Interview with Professor Li Tao | Couple-Centered Treatment: Bringing Back the "Neglected Half" to the Clinic

Against the backdrop of surging demand for assisted reproduction, public attention is often fixated on women: every step of ovarian stimulation, oocyte retrieval, embryo culture and transfer is highly visible. In contrast, men are often reduced to the simple act of "submitting a semen analysis report".

In Professor Li Tao’s view, however, the factors that truly determine treatment outcomes are often hidden in these "overlooked aspects". If male assessment is postponed to the last stage, many families may miss the critical window in repeated waiting—this time cost becomes even more amplified especially when the female partner is approaching or has passed the age of 35, a pivotal threshold for fertility.

Professor Li Tao has a combined professional background in urology and reproductive andrology. He received systematic training at the Andrology Research Institute of Shanghai Renji Hospital in his early career and worked at the Sperm Bank of the Obstetrics and Gynecology Hospital of Fudan University (Hongfangzi Hospital) for many years. This unique background equips him to not only manage urological diseases but also deeply integrate reproductive andrological diagnosis and treatment with the clinical needs of assisted reproduction from the perspective of fertility outcomes.

We are fortunate to have invited Professor Li Tao from the Reproductive Center of Shanghai Jiahui International Hospital to share insights on the topic "From Standardized Assessment to Stepwise Intervention: The Critical Role of Men in Assisted Reproduction". He discussed the most common cognitive biases in clinical practice—such as regarding male examinations as the "final step"—and noted that the role of andrology is shifting from "passive supplementation" to "proactive early intervention". What he aspires to promote most is helping more families conduct assessments in the correct order at the very beginning of pregnancy preparation and seize the right timing for intervention, thereby maximizing the chances of natural conception or successful assisted reproduction within the limited time window.

Joint Examination for Couples: Male Andrological Assessment Is Not a "Make-Up Exam", But a Starting Point

"Having a baby is not a woman’s sole responsibility!" Professor Li Tao stated straightforwardly.

He pointed out that clinical epidemiological data show that pure male factors account for approximately 20%–30% of infertile couples; when combined with the male components in "combined factors of both partners", the total proportion can approach 50% [1,2]. However, in reality, male assessment is often delayed until the female partner has experienced multiple treatment failures—not only does this waste time, but it may also turn reversible problems into irreversible damage.

"Male fertility tests are non-invasive, cost-effective and efficient, and should undoubtedly be initiated simultaneously with female tests," he said.

The first step of diagnosis, however, goes far beyond a single semen analysis report.

Professor Li Tao emphasized that a comprehensive male fertility assessment should include three levels of perspective [3]:

1. Presence: Initial judgment of azoospermia through semen analysis, which determines the possibility of natural conception. Azoospermia, however, encompasses significant subtypes: obstructive and non-obstructive azoospermia require entirely different clinical management approaches.

2. Quality: Beyond oligospermia, asthenospermia and teratozoospermia, he highlighted the importance of indicators such as sperm DNA fragmentation index (DFI) [3]. This is because "sperm quality impacts embryo quality" during embryonic development, and the influence of male genetic material becomes even more prominent in the late stages of embryonic development.

3. Etiology: Tracing endocrine, infectious, varicocele or genetic factors to determine whether etiological treatment or empirical intervention is appropriate.

He particularly emphasized a key entry point overlooked by the public: erectile dysfunction (ED).

"Many families do not lack fertility potential, but fail to achieve high-quality, sustainable sexual intercourse." Sexual failure and reduced frequency caused by ED directly block the pathway of sperm entering the female reproductive tract, leading to "male infertility due to sexual dysfunction".

Professor Li Tao pointed out that effective intervention at the ED stage could eliminate the need for many families to undergo more complex, costly assisted reproduction procedures that place a heavier burden on women.

From Standardized Diagnosis to Stepwise Intervention

ED assessment is by no means a simple matter of "prescribing medication and calling it a day". Professor Li Tao stressed that standardized diagnosis must distinguish between psychological, organic and mixed causes:

· Comprehensive medical history taking and scale tools: such as the International Index of Erectile Function-5 (IIEF-5)

· Objective instrumental examinations: such as nocturnal penile tumescence (NPT) monitoring, which can objectively distinguish psychological from organic ED and rule out "pseudo-ED"; audiovisual sexual stimulation (AVSS) may be combined when necessary

· Vascular function assessment: intracavernous injection of vasoactive drugs combined with penile color Doppler ultrasound

"Only accurate subtyping enables precise treatment," Professor Li Tao said.

After a clear diagnosis, the vast majority of male fertility issues do not require surgery.

Taking ED as an example, Professor Li Tao follows a standardized stratified treatment approach:

1. First-line treatment: primarily phosphodiesterase type 5 (PDE5) inhibitors (oral medications) combined with psychological and behavioral interventions [3,4];

2. Adjuvant options: low-intensity extracorporeal shock wave therapy (Li-ESWT), a physical therapy explored and applied in ED treatment in recent years, for patients with poor response to oral medications [4];

3. Second-line treatment: intracavernous injection of vasoactive drugs (only when first-line treatment fails and the patient consents);

4. Third-line treatment: surgical interventions such as penile prosthesis implantation, for which indications must be strictly controlled.

ED is not an "embarrassing topic to mention"; it is a preventable and treatable disease, and more importantly, a "warning sign" of male physiological function.

For patients with oligoasthenospermia or idiopathic infertility, spermatogenic cycle management is initiated:

· A 3-month observation cycle (the human spermatogenic cycle is approximately 72 days);

· Administration of antioxidant therapy, lifestyle modifications and etiological treatment (e.g., anti-infection, hormonal regulation);

· Re-evaluation of varicocele from a fertility perspective if detected.

Professor Li Tao pointed out a crucial distinction: "In traditional urological thinking, surgical decisions are often based on objective indicators such as pain symptoms, venous diameter or reflux time; from a reproductive andrology perspective, however, the more critical factor is the long-term impact on testicular function, sperm quality and future fertility risks."

He stated that intervention for such diseases should be based on the early assessment of fertility risks [5]. "If young patients neglect follow-up due to the absence of symptoms and seek treatment only when fertility difficulties arise, they often miss the optimal intervention window."

Surgical Indications and a Multidisciplinary Assessment Framework

Surgery is only considered when conservative treatment fails and structural or irreversible problems are clearly identified.

"For example, microsurgical vasovasostomy may reconstruct the reproductive tract in obstructive azoospermia; for non-obstructive azoospermia, microdissection testicular sperm extraction (Micro-TESE) can provide sperm for assisted reproduction," Professor Li Tao explained.

Such decisions, however, can never be made by an andrologist alone.

"Multidisciplinary team (MDT) collaboration becomes a necessity at this point [1]," he said. Genetic counselors assess genetic risks such as Y-chromosome microdeletions and Klinefelter syndrome; embryo laboratories predict the fertilization potential of the obtained sperm; gynecology and reproductive centers synchronously plan the timing of oocyte retrieval for the female partner to ensure a "seamless connection" between sperm and oocytes. "Surgery is not the goal; obtaining healthy embryos is. All of this is based on adequate preliminary diagnosis and reasonable clinical attempts."

Humanistic Care to Break the "Stigma of Andrology"

In China, andrological diagnosis and treatment have long been shrouded in a veil of mystery and shyness. Take sperm collection as an example: limited space, insufficient privacy and crowded procedures often leave patients "too anxious to produce a sample". Breaking this veil requires fundamental improvements in the clinical environment and service processes.

Taking Shanghai Jiahui International Hospital where he practices as an example, Professor Li Tao has implemented measures such as appointment-based scheduling, one-on-one consultation rooms, independent sperm collection spaces and nursing guidance to reduce patients’ embarrassment and psychological burden. In his view, such thoughtful details are indispensable for realizing humanistic care in andrological diagnosis and treatment.

In his work with patients from diverse cultural backgrounds at Jiahui International Hospital, Professor Li Tao has also observed the diversity of doctor-patient communication styles. For instance, some patients accustomed to Western medical systems tend to express their demands clearly and actively participate in decision-making around the framework of "goals-schemes-risks"; in contrast, some patients from East Asian cultural backgrounds may hide their true concerns in silence due to reserve or respect for authority, requiring doctors to gradually clarify them through patient guidance. In addition, there are cultural differences in sensitivity when discussing privacy or sexual health topics, which places higher demands on the communication skills of the medical team.

These differences have prompted him to reflect deeply: perceptions are not unchangeable. He found that Chinese patients’ avoidance and anxiety regarding fertility issues stem largely from long-standing cultural inertia—the reluctance to discuss male reproductive problems, the shame associated with relevant examinations, and excessive reliance on medical authority. This inertia often leaves men in a state of "passive absence" in the process of assisted reproduction.

Therefore, he firmly believes that only by consistently conveying the concept that "fertility is a medical issue that couples face together" can more men be encouraged to take the initiative to visit the clinic, understand their own roles, and share decision-making responsibilities with their partners. In his opinion, reproductive medicine is not only a technology-intensive discipline but also a humanistic medicine that highly relies on communication, empathy and cultural understanding.

Looking to the Future: Fertility Management Needs to Be "Early" and "Comprehensive"

At the end of his sharing, Professor Li Tao turned his attention to the future: how andrology can achieve "early integration" in reproductive medicine. He put forward two key words: holism and timing.

Holism means treating the couple as a single treatment unit. "We must consider that this is a matter for both partners."

Timing means incorporating the female partner’s age into the core of decision-making: when the female partner is young, male treatment can be fully observed or implemented according to the spermatogenic cycle; when the female partner is approaching or over 35 years old, treatment strategies must emphasize efficiency and pathway selection, and "we cannot keep treating indefinitely".

On this basis, he proposed a more long-term direction: fertility preservation should start earlier. This includes sperm cryopreservation for cancer patients before radiotherapy and chemotherapy, as well as early intervention for young patients with varicocele—these all follow the medical logic of resolving "potential future problems" in advance.

At the popular science level, he hopes to spread the concept of "couple-centered treatment" more widely: to let men know that fertility examinations are not a source of shame, and to let women understand that "examining men first" is not favoritism, but a more rational and less harmful choice of fertility pathway.

To promote these concepts to truly take root in families, Professor Li Tao stated that he plans to explore the establishment of a specialized clinic model focusing on the full-cycle management of male fertility in the future. Through such practices, he hopes to integrate early screening, risk assessment, multidisciplinary collaboration and humanistic care, helping more families shift from "passively coping with infertility" to "proactively safeguarding fertility", and making "couple-centered treatment" more than just a slogan, but a real practice that happens in the clinic every day.

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