Doctors urged to evaluate men first in infertility care

On August 15, 2024, the American Urological Association and the American Society for Reproductive Medicine updated their Male Infertility Guideline with a blunt warning: without an adequate male infertility workup, unnecessary costly, time-consuming, and invasive treatment might be pursued for the female partner. The guideline says the male partner should be evaluated early because a complete workup is necessary to design care for the couple.

Why male evaluation belongs at the start

Delay can mean months of emotion, medical appointments, and procedures built on an incomplete diagnosis.

Infertility is still widely treated as a women’s issue first, even though contraception and fertility are often culturally coded that way long before a couple reaches a specialist. In practice, that bias can keep male factors in the shadows until the female partner has already been placed on the most intensive path.

What counts as infertility, and why the definition matters

The World Health Organization defines infertility as the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. The National Institute of Child Health and Human Development uses a similar clinical definition, describing infertility as the inability to achieve pregnancy after one year of intercourse without birth control.

Those definitions shape who gets screened, when they get screened, and what happens next. More than one-third of infertility cases are caused by male reproductive issues alone or in combination with female reproductive issues, NICHD says.

Certain causes of male infertility may have life-threatening, genetic, or broader health implications for the patient and future offspring, the AUA and ASRM guideline says.

The public health case for looking beyond pregnancy

Infertility has public-health implications beyond the ability to have children and can serve as a marker of the past, present, and future health of reproductive-age women and men, the Centers for Disease Control and Prevention’s National Center for Health Statistics says.

The CDC’s National Public Health Action Plan for the Detection, Prevention, and Management of Infertility, developed with governmental and nongovernmental partners, takes that population-level approach. Its focus is on healthy behaviors, early detection, and treatment of medical conditions that can threaten fertility.

Men have often been overlooked in reproductive-health discussions. NICHD says males are frequently sidelined when infertility is treated as if it is mainly a female problem, and the result is a blind spot that can delay diagnosis for everyone involved.

The emotional cost of being left out

Research on male-factor infertility finds that many men want more information and support after diagnosis, yet a persistent gap remains in what clinicians provide. Studies also find that men feel overlooked in reproductive-health conversations, with limited research still available on what they need once they are told fertility may be a concern.

Psychosocial studies are consistent in what men report: depression, anxiety, stress, shame, and stigma. Recent qualitative work shows that men undergoing fertility treatment can feel that no one asked whether they were alright, and that the process can involve confusion, self-blame, and social silence.

The emotional burden is often worsened by the way care is organized. If a couple is routed into a system that speaks mainly to the female partner, men can become spectators in their own diagnosis, making it harder to ask questions, understand options, and stay engaged long enough to get the right answer.

What a more balanced standard of care looks like

A better system would normalize male evaluation at the start of infertility workups, not after months of female-directed treatment. That means reproductive-urology and fertility services should be coordinated so that both partners are assessed in parallel, rather than one partner being treated as the default patient while the other waits on the sidelines.

Clearer counseling is part of that shift. Men need plain-language explanations of what testing is being done, what the results can mean for fertility and overall health, and when a finding suggests a broader medical problem. Mental-health support should be built in as well.

If care remains fragmented, couples lose time and money moving between specialties that do not communicate. A more balanced standard would make it easier to move from diagnosis to treatment without forcing the female partner through invasive steps before the male partner has been properly evaluated.