Male infertility in India: Demographics, aetiology and outcomes of standard clinical practice.

BACKGROUND

. Although the outcomes of assisted reproductive technologies (ART) and corrective surgery for male infertility are reported in the literature, these are based on studies specifically designed to assess the outcomes of individual interventions and do not reflect the real-life (intent-to-treat) outcomes of managing infertility. There are sparse data on the actual utilization of treatment and pregnancy outcomes in these patients. We aimed to evaluate the demographics, aetiology, treatment utilization and outcomes of treatment of male infertility in a tertiary care centre.

METHODS

. We prospectively enrolled 447 infertile males for evaluation over 30 months beginning October 2015. All patients were evaluated and investigated as per the study protocol to identify the cause of infertility. The patients were advised interventions based on the diagnosis and were followed up to assess delivery of treatment and outcomes of interventions in terms of pregnancy rates.

RESULTS

. Of the 447 enrolled patients, 426 (mean age 31 years) completed the initial diagnostic evaluation. About 83% had primary infertility, 40% had oligo/astheno/ teratozoospermia, 40% had azoospermia, and 21.1% had obstructive azoospermia. Genetic abnormalities were detected in 9.3% of the 162 patients screened. ART was advised for 71.8% of patients, but only 18% of patients actually received the treatment though they had a high success rate (38%). In contrast, surgery was recommended to only 35 (8.2%) patients, but only 18 (58%) received the recommended treatment with a pregnancy rate of 33.3%. Overall, only 24.4% of patients received the advised treatment with a pregnancy rate of 36.8%.

CONCLUSIONS

. ART was the most common intervention recommended, but less than one-fourth of couples received the recommended treatment. Surgery is indicated in a small number of patients, but is delivered to a larger proportion than those advised ART with both modalities having similar pregnancy outcomes.