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Improving male fertility – a missed opportunity

Lack of knowledge and lack of opportunity are two key reasons why Australian GPs aren’t counselling men about how to improve their fertility.

According to a survey of over 300 practising GPs, the vast majority (90%) did not feel confident in their knowledge about modifiable risk factors that affect male fertility.

And when the researchers got specific, it appeared there was greater awareness of the potential of STIs and smoking to cause fertility problems than a number of other factors such as obesity, undernutrition and poor diet, paternal age and diabetes.

For example, only 55% of GPs were aware that obesity could damage sperm DNA and lower sperm quality, the survey published in the Australian Journal of Primary Health found. There were similar rates of lack of knowledge among GPs that older paternal age was associated with an increased the risk of miscarriage and a higher incidence of autism in the offspring.

The survey was conducted by the organisation Healthy Male (formerly Andrology Australia), which partners with the government-funded Fertility Coalition to promote fertility in the community. The researchers wanted to investigate the possible barriers to GPs delivering fertility and pre-conception health advice to men, which they considered to be a missing component of current preventive health strategies.

“Preconception health promotion focusses mainly on women with the male partner being largely overlooked,” the study authors wrote.

Interestingly, even though the majority of GPs felt they didn’t have sufficient knowledge to confidently advise men on fertility issues, almost two thirds of respondents agreed it was part of their role to discuss modifiable risk factors affecting fertility with male patients.

However, the reality was that most GPs only raised the issue when specifically asked or opportunistically when male patients attended for issues such as an STI check. Added to this is the fact that younger male patients infrequently attend general practice. The study authors quote Australian data that showed that in 2015 only 8.3% of GP encounters were with men aged 25 to 44.

This means, of course, men in this age group are rarely exposed to key preventive health messages across the full spectrum of medical conditions where risk factors are modifiable, the researchers suggest.

To improve this situation will require a collaborative approach, involving contributions from many sources including health organisations, health professionals, policy makers and the general public, they said.

Ultimately we need men to consider their ‘inclusion in preconception care consultations and interventions in Australian general practice to ‘become the norm’’.

In addition, the study authors say, we need strategies for improving GPs’ fertility-related knowledge and capacity to discuss fertility and preconception issues with men. Basically, some attention needs to be paid to this missed opportunity for prevention of male fertility problems.

“A national framework for preconception health promotion and care that includes men, GP education and training, and male-specific reproductive health resources may help GPs promote fertility and preconception health to men,” they concluded.

 

Reference

Hogg K, Rizio T, Manocha R, McLachlan RI, Hammarberg K. Men’s preconception health care in Australian general practice: GPs’ knowledge, attitudes and behaviours. Aust J Prim Health. 2019 Sep 26. DOI: 10.1071/PY19069. [Epub ahead of print]