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Male Infertility

Male infertility at a glance

  • In couples that have difficulty with conception, 50 percent of the time it is due to a male factor and 50 percent of the time there is a female factor.
  • Male infertility can be due to genetic, developmental or exposure factors.
  • Urology Associates offers both evaluation and treatment for male infertility, which commonly is due to issues with sperm production.
  • Male infertility is a common condition, and typically very treatable.
  • The goal of the evaluation is to identify and correct any reversible causes.

What are the causes of male infertility?

Generally, male infertility can be due to one of the following issues:

  1. Decreased sperm production
  2. Blockage in the ducts that carry sperm
  3. Sperm quality problems, such as abnormally shaped sperm (poor morphology) or poor sperm motility (sperm’s ability to swim)

Testosterone Therapy – A Common Cause of Infertility

Causes of and contributors to these conditions can be numerous and complex, including:

  • Exposure to toxic substances, chemotherapy or radiation
  • Physical problems with the testes
  • Lifestyle, notably poor health habits and conditions (smoking, obesity, excessive alcohol consumption, use of drugs, testosterone or anabolic steroids)
  • Undescended testicle (cryptorchidism)
  • Infections and/or high fever
  • Torsion (constricted blood flow to a testicle)
  • Environmental factors, including exposure to certain medications, pesticides and other toxins
  • Injury to the spinal cord
  • Prostate surgery
  • Hormone problems
  • Genetic or chromosomal conditions
  • Testicular cancer
  • Vasectomy
  • Sexually transmitted diseases
  • Varicocele (dilated veins in the scrotum)
  • Ejaculatory disturbances

Diagnosing & treating infertility in men

If concerned with any difficulty in conceiving, a man may opt to visit a urologist for evaluation.

The first step in diagnosing male infertility is taking a medical history and performing a physical exam. The patient normally also provides a semen sample for a laboratory analysis of the quantity of seminal fluid, sperm count, sperm motility and morphology.

Often patients also undergo blood testing for identification of any hormone issues.

Urology Associates provides the following treatments for causes of male infertility:

  • Recommendations for lifestyle changes and avoidance of toxins
  • Hormonal therapy
  • Use of nutritional supplements
  • Surgical therapy.

Varicoceles and treatment

A varicocele is a dilated vein in the scrotum and the most common, correctable cause of male infertility. Varicoceles, which are similar to varicose veins, frequently contribute to low sperm production and motility, as well as to abnormally shaped sperm. Varicocelectomy is a surgical treatment of the dilated veins, requiring a small incision below the groin, where the urologist ties off the enlarged veins.

Sperm blockage and low sperm counts

One common treatment is microsurgery in which a surgeon surgically corrects an obstruction in the sperm ducts (vasectomy reversal, for example). However, in some cases, the obstruction cannot always be identified or repaired. In these instances, a urologist can remove sperm directly from the testicle through one of several techniques of sperm retrieval:

    • Testicular sperm aspiration (TESA) is used as a diagnostic procedure and also to recover sperm from the man’s testicles for use in intracytoplasmic sperm injection (ICSI) that assists fertilization during in vitro fertilization (IVF). In TESA, a doctor uses local anesthesia on the man’s testicles then places a very thin needle into the testicles and removes the tissue blockage or removes sperm for use in ICSI.
    • Percutaneous epididymal sperm aspiration (PESA) is performed on men who have had a vasectomy or have a congenital or acquired genital tract obstruction. The PESA procedure is done with local anesthesia, and the doctor inserts a needle attached to a syringe into the epididymis, the small tube located in the back of the testicles that stores and carries sperm to the vas deferens. PESA is used to retrieve sperm for IVF/ICSI.
    • Testicular sperm extraction (TESE) is a means of extracting sperm from a male in which a physician inserts a needle into the testicle and draws out sperm or tissue that may contain sperm. TESE is normally performed on men who have obstructive azooapermia, and take place in an operating room using sedation or in an office visit with local anesthesia.
    • Microsurgical epididymal sperm aspiration (MESA) is a process where the doctor retrieves sperm using an operating microscope inserted through a micro incision into the epididymis where sperm is stored. This is the favored sperm extraction technique for men with congenital bilateral absence of the vas deferens, which means the tubes that carry sperm from the testes are not properly developed. This procedure usually allows the doctor to collect enough sperm to freeze for future IVF cycles.

Once sperm has been retrieved through one of these procedures, a fertility clinic can use it to achieve pregnancy through artificial reproductive technologies, including:

In vitro fertilization (IVF). In IVF, fertility doctors retrieve sperm and mix it with a female egg in the laboratory in order to create a fertilized embryo that is then implanted into the female’s womb.

Intracytoplasmic sperm injection, or (ICSI) with IVF. This procedure used in IVF involves microscopically injecting sperm individually into one or more eggs retrieved from the female partner.

For men who have no sperm in their ejaculate due to severe issues with sperm production, it may be possible to obtain sufficient numbers of sperm through a microsurgical technique know as a testicular microdissection. This technique allows men to father children when otherwise it would be impossible.