Half of Infertility Cases Involve Men. Why Does Care Still Treat It as a Women’s Issue?
By Robert E. Brannigan, MD, urologist and President of the American Society for Reproductive Medicine (ASRM)
Since 1989, National Infertility Awareness Week (NIAW) has marked a critical moment each April to elevate public understanding of infertility and push for better care. This year, that conversation carries new urgency as fertility care becomes a growing focus of national policy debates, often without a full understanding of how care is delivered in practice.
Fertility care is now firmly in the national spotlight, following renewed political attention, including the TrumpRx program, which promotes lower-cost drugs used in IVF. While such efforts are encouraging and signal growing interest in expanding access, their overall impact unfortunately remains limited. Medications account for only a fraction of the total cost of treatment. For the millions of Americans navigating infertility, barriers to care are rarely driven by a single factor.
For many patients, the path to fertility care is already complex, involving months or even years of uncertainty, significant financial strain, and emotional stress. Access is shaped not only by cost, but by how care is delivered, how conditions are diagnosed, and whether patients receive timely, appropriate evaluation at all. Efforts to improve access must take a comprehensive view of care, not just one piece of the cost equation.
As attention to fertility care grows, it also risks reinforcing an outdated narrative. In many cases, the national conversation has not caught up to the science. Infertility continues to be treated primarily as a women’s issue, despite being a shared medical condition that requires a more balanced, evidence-based approach.
Male factors are the sole cause of infertility in 20–30% of cases and play a contributing role in another 20–30% of cases. Taken together, about half of all infertile couples have a male-factor component. Yet care delivery has not kept pace with this reality, with women still undergoing the majority of testing and treatment regardless of the underlying cause.
This imbalance has real consequences. Women are frequently assumed to be the source of infertility, placing a disproportionate medical and emotional burden on them, even when male factors are involved. The World Health Organization (WHO) has documented the stigma, stress, and, in some cases, violence or divorce that women may face as a result.
In some settings, these pressures are so acute that couples may feel compelled to demonstrate fertility early, even avoiding contraception out of fear of social consequences. These dynamics are not theoretical. They shape real decisions about health, timing, and family building.
This imbalance is not just outdated, it is harmful. When men are not evaluated early, underlying causes can go undiagnosed, delaying effective care and increasing the likelihood of unnecessary, and sometimes invasive, interventions for women.
A more balanced model requires evaluating both partners from the outset, avoiding assumptions about causation, and ensuring each patient receives appropriate, individualized support. This shift can reduce unnecessary burden, improve clinical outcomes, and lead to more efficient, evidence-based care. It can also help ensure that healthcare resources are used more effectively, an increasingly important consideration as policymakers look for ways to expand access.
Male fertility is about more than reproduction; it can also serve as an important indicator of overall health. Abnormal semen parameters have been associated with increased risks of certain cancers and other medical conditions, offering an early signal of broader health concerns that extend well beyond fertility. Early evaluation, therefore, is not only about building families, it is an opportunity to identify risks that might otherwise go undetected and connect patients to appropriate care.
Encouragingly, many causes of male infertility are treatable. Conditions such as varicoceles, reproductive tract obstruction, and hormonal imbalances can often be addressed directly, improving both reproductive and overall health outcomes. When treatment is not possible, advancements in assisted reproductive technologies (ART) provide additional pathways to parenthood, including techniques that can utilize even small numbers of viable sperm.
Infertility is common and increasingly understood. With that understanding should come a shift in how we approach care, one that reflects both the shared nature of infertility and the importance of early, comprehensive evaluation. Clinicians, policymakers, and patients must move beyond outdated assumptions and embrace an evidence-based model that recognizes the role of both partners. That shift is not just good medicine. It is essential to designing policies that improve access and outcomes.
By evaluating and treating male and female factors together, we can reduce unnecessary interventions, improve outcomes, and better support the millions of individuals and couples navigating infertility.
National Infertility Awareness Week is an important moment to elevate this conversation, but meaningful change will require sustained attention. At a time when reproductive medicine is receiving increased national focus, it is critical that clinical expertise and evidence guide the path forward, ensuring a more balanced, effective, and patient-centered approach to infertility care, grounded in evidence, equity, and the realities patients face every day.
-------------
Robert E. Brannigan, MD, is President of the American Society for Reproductive Medicine
Fertility care is now firmly in the national spotlight, following renewed political attention, including the TrumpRx program, which promotes lower-cost drugs used in IVF. While such efforts are encouraging and signal growing interest in expanding access, their overall impact unfortunately remains limited. Medications account for only a fraction of the total cost of treatment. For the millions of Americans navigating infertility, barriers to care are rarely driven by a single factor.
For many patients, the path to fertility care is already complex, involving months or even years of uncertainty, significant financial strain, and emotional stress. Access is shaped not only by cost, but by how care is delivered, how conditions are diagnosed, and whether patients receive timely, appropriate evaluation at all. Efforts to improve access must take a comprehensive view of care, not just one piece of the cost equation.
As attention to fertility care grows, it also risks reinforcing an outdated narrative. In many cases, the national conversation has not caught up to the science. Infertility continues to be treated primarily as a women’s issue, despite being a shared medical condition that requires a more balanced, evidence-based approach.
Male factors are the sole cause of infertility in 20–30% of cases and play a contributing role in another 20–30% of cases. Taken together, about half of all infertile couples have a male-factor component. Yet care delivery has not kept pace with this reality, with women still undergoing the majority of testing and treatment regardless of the underlying cause.
This imbalance has real consequences. Women are frequently assumed to be the source of infertility, placing a disproportionate medical and emotional burden on them, even when male factors are involved. The World Health Organization (WHO) has documented the stigma, stress, and, in some cases, violence or divorce that women may face as a result.
In some settings, these pressures are so acute that couples may feel compelled to demonstrate fertility early, even avoiding contraception out of fear of social consequences. These dynamics are not theoretical. They shape real decisions about health, timing, and family building.
This imbalance is not just outdated, it is harmful. When men are not evaluated early, underlying causes can go undiagnosed, delaying effective care and increasing the likelihood of unnecessary, and sometimes invasive, interventions for women.
A more balanced model requires evaluating both partners from the outset, avoiding assumptions about causation, and ensuring each patient receives appropriate, individualized support. This shift can reduce unnecessary burden, improve clinical outcomes, and lead to more efficient, evidence-based care. It can also help ensure that healthcare resources are used more effectively, an increasingly important consideration as policymakers look for ways to expand access.
Male fertility is about more than reproduction; it can also serve as an important indicator of overall health. Abnormal semen parameters have been associated with increased risks of certain cancers and other medical conditions, offering an early signal of broader health concerns that extend well beyond fertility. Early evaluation, therefore, is not only about building families, it is an opportunity to identify risks that might otherwise go undetected and connect patients to appropriate care.
Encouragingly, many causes of male infertility are treatable. Conditions such as varicoceles, reproductive tract obstruction, and hormonal imbalances can often be addressed directly, improving both reproductive and overall health outcomes. When treatment is not possible, advancements in assisted reproductive technologies (ART) provide additional pathways to parenthood, including techniques that can utilize even small numbers of viable sperm.
Infertility is common and increasingly understood. With that understanding should come a shift in how we approach care, one that reflects both the shared nature of infertility and the importance of early, comprehensive evaluation. Clinicians, policymakers, and patients must move beyond outdated assumptions and embrace an evidence-based model that recognizes the role of both partners. That shift is not just good medicine. It is essential to designing policies that improve access and outcomes.
By evaluating and treating male and female factors together, we can reduce unnecessary interventions, improve outcomes, and better support the millions of individuals and couples navigating infertility.
National Infertility Awareness Week is an important moment to elevate this conversation, but meaningful change will require sustained attention. At a time when reproductive medicine is receiving increased national focus, it is critical that clinical expertise and evidence guide the path forward, ensuring a more balanced, effective, and patient-centered approach to infertility care, grounded in evidence, equity, and the realities patients face every day.
-------------
Robert E. Brannigan, MD, is President of the American Society for Reproductive Medicine
For almost a century, the American Society for Reproductive Medicine (ASRM) has been the global leader in multidisciplinary reproductive medicine research, ethical practice, and education. ASRM impacts reproductive care and science worldwide by creating funding opportunities for advancing reproduction research and discovery, by providing evidence-based education and public health information, and by advocating for reproductive health care professionals and the patients they serve. With members in more than 100 countries, the Society is headquartered in Washington, DC, with additional operations in Birmingham, AL. www.asrm.org
For media inquiries regarding this press release contact:
Sean Tipton
ASRM Chief Advocacy and Policy Officer
E: stipton@asrm.org
Anna Hovey
Advocacy Engagement Specialist
E: ahovey@asrm.org
J. Benjamin Younger Office of Public Affairs
726 7th St. SE
Washington, DC 20003
Tel: (202) 863-2494
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Journal Club Global: SREI Fellows Symposium 2025
Journal Club debate: do surgically retrieved sperm match ejaculated sperm in donor-egg IVF? Review of evidence, blastulation, fertilization, outcomes, equity. View the Video
Journal Club Global LIVE at ANZSREI 2025
ANZSREI panel reviews a PGT-A study on male age and sperm factors in blastulation and euploidy, finding female age dominates and calling for better research. View the Video
Journal Club Global LIVE at MRSi 2025: Sibling Oocyte Studies in ART
Experts discuss sibling oocyte trials, PIEZO-ICSI, and microfluidics in ART, evaluating outcomes, design limits, lab impact, and clinical implications. View the Video
Journal Club Global Portuguese: A relação entre Fertilidade e Saúde do Homem
Experts discuss male infertility, its health links, lifestyle impact, and treatment strategies, emphasizing proactive care and fertility preservation. View the Video
Billing for the partner workup
Are most practices in REI billing male partners for their history? We also order labs and sperm count on all male partners. View the Answer
Billing both partners for 99205 initial consultation
We discussed the ability to bill 99205 for an initial consultation on both the male and female partners if they both present for the consultation. View the Answer
Semen analysis and thaw code
Can we use the semen analysis presence and motility (89300) code along with a reproductive tissue thaw code (89354) View the Answer
TESE test thaws
We perform test thaws to determine if frozen TESE specimens from other clinics are suitable for our procedures. View the Answer
Tobacco or marijuana use and infertility: a committee opinion (2023)
In the United States, approximately 21% of adults report some form of tobacco use, although 18% report marijuana use. View Committee Opinion
Improving the Patient Experience - Male
Male factor evaluation is essential in diagnosing infertility causes, enhancing ART outcomes, and improving patient confidence. Learn why this assessment matters.. View the ASRMed Talk Video
Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility: a committee opinion (2023)
It is the responsibility of the clinician to assess for erectile dysfunction, ejaculatory dysfunction, or diminished libido in men presenting for infertility. View the Committee Opinion
A Few Good Sperm: The Critical Role of the Male Reproductive Urologist
REI consults involve thorough female evaluations with recommended male infertility assessment, including semen analysis per ASRM guidelines and urology referrals. View the ASRMed Talk Video
Post Vasectomy Infertility
If a husband has had a vasectomy, does the sterilization code apply to the wife's visits? View the Answer
Semen Analysis For Assessment of Fertility
What is the appropriate diagnostic code to use for a semen analysis for the assessment of infertility? View the Answer
Testing With No History of Infertility
What diagnosis codes should providers submit to insurance carriers while trying to evaluate fertility issues? View the Answer
Lab RVUs
Is there a list of RVUs for embryology and andrology laboratory procedures, and if so, where can it be found? View the Answer
Male Consult
My group was wondering if and how to code for a male partner consultation. View the Answer
Diagnostic Testing of an Infertile Couple
The Z31.41 is or is not the correct code to use for diagnostic testing of an infertile couple? And If so can if be used as the primary and only code? View the Answer
Male Infertility
A summary of common codes for Male Infertility compiled by the ASRM Coding Committee. View the Coding Summary
Journal Club Global Live from PCRS - ICSI for Non-Male Factor Infertility
While intracytoplasmic sperm injection (ICSI) has revolutionized the treatment of male factor infertility, a significant controversy still remains regarding its ubiquitous use in all IVF cycles. View the Video
Optimizing natural fertility: a committee opinion (2022)
This committee opinion provides practitioners with suggestions for optimizing the likelihood of achieving pregnancy in couples... View the Committee Opinion
Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2021)
Comprehensive AUA/ASRM guideline on evaluating and treating male infertility, linking diagnosis to health risks and offering evidence-based recommendations. View the Guideline
Diagnosis and Treatment of Infertility in Men: AUA/ ASRM Guideline Part II (2021)
The summary presented is Part II of the two-part series dedicated to the Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. View the Guideline
Intracytoplasmic sperm injection (ICSI) for non–male factor indications: a committee opinion (2020)
Intracytoplasmic sperm injection is frequently used in combination with assisted reproductive technologies. View the Committee Document
Guidance for Providers Caring for Women and Men Of Reproductive Age with Possible Zika Virus Exposure (Updated 2019)
This ASRM guidance specifically addresses Zika virus infection issues and concerns of individuals undergoing assisted reproductive technologies (ART). View the Guideline
