THE PROVIDER LANDSCAPE OF MALE INFERTILITY CARE IN THE UNITED STATES

Recent studies have demonstrated that reproductive endocrinologists perform sperm extraction procedures for male infertility, yet the overall proportion of male infertility care provided by non-urologists is unknown. Using a nationally representative cohort, we sought to assess male infertility visits to examine provider specialization and patient characteristics across the United States. Retrospective cohort review. We examined all male patient visits in the National Ambulatory Medical Care Survey (NAMCS) between 2006-2016, a Center for Disease Control and Prevention (CDC) sponsored data-set designed to characterize ambulatory medical care in the US. The diagnosis of infertility was made using the International Classification of Disease (ICD) 9 codes 606.x for the years 2006-2015 and ICD 10 codes N46.x for the year 2016. Chi-squared tests were used to compare demographic and clinical information of men with and without infertility. A total of 3,410,129 weighted visits were analyzed of which 1513 (0.04%) were for infertility. Men seen with a diagnosis of infertility compared to those without were on average younger (35 years vs. 58 years, p<0.05) and more likely to have private insurance (89.2% vs 50.4%, p<0.05). Urologists were responsible for the majority (N=957, 64.6%) of visits for infertility, followed by gynecologists (N=205, 13.6%). When examining the primary diagnosis for each encounter, gynecologists represented 69.4% of infertility diagnoses among non-urologists. Compared to men seen for infertility by urologists, those seen by non-urologists were more likely to be younger (31 years vs. 36 years, p<0.05) and Black (18.2% vs. 10.0%, p=0.04). Over a third (35.4%) of office visits for male infertility were performed by non-urologists, primarily gynecologists. Given the high prevalence of medical comorbidity and treatable etiologies of male infertility among male partners of infertile couples, it is critical that these men undergo evaluation by a reproductive urologist. As models for delivery of care in reproductive medicine continue evolve, further studies are needed to examine referral patterns and integration of care between reproductive endocrinologists and urologists. This will aid in the optimization of access to reproductive urologic evaluation.