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Treating infertility

Ellen D. Mandel, DMH, MPA, MS, PA-C

An article in this month’s issue titled
“Infertility: A primer for primary care providers” aids our diagnosis and management of a common issue, failure of reproduction. As I navigate this article, reviewing the important phases of the menstrual cycle and the diagnostics and treatment for the “her” of the equation, I am once again struck by the intricacies of conception and how one should not take it for granted. And, as we know, there are couples thwarting the march of procreation.

However, I am most struck (maybe a better word is dismayed) by the statistic that “18% to 27% of the men from infertile couples lacked any evaluation,” which translates into a large number of men possibly having undiagnosed male factor infertility. This gives me pause. If having a baby “togetherâ is a goal, then a full diagnostic workup should be a requirement of treatment, not an option.

According to the
IVF Worldwide website, men and women react differently to infertility. This is no surprise. Women are more open about infertility issues, desiring discussion with their partner, family, and friends. However, if the infertility is due to a male factor, it is held in secret, as the woman seeks outside counseling, alone. This places quite a burden on the woman. The website relates that if male factor infertility is diagnosed, “some men can feel that they are less of a man.” Their masculinity is under siege, leading to both feelings of, and actual physical impotency. The website does not state that if female factor infertility is diagnosed, that the woman may feel like less of a woman.

If we allow an incomplete workup of infertility, we become part of the problem, not a solution. If a male factor is isolated, then the man needs emotional support along with the woman. A descriptive phenomenological study looked at 10 infertile men, isolating several themes. These include new somatic complaints (anorexia, chronic headache, insomnia), new-onset loss of libido and impotency, and the wifeâ€s disinterest in sex with her infertile husband. However, these are the downsides.
This study also reported that male factor infertility brought some couples closer.

Although modern science affords singles and couples reproductive options, the “classic” male and female coital approach prevails (for now). Somehow, sperm and egg must meet each other, in a laboratory or the fallopian tube. As PAs, we should cover all our bases when working up infertility, providing medical and psychological support. This includes the holders of both the XX and XY chromosomes.


Ellen D. Mandel is a clinical professor in the Department of PA Studies at Pace University-Lenox Hill Hospital in New York City. The views expressed in this blog post are those of the author and may not reflect AAPA policies.

Published: 9/5/2017 7:53:00 AM

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