Faculty in Focus

No sperm used to mean no children.  However with the introduction of in-vitro fertilization only a few sperm are necessary for a pregnancy.  Male factors play a role in up to 50% of cases of couple infertility.  Now, at OhioHealth, no sperm still allows options for men to become fathers.  

Dr. Gregory Lowe completed his urology residency at Ohio State prior to pursuing fellowship at the University of Virginia.  He trained in Mens’ Sexual Health and Male Infertility under Raymond Costabile, MD and Bill Steers, MD.  Dr. Costabile has performed nearly 2800 vasectomy reversals and he has been instrumental in the development of MUSE and Cialis.  His expertise and guidance rapidly advanced the training Dr. Lowe had previously received in male infertility.  Dr. Steers is one of the brightest minds in urology and provided research guidance in erectile dysfunction, especially following prostate surgery.  

Dr. Lowe grew up outside Cincinnati and went to Miami University (the one established before Florida was a state) for undergraduate studies.  He completed his medical school training in Toledo, Ohio prior to his residency at Ohio State.  Prior to fellowship, Dr. Lowe recognized there was very little male infertility care provided in central Ohio.  Unfortunately, this area is not taught in all residency programs and many practicing urologist are not comfortable with providing infertility guidance.   Dr. Lowe decided to return to central Ohio to become the first fellowship trained specialist to work full time in Columbus.

Infertility care for the male patient requires an understanding of the hormone influences and testicle role in sperm production.  Many of the male patients coming to see Dr. Lowe have not seen a physician in years.  At times, the infertility evaluation provides the opportunity to identify significant diseases such as testicular cancer, diabetes, genetic diseases or low testosterone.  Many of the surgical procedures in male infertility require specialized operating microscope training to be performed with the best chances of success.  Vasectomy reversal is most successful in the hands of a fellowship trained surgeon, and has success rates of greater than 95%.  Micro-dissection testicular sperm extraction is a surgical procedure to identify small areas of sperm production in men who do not have sperm in the ejaculate.  This procedure allows men with even 5-10 sperm to have a child through in-vitro fertilization.  Dr. Lowe enjoys seeing the ultrasound pictures and joy in the couples who achieve successful pregnancies.  He also knows the importance of sensitivity and care when telling couples they will not be able to have their own children.

Besides infertility, Dr. Lowe has an interest in low testosterone (hypogonadism) and hormonal imbalances in men.  Recent advertisements on tv and the radio for medications have made this a booming part of Dr. Lowe’s practice.  Testosterone has many effects in men.  Some men do not even realize how good they could feel with normal testosterone, and assume it is “old age”.  Testosterone treatment has many misconceptions and is difficult to study due to the normal fluctuations.  Testosterone does not cause prostate cancer and in some cases men with a prior history of prostate cancer are receiving testosterone therapy.  Testosterone also does not make men angry or aggressive.  In fact, most men on testosterone therapy have an improved and more stable mood.   There are many ways to replace testosterone and it is important to find the most appropriate for each patient.  Patients desiring maintained fertility/sperm production should not get testosterone injections because this will lower sperm counts.  There are treatments to help these men achieve higher testosterone levels without lowering sperm counts.

Many men presenting with low testosterone often complain of erectile dysfunction as well.  For most men, simply replacing testosterone will not restore normal erections.  Dr. Lowe focuses many clinical hours and research efforts into treating erectile dysfunction.  Many factors can lead to erectile dysfunction and it is now well recognized that the penis can act as “the canary in the coal mine”.  The arteries that supply the penis with blood are about half the size of heart arteries.  Therefore, men who present with erectile dysfunction have been found to have a higher risk of heart attacks in the next 10 years.  Usually the erection problems precede the heart attack by 2-5 years, and this provides an opportunity for intervention prior to an event.  Dr. Lowe takes this into account when treating his sexual health patients.  Often the evaluation is detailed to monitor blood sugar levels, cholesterol levels, blood pressure and medications used to treat each of these.  Men who fail the typical initial treatments of oral medication are offered penile injection therapy and surgical options.  The injection therapy works well and once men overcome the anxiety associated with a needle injection in the penis, the results are dramatic.  When men fail this approach, surgery to implant a penile prosthesis is a wonderful option.  Penile prosthesis is associated with very high satisfaction rates for patients and their partners.  The new penile prosthesis work well, last a long time and provide near normal feeling erections.  Surgery to place the prosthesis can be performed as an outpatient surgery and recent research has shown that success rates for this operation are highest when performed at a higher volume center.  

Dr. Lowe enjoys one area of urology that has been notoriously difficult to treat, testicular pain.  He follows a protocol to allow a trial of conservative measures, followed by medication and ultimately resulting in surgery if needed.  Many of these men present requesting the testicle be removed because of their bother with the pain, however removing the testicle does not always resolve the pain.  Dr. Lowe offers microscopic spermatic cord denervation to remove the nerves travelling along the cord to the testicle and resulting in pain relief in 70% of men.  This is an area of active research for Dr. Lowe.  Many men struggle with this problem and few good solutions exist.  Dr. Lowe is ready to study a treatment algorithm to determine if a simplified way to address this problem is available for urologists.