Male Infertility Practice Among Filipino Urologists: A Road Less Traveled

Abstract

Introduction: Advancement in male infertility were evident during the past several decades where a shift to evidence-based management is becoming apparent. However, there is still a knowledge gap among training urologists in the said field where the Philippines is no exception. This is the first study that would determine the current trend of practice in male infertility among Filipino urologists and recommend solutions to this problem

Materials and Methods: A 42-item self-administered survey questionnaire was carried out using the Survey Monkey. This Institutional Review Board (IRB)-approved online survey consisted of 3 parts: demographics, adherence to the guidelines and clinical practice. The authors contacted the Philippine Urological Association (PUA) via email and requested for confidential distribution of an online survey. The participants were given 4 weeks from the date of initial mailing until end of the survey process. STATA 15.0 was used for data analysis.

Results: A total of 131 respondents participated in the survey. Only 13% responded that they are “very interested” in the specialty of male infertility. About 84% of respondents see less than 5 male infertility cases per month with 67% of them reporting that male infertility constitutes less than 10% of their practice. For the treatment, 36% of them prescribe testosterone for empiric medical therapy of male infertility which is contraindicated in the treatment of male infertility and only 5% of respondents offer the gold standard microsurgical varicocoelectomy in patients with varicocoele. Only 8% of respondents are affiliated with IVF centers, which is troubling with regards to how men with poor reproductive potential are treated especially in azoospermic men. Two percent of the respondents rated their exposure to male infertility during residency as “excellent” while only 3% of them rated their knowledge as excellent. With this, responders suggest more exposure to the specialty, more postgraduate courses, lectures, and webinars, more training opportunities, a local guideline for Filipino urologists to follow, and more exposure to professional networks.

Conclusion: Practice of male infertility in the Philippines is inadequate in terms of knowledge and treatment for these patients. Most respondents follow the male infertility guidelines available, but it does not translate into practice, highlighting their own preferences in diagnosis and treatment. Even though they consider it as a necessary part of Urology, lack of exposure to cases, surgical loads, and research makes it a challenge when faced with these cases in their clinics. A change in the residency, postgraduate, and national level are recommended to have the best clinical outcome and well-being for these patients.