If you and your partner are having trouble achieving a pregnancy, we can evaluate you. We will help treat and manage any aspect of male infertility that may be hindering your quest for a child.
Male infertility can stem from several issues. It’s vital that we begin with an extensive questionnaire. These are some of the more common causes:
- Varicocele (varicose veins in the scrotum)
- Infection (prostatitis, epididimitis, orchitis, TB)
- Injury (trauma, torsion)
- Chemotherapy or exposure to high doses of radiation
- Undescended testicle (cryptorchidism)
- Obstructed sperm transport system (Vasectomy, epididimitis, congenital, TB)
- Chromosomal abnormalities (Cystic Fibrosis, Sickle Cell Disease)
- Hormonal imbalance (disorder of the hypothalamic-pituitary-testicular axis)
- Exposure to toxins (pesticides, certain medications)
- High fever
- Testicular Cancer
After the initial consultation and questionnaire, we will perform a physical exam. We will also need a semen sample for analysis. Usually, a battery of blood tests will be obtained to assess general health, male hormone levels, and Pituitary hormone levels. In some situations, a biopsy of the testicles will be recommended. Once our analysis is complete, we can offer treatment options.
Causes and Treatments
Low Sperm Counts (Oligospermia) can be caused by Varicocele, environmental factors, hormonal factors, drug-related factors, and use of dietary supplements. Some of these causes could be indicated on your questionnaire. A physical exam, blood tests and perhaps other tests are required to find the cause. Once the cause is identified, treatment can be directed specifically to your particular problem. Treatment success rates certainly vary depending on the underlying cause.
If there is no identifiable cause, the problem may be congenital. Biopsy of the testicles is sometimes indicated to determine the cause. If there is no medical treatment which can be offered, then couples are referred for Assisted Reproductive Techniques, such as in vitro fertilization or Intracytoplasmic Sperm Injection (ICSI).
Varicocele and Repair (Varicocelectomy) – The most common cause of male infertility is a Varicocele, or dilated veins in the scrotum next to the testicle. When males with infertility are examined, 40% are found to have a Varicocele as the cause of their infertility. Patients with Varicocele often have low sperm counts, low sperm mobility, and abnormally formed sperm. Fortunately, fixing the Varicocele (Varicocelectomy) is associated with an improvement in semen parameters and improved pregnancy rates in many patients.
Varicocelectomy is an outpatient procedure, usually performed in a surgery center. It involves a small incision in the groin area, where the enlarged veins are tied. Optical magnification or the operating microscope are often utilized in order to achieve optimum results. Whenever an incision is made, there will be some discomfort, and there will be a period of recuperation lasting up to one month.
Another method of Varicocele repair involves fixing the enlarged veins laparoscopically. This method involves placing a small camera through the belly button and placing small instruments through small openings in the abdomen in order to tie the offending veins. Laparoscopic Varicocelectomy is more invasive than the groin incision approach, but there is less pain and quicker return to normal activity, usually a few days. It is also more expensive than the groin approach, and is usually performed in the hospital under general anesthesia, rather than in a Surgery Center. It can involve an overnight stay in the hospital. The laparoscopic approach is best suited for patients who need bilateral (right and left side) varicocele repair.
Lastly, a varicocele can be treated in the radiology suite of the hospital, under local anesthesia. A wire is placed up the main leg vein all the way into the enlarged varicocele, where it places an occluding coil in the vein to stop the flow. This is an outpatient procedure, with minimal discomfort, and patients can return to normal activity the next day. However, it is the most expensive approach and has a 10% failure rate.
Many insurance plans have limited or no infertility coverage, so cost often becomes a factor for patients to consider when they select a particular treatment.
Zero Sperm Count (Azoospermia) can fall into two separate categories: Obstructive azoospermia and non-obstructive azoospermia. Appropriate tests the appropriate category and course of treatment. Blood tests are very helpful in determining if the cause is obstructive or non-obstructive azoospermia. A testicle biopsy is needed to make a definitive diagnosis.
In men with obstructive azoospermia, the testicle is making sperm normally, but there is a blockage in the sperm transport system, so that no sperm appear in the semen. A vasectomy is an example of obstructive azoospermia, but there are many other causes. For many cases of obstructive azoospermia, the cause of the obstruction can be identified and repaired, using microsurgical techniques or endoscopic techniques. If it cannot be repaired, sperm can be removed directly form the testicle and used for Intracytoplasmic Sperm Injection (ICSI). The methods to obtain sperm include Microepididimal Sperm Aspiration (MESA), Percutaneous Epididimal Sperm Aspiration (PESA), Testicular Sperm Aspiration (TESA), Testes Biopsy, and Extended Testes Biopsy.
For patients with non-obstructive azoospermia, it’s more difficult to find the cause and determine treatment. Sometimes the testicle is not making sperm, and there is nothing that can be done. Sometimes there is a hormonal imbalance which can be treated. Sometimes, even when the sperm count is zero, we can still find a few sperm for Intracytoplasmic Sperm Injection (ICSI). The urologist can determine the cause and advise you of your options.