Geographical Differences in Male Infertility between the United States and Canada: Insights from the Andrology Research Consortium

Abstract

We sought to compare the demographics and fertility characteristics of men presenting to reproductive urologists (RU) for evaluation in the United States (US) and Canada using data from the Andrology Research Consortium. A standardized patient questionnaire was used to prospectively evaluate men across fifteen North American male infertility practices between 2015 and 2018. Patient demographics, fertility histories, including female partner infertility testing and treatment, and referral data were assessed. Univariate analysis was used to determine geographical differences between the various patient characteristics and the geographical region. We sampled 6,462 men with a mean age of $36.6\pm 7.5$ years. The average duration of infertility was significantly higher in US men ( $4.5\pm 7.2$ years) compared to Canadian men ( $3.6\pm 4$ years) ( $p=0.007$ ). Significantly more men in the US were obese (63% vs. 26%, $p<0.001$ ) compared to Canada. Intrauterine insemination use among female partners was more common in Canada (13% vs. 7%, $p<0.001$ ) while in vitro fertilization was less common (6% vs. 9%, $p=0.01$ ) when compared to the US. Finasteride (3% vs. 0%) and testosterone usage (4% vs. 1) were more common among US men versus Canadians, respectively. In conclusion, geographical differences exist between North American males undergoing fertility evaluation. American men are older and more obese and have a longer average duration of infertility. Potentially reversible factors contributing to male infertility are more prevalent in the US.