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

Abstract

Objective: To assess changes in the practice patterns of urologists performing male infertility procedures (vasal reconstruction, sperm retrieval, varicocelectomy) from 2004 to 2015 in the United States.

Design: Examination of self-reported procedural volumes from urologists undergoing certification and recertification using case log data provided by the American Board of Urology. The study period was stratified into early (2004-2007) and recent (2012-2015) time periods.

Setting: Not applicable.

Patient(s): None.

Intervention(s): None.

Main outcomes measure(s): Temporal variations in male infertility practice patterns among different urologic subspecialties between the early and recent time periods.

Result(s): The overall proportion of total male infertility procedures performed by andrologists significantly increased between the early and recent groups (23% to 26%). This growth was driven by a significant increase in the proportion of varicocele repairs being performed by andrologists between the early and recent periods (19% to 25%). Most notably, an assessment of total number of male infertility procedures performed by newly certifying urologists showed that there was a significant increase in the overall proportion of all male infertility procedures being performed by recently trained andrologists (24% to 35%). This significant increase was seen individually among all three types of male infertility procedures.

Conclusion(s): With the increased trend in urologists obtaining fellowship training, male infertility surgical volume is beginning to shift from general urologists to subspecialized andrologists.

Keywords: Andrology; male infertility; sperm retrieval; varicocelectomy; vasal reconstruction.