News | Treatable but undiagnosed: male infertility is a blind spot in UK fertility care
Reproductive medicine experts warn that the UK's National Health Service (NHS) has long neglected the diagnosis and treatment of male infertility, leading to many potentially avoidable in vitro fertilization (IVF) cycles. This raises healthcare costs and adds to patients' physical and psychological burden.
Although male factors account for about half of all infertility cases, experts say male infertility is often not systematically assessed, let alone treated specifically, because general practitioners (GPs) have limited awareness of male fertility problems, specialist andrologists are scarce, and testing pathways are limited.
Many causes of male infertility are, in fact, treatable. The most common, varicocele, can impair sperm quality by increasing scrotal temperature and may improve with surgery. Lifestyle changes and nutritional supplements may also benefit some patients.
Vaibhav Modgil, emeritus clinical professor at the University of Manchester and a specialist in urology and male reproductive medicine, said male infertility affects about 5% to 10% of men in the UK but receives insufficient attention from society and the healthcare system.
He noted that when a woman seeks care after difficulty conceiving, she is often quickly offered "almost every test imaginable," while a man may wait years for even basic testing. "The problem never really went away; it simply never received the attention it deserved," he said. "Changing this requires systemic reform from the top down, but I currently see no sign of that."
Experts broadly agree that the current fertility care pathway structurally compounds the problem. Most couples having difficulty conceiving first see a gynecologist, whose specialty focuses on women's health. In many regions, only one or two andrology specialists focus on male reproductive health.
The UK's first Men's Health Strategy, released this week, had raised hopes. Experts expected it to address male infertility explicitly, as Australia's national strategy does, but were disappointed when it did not. The government said the updated Women's Health Strategy may cover male infertility.
Michael Carroll, a researcher at Manchester Metropolitan University, said the strategy itself is a positive step but missed an opportunity to address the mental health effects of male infertility and its association with shorter male life expectancy. He is writing a book on male infertility to help close the wide gap in public awareness compared with women's reproductive health.
Carroll said many men do not know they should avoid high temperatures, tight underwear, and frequent hot baths, or that lifestyle factors such as smoking, alcohol use, diet, sleep, and exercise directly affect sperm quality. "Historically, fertility has been viewed as a women's health issue," he said. "If a man could produce semen, he was assumed to be fertile."
He stressed that men should have equal status in fertility assessment: "We need more systematic testing, a fuller review of life and medical history, and an actual physical examination of the testicles—not just a semen analysis report."
Raj Mathur, former chair of the British Fertility Society and a consultant in reproductive medicine, also said male infertility has long been underfunded in research. "There are currently very few evidence-based tests for men. We urgently need more funding for randomized controlled trials to establish which tests and interventions actually work."
The National Institute for Health and Care Excellence (NICE) is updating its guidance and is expected to recommend more comprehensive examinations for men. Tim Shand, founder of the advocacy group Men's Sexual and Reproductive Health Matters, said the latest draft is encouraging but still does not go far enough.
Data suggest that the roots of the problem also lie in primary care. A recent Fertility Action study found that 80.6% of GPs had never received training on male fertility and 97% could not correctly examine for varicocele. Shand said fully assessing men before starting standard IVF could save the NHS substantial costs and reduce psychological stress for both partners.
A spokesperson for the UK Department of Health and Social Care said society has long failed to confront inequalities in men's health, including male infertility. The Men's Health Strategy lays the foundation for improvement, and the government will continue to refine it as implementation proceeds.
News | Treatable but undiagnosed: male infertility is a blind spot in UK fertility care
News | Treatable but undiagnosed: male infertility is a blind spot in UK fertility care
Reproductive medicine experts warn that the UK's National Health Service (NHS) has long neglected the diagnosis and treatment of male infertility, leading to many potentially avoidable in vitro fertilization (IVF) cycles. This raises healthcare costs and adds to patients' physical and psychological burden.
Although male factors account for about half of all infertility cases, experts say male infertility is often not systematically assessed, let alone treated specifically, because general practitioners (GPs) have limited awareness of male fertility problems, specialist andrologists are scarce, and testing pathways are limited.
Many causes of male infertility are, in fact, treatable. The most common, varicocele, can impair sperm quality by increasing scrotal temperature and may improve with surgery. Lifestyle changes and nutritional supplements may also benefit some patients.
Vaibhav Modgil, emeritus clinical professor at the University of Manchester and a specialist in urology and male reproductive medicine, said male infertility affects about 5% to 10% of men in the UK but receives insufficient attention from society and the healthcare system.
He noted that when a woman seeks care after difficulty conceiving, she is often quickly offered "almost every test imaginable," while a man may wait years for even basic testing. "The problem never really went away; it simply never received the attention it deserved," he said. "Changing this requires systemic reform from the top down, but I currently see no sign of that."
Experts broadly agree that the current fertility care pathway structurally compounds the problem. Most couples having difficulty conceiving first see a gynecologist, whose specialty focuses on women's health. In many regions, only one or two andrology specialists focus on male reproductive health.
The UK's first Men's Health Strategy, released this week, had raised hopes. Experts expected it to address male infertility explicitly, as Australia's national strategy does, but were disappointed when it did not. The government said the updated Women's Health Strategy may cover male infertility.
Michael Carroll, a researcher at Manchester Metropolitan University, said the strategy itself is a positive step but missed an opportunity to address the mental health effects of male infertility and its association with shorter male life expectancy. He is writing a book on male infertility to help close the wide gap in public awareness compared with women's reproductive health.
Carroll said many men do not know they should avoid high temperatures, tight underwear, and frequent hot baths, or that lifestyle factors such as smoking, alcohol use, diet, sleep, and exercise directly affect sperm quality. "Historically, fertility has been viewed as a women's health issue," he said. "If a man could produce semen, he was assumed to be fertile."
He stressed that men should have equal status in fertility assessment: "We need more systematic testing, a fuller review of life and medical history, and an actual physical examination of the testicles—not just a semen analysis report."
Raj Mathur, former chair of the British Fertility Society and a consultant in reproductive medicine, also said male infertility has long been underfunded in research. "There are currently very few evidence-based tests for men. We urgently need more funding for randomized controlled trials to establish which tests and interventions actually work."
The National Institute for Health and Care Excellence (NICE) is updating its guidance and is expected to recommend more comprehensive examinations for men. Tim Shand, founder of the advocacy group Men's Sexual and Reproductive Health Matters, said the latest draft is encouraging but still does not go far enough.
Data suggest that the roots of the problem also lie in primary care. A recent Fertility Action study found that 80.6% of GPs had never received training on male fertility and 97% could not correctly examine for varicocele. Shand said fully assessing men before starting standard IVF could save the NHS substantial costs and reduce psychological stress for both partners.
A spokesperson for the UK Department of Health and Social Care said society has long failed to confront inequalities in men's health, including male infertility. The Men's Health Strategy lays the foundation for improvement, and the government will continue to refine it as implementation proceeds.
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