Faculty Bibliography

Gender dysphoria, or the incongruence between gender identification and sex assigned at birth with associated discomfort or distress, manifests in transgender patients, whose multifaceted care includes puberty suppression, cross-sex hormonal therapy, and gender-affirming surgery. Discussion of fertility preservation (FP) is paramount because many treatments compromise future fertility, and although transgender patients demonstrate desire for children, use of FP remains low for a plethora of reasons. In transgender women, established FP options include ejaculated sperm cryopreservation, electroejaculation, or testicular sperm extraction. Further research is needed regarding reproductive health and FP in transgender patients.

Objective: Epidemiologic studies have found that a greater degree of comorbidity is associated with worse fertility potential. However, these findings are largely based on retrospective studies of men interacting with the health care system. Our objective was to evaluate the association of fertility and health status in men in the United States using a nationally representative survey.
Design(s): We compared the demographics, healthcare utilization, and overall health status of fertile and infertile men in the National Survey for Family Growth (NSFG).
Material(s) and Method(s): We performed an analysis of the male 2011-2017 cycles of the NSFG, a nationally representative survey of family planning. Infertile men were defined as men who had ever used infertility services or men who self-reported as non-surgically sterile. Men who reported completed pregnancies were considered fertile.
Result(s): Of the 13,861 men surveyed, 1,071 men were infertile, and 5,661 men were known to be fertile. Projecting to the national population, this translates to 5,205,771 infertile men and a 26,577,702 fertile men. Of the total population of sexually active men aged 15-49, roughly 8.5% (95%CI: 7.8-9.3) of men were infertile. Compared to known fertile men, infertile men had significant demographic and healthcare utilization differences (Table). Infertile men were wealthier, better educated, more likely to be white, more likely to be married, and more likely to have private insurance. Importantly, infertile men and fertile men had similar overall health status. On multivariate analysis, differences in income, marital status, and usual healthcare place remained significant.
Conclusion(s): While infertile men do have significant demographic and healthcare utilization differences compared to fertile men, the overall health status of both infertile and fertile men appear similar. [Figure presented]
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OBJECTIVE: Epidemiologic studies have found that a greater degree of comorbidity is associated with worse fertility potential. However, these findings are largely based on retrospective studies of men interacting with the health care system. Our objective was to evaluate the association of fertility and health status in men in the United States using a nationally representative survey. DESIGN: We compared the demographics, healthcare utilization, and overall health status of fertile and infertile men in the National Survey for Family Growth (NSFG). MATERIALS AND METHODS: We performed an analysis of the male 2011-2017 cycles of the NSFG, a nationally representative survey of family planning. Infertile men were defined as men who had ever used infertility services or men who self-reported as non-surgically sterile. Men who reported completed pregnancies were considered fertile.
RESULT(S): Of the 13,861 men surveyed, 1,071 men were infertile, and 5,661 men were known to be fertile. Projecting to the national population, this translates to 5,205,771 infertile men and a 26,577,702 fertile men. Of the total population of sexually active men aged 15-49, roughly 8.5% (95%CI: 7.8-9.3) of men were infertile. Compared to known fertile men, infertile men had significant demographic and healthcare utilization differences (Table). Infertile men were wealthier, better educated, more likely to be white, more likely to be married, and more likely to have private insurance. Importantly, infertile men and fertile men had similar overall health status. On multivariate analysis, differences in income, marital status, and usual healthcare place remained significant.
CONCLUSION(S): While infertile men do have significant demographic and healthcare utilization differences compared to fertile men, the overall health status of both infertile and fertile men appear similar