitate the critical relationship between young men and PCPs, which should be a key component of the male fertility treatment paradigm.