Male factor infertility contributes to 30-50% of infertility cases. Of these, 30-50% of the male partners are diagnosed with unexplained infertility and are often directed to a treatment plan focused on assisted reproductive technology. This comes at a substantial cost to both the individuals and the healthcare system.
A study published in Andrology in February 2025 sought to verify the impact of a multidisciplinary approach to care for couples with isolated male factor infertility using as the primary outcome the natural pregnancy rate.
Is a comprehensive approach to natural fertility care effective?
The multicenter, retrospective study incorporated 1014 couples with primary infertility seeking natural conception. Each couple underwent a multidisciplinary evaluation, including a gynecologist and an andrologist with expertise in infertility, a fertility awareness practitioner and a psychologist, when requested.
Both partners underwent thorough evaluations following established guidelines. Women had hormonal assessments, infection screenings, ultrasound imaging, and tubal patency tests. Treatment included antibiotics for infections, Letrozole for PCOS-related anovulation, hysteroscopic correction for uterine anomalies, and surgery for tubal disease or severe endometriosis. Men had semen analysis, hormonal testing, scrotal ultrasound, and infection screenings. Further assessments included genetic testing, testicular aspiration in severe cases, and treatments such as antibiotics, FSH therapy, prednisone for inflammation, antioxidants, and varicocele repair.
Idiopathic infertility was diagnosed when no significant abnormalities were found in either partner despite comprehensive evaluation. 9.4% of couples were diagnosed with secretive azoospermia, premature ovarian failure or genetic abnormalities and were therefore impossible for them to be offered a therapeutic option aimed at natural conception.
Interestingly, 13% of patients had a ‘normal’ semen analysis. These couples are usually faced with an unexplained infertility diagnosis if the diagnostic protocol stopped at this stage. However, as noted by the study authors, “semen analysis is not always and not strictly predictive of fertility”. Instead, it is a starting point for further analysis based on history, clinical examination, and other diagnostic procedures.
The study observed a spontaneous pregnancy rate of 40.9%, with, predictably, the rate declining as the age of the women increased. The study also recorded a 36% spontaneous pregnancy rate in couples with previous ART failure. The results suggest that directly performing IVF/ICSI as the first line of treatment does not lead to a significant advantage in pregnancy rates. Instead, an extensive diagnostic and therapeutic process for male factor infertility should be first applied. The study proposes a new classification of male infertility based on underlying clinical conditions rather than semen abnormalities, identifying key factors such as infections, inflammation, hypo-spermatogenesis, genetic alterations, varicocele, and secretive azoospermia. This way, the root cause is evaluated, paving the way for improved diagnosis and treatment.
Study’s Key Take Away
The findings of this study emphasize the importance of a multidisciplinary approach to fertility care and its potential in diagnosing and treating male factor infertility. This approach can help reduce the number of cases of unexplained infertility and restore natural fertility based on targeted, and often less invasive, treatment. It is particularly beneficial for younger couples who may have time to explore other treatment options before considering ART. With proper diagnosis and personalized care, many cases of unexplained infertility may, in fact, be treatable, offering new hope to those trying to conceive.
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