title: Characterization of patients presenting with male factor infertility in an equal access, no cost medical system.
abstract: OBJECTIVE
  Demographic information on patients presenting for the diagnosis and treatment of male factor infertility has been limited in the past by the paucity of subspecialty trained providers and concentrated sequential patient information. Previously reported studies looking at the characteristics of patients being evaluated for male subfertility may represent a selected subset of patients able to access these services. The changes in the diagnostic modalities available in the 1990s and new diagnostic categories may also affect the characterization of patients seen with the diagnosis of male factor infertility.
  
  
  METHODS
  A retrospective analysis was performed using a centralized database of patient records at a single military male infertility clinic. Seven hundred consecutive patients were studied to obtain information on patient and spouse age, race, length of subfertile period, medical history and examination, and laboratory evaluation. A single provider categorized the etiology of male factor infertility after the evaluation.
  
  
  RESULTS
  The mean patient age was 36 years (range 17 to 68). The mean spouse age was 31.2 years (range 19 to 50). The mean subfertile period was 5.5 years (range 0.5 to 35). Of the 700 patients, 51% were white, 10% African American, 2% Hispanic, and 37% other/unknown. Eleven percent of the patients were active smokers. The most common etiologic category groups describing male subfertility were previous vasectomy (56%), varicocele (14%), idiopathic infertility (8%), and nonobstructive azoospermia (6%).
  
  
  CONCLUSIONS
  An equal access, no cost medical system mirrors the demographics of the military population served. The clinical characteristics of patients presenting with male factor infertility have changed significantly during the past 30 years. Obstruction from a previous vasectomy is now the most common presenting complaint of patients visiting an infertility clinic. Vasectomy reversal may be more frequently requested when the cost is not a factor in providing fertility services. Idiopathic male factor infertility occurs in less than 10% of patients.
authors.affiliation: Madigan Army Medical Center, Tacoma, Washington, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Costabile
authors.forename: M
authors.initials: M
authors.lastname: Spevak
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data; D009845:Oligospermia / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012671:Seminiferous Tubules; D013733:Testicular Diseases / Q000150:complications; D014481:United States / Q000453:epidemiology; D014646:Varicocele / Q000150:complications; D014659:Vasectomy; D014669:Vasovasostomy