Delays in male infertility evaluation and their financial and emotional impact on couples.

BACKGROUND

Although male and female factors contribute equally to infertility, evaluation pathways frequently prioritize female-focused care, delaying appropriate assessment of male-factor infertility. This study aims to assess the impact of delayed urologic care for male-factor infertility couples by assessing emotional and financial well-being and evaluating how gendered assumptions influence the diagnostic and treatment pathways in their care.

METHODS

An anonymous, electronic Research Electronic Data Capture (REDCap) survey was distributed from January 2023 to June 2025 to patients seeking infertility services. The survey included both quantitative and qualitative items addressing participants' healthcare journey, timing of male-factor evaluation, and related burdens. Descriptive statistics, Chi-square tests, logistic regression, and thematic analysis were performed.

RESULTS

Among 226 surveyed couples, 26.0% first sought gynecologic care and 10.2% consulted a reproductive endocrinologist before urologic evaluation. Time spent addressing only female-factor infertility ranged from 2 months to 6 years. Overall, 38.3% regretted not seeking urologic care sooner. Significant associations were found between regret and both initiating care with female providers and financial burden. Patients reported out-of-pocket costs between $1,500 and $300,000 prior to male evaluation, with several citing the need to take out loans to cover the cost of treatments. The qualitative responses highlighted fertility treatment delays, confusion surrounding the role of urologists in the fertility journey, and high costs as major concerns.

CONCLUSIONS

Our findings highlight the urgent need to address gender bias in infertility care as delays in evaluating male-factor infertility led to significant emotional and financial harm, inefficient use of healthcare resources, and a disproportionate burden on women. A paradigm shift toward an earlier, inclusive, couple-based evaluation is essential to advancing equitable reproductive care in the face of a global fertility crisis.