When a couple looks to get pregnant, the standard recommendation for a woman younger than 35 is to try for a year without getting evaluated for fertility issues, a Douglas County doctor says.
But if a woman waits until that point, and then she waits for an appointment and undergoes testing — and then finds out she has no issues — the focus then turns to the man. And if he gets checked out, that process could also take months.
Before a couple knows it, they’ve gone a year and a half without getting pregnant.
“It takes two to tango — it’s really important for the male factor to be addressed,” said Barrett Cowan, a physician who sees patients both via “telehealth,” or virtual, visits as well as in person at his office in Lone Tree.
Many people, including women, assume that infertility is the woman’s issue, Cowan said.
In the United States, the number of physicians who specialize in male fertility care likely pales in comparison to the number of obstetrician-gynecologists, or OB-GYNs — doctors who specialize in female reproductive health and pregnancy. That’s according to Cowan’s analysis of directories from two male-fertility specialist organizations.
A desire to increase awareness of male infertility and to help couples achieve their goal of a having a healthy baby led Cowan — who lives in Castle Rock and was educated at Stanford University — to start Posterity Health, a company that offers services to patients in Colorado, California and New York. Cowan has specialized in male fertility for more than 20 years.
Here are a few things to know about male infertility and what Cowan’s company offers.
A long list of lifestyle choices can affect male fertility, including many common activities, Cowan said.
“What I tell people is all those things that your mom told you not to do as a kid: Don’t smoke, don’t drink, don’t do drugs, exercise in moderation,” Cowan said.
Use of tobacco products or cannabis, exposure to heat such as in a sauna, and some medications can affect male fertility, Cowan said.
“Anatomic” issues — such as being obese — can affect male fertility as well, along with problems with veins in the testicle area. For some people, problems can arise if certain tubes didn’t develop properly, according to Cowan.
“Each person is different, and making sure that the patient undergoes a thorough evaluation to identify what the particular issue is with that individual is (important),” Cowan said.
For men wanting to be seen in person, examinations take place in Lone Tree. But Cowan’s company also allows for at-home semen testing so men can send a sample overnight to a lab.
Cowan also offers telehealth visits. As he learned from care during the coronavirus pandemic, treatment from a distance “turned out to be a real blessing,” he said.
“Some men have a more difficult time talking about these issues, and we found they were more open to talking about these issues at home,” Cowan said. Virtual visits also avert the need for taking time off work or making a long drive, he said.
Cowan’s company works in partnership with OB-GYNs because it’s “a couple’s issue,” he said.
“We work very closely with gynecologists,” Cowan said, to “create an environment where the couple can conceive as easily and efficiently as possible.”
At Posterity Health, a baseline evaluation costs $300 and includes at-home semen testing and a consultation to discuss the results. A more personalized, hourlong evaluation that talks about a person’s reproductive and medical history costs $400. If a man opts for the $400 evaluation, that would entail an examination in person.
Infertility care is “very variable” among health insurance plans, Cowan said, and Posterity Health doesn’t accept insurance.
It does allow patients to use a health savings account, or HSA, or flexible spending account, or FSA. The company also provides a statement that can be submitted for out-of-network coverage, Cowan said.
Posterity Health is based in Colorado and carries out visits in New York and California via telehealth services. The company had a “soft opening” in March but officially opened in May. Cowan is its founder and chief medical officer.
Colorado is the only place where the company does in-person evaluations, Cowan said. It has “network” providers in other states that will do in-person visits when necessary, he added.
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