What does a General Practitioner (GP) do in the UK for male fertility issues?

Role of UK General Practitioners in Male Fertility Issues

UK General Practitioners (GPs) should evaluate both partners simultaneously when couples have not conceived after 12 consecutive months of regular, unprotected intercourse. 1

Initial Assessment by GP

• Take a comprehensive reproductive history including duration of attempting conception, frequency of intercourse, previous pregnancies, and medical conditions that could affect fertility 1
• Perform a focused physical examination to assess for potential causes of infertility, including examination of secondary sex characteristics, testicular size and consistency, and presence of varicocele 1, 2
• Order at least one semen analysis as the cornerstone of initial male fertility evaluation 1
• If the first semen analysis is normal according to WHO criteria, a single test is sufficient; if abnormal, at least one additional test should be performed a month apart 1
• Assess basic hormonal parameters including testosterone and follicle-stimulating hormone (FSH) levels when indicated by abnormal semen parameters 1, 2

Interpretation of Findings

• Counsel patients that semen analysis alone cannot definitively distinguish fertile from infertile men 1
• Use WHO reference limits for semen parameters (including sperm concentration ≥16 million/mL, total sperm count ≥39 million per ejaculate, and progressive motility ≥30%) to guide clinical decision-making 1
• Recognize that azoospermia requires centrifugation of the sample to confirm complete absence of sperm 2
• Understand that normal-sized testes with normal FSH levels (<7.6 IU/L) suggest obstructive azoospermia, while atrophic testes with elevated FSH suggest non-obstructive azoospermia (spermatogenic failure) 2

Lifestyle Counseling

• Advise patients about modifiable risk factors that may impact fertility, including smoking, excessive alcohol consumption, anabolic steroid use, and obesity 1, 3
• Recommend a diet lower in fats and higher in fruits and vegetables to potentially improve semen parameters 1
• Discuss the potential impact of medications on fertility and consider alternatives when appropriate 1

When to Refer to Specialist

• Refer men with one or more abnormal semen parameters to a male reproductive specialist for complete evaluation 1, 3
• Refer urgently if physical examination reveals concerning findings such as testicular masses or severe atrophy 2
• Consider specialist referral for genetic testing in men with severe oligospermia (<5 million sperm/mL) or azoospermia 1, 2
• Refer couples with failed assisted reproductive technology cycles or recurrent pregnancy losses for specialized evaluation 1

Coordination of Care

• Investigate both partners simultaneously to efficiently categorize the cause of infertility 1, 4
• Communicate with reproductive specialists regarding findings and management plans 3
• Provide ongoing support and counseling throughout the fertility journey, recognizing the significant psychological impact of infertility 3, 5
• Educate patients about the health implications of abnormal sperm production, as men with abnormal semen parameters have higher rates of certain cancers and other health conditions 1

Important Considerations

• Male factors contribute to approximately 50% of infertility cases, making thorough evaluation essential 1, 6
• Point-of-care and mail-in semen tests may provide preliminary information but are not substitutes for laboratory analysis conducted in a specialized andrology laboratory 1
• Advanced paternal age (≥40) is associated with increased risk of adverse health outcomes for offspring 1
• Recognize that male reproductive health often correlates with overall health status 1, 3