Infertility
What is male infertility?
Male infertility is the inability of a couple to achieve a pregnancy with unprotected intercourse. This occurs in about 15% of couples overall, and in 30% of these cases it is due to only a male abnormality. In another 20%, there are combined male and female factors.
What causes male infertility?
There are a large number of factors that can lead to male infertility. These factors vary from sexual problems, poor timing of intercourse, prior childhood or developmental problems, medical conditions, prior surgery, infections, exposure to chemicals, genetic diseases, or even prior chemotherapy for cancer. Some men are infertile because of a prior vasectomy and subsequently desire another child. Recent publications have noted laptop computers left on the man’s lap may raise scrotal temperature. Frequent hot tub use also raises the scrotal temperature, causing poorer production of sperm.
Male infertility is a subspecialty that is involved in nearly 50% of all infertile couples. Dr. Lowe has expanded operations to provide comprehensive fertility diagnostics and treatments for the male patient. Many treatment options for men provide a lower cost approach to infertility than typical IVF. However treatments can enhance the availability of couples to pursue IVF with success as well. Patients previously found to have no sperm present on a simple testicular biopsy are ideal candidates for micro-dissection TESE, a procedure allowing for the recovery of small numbers of sperm for IVF in approximately 30-50% of patients. This involves the use of an operating microscope and expertise on regions most likely to harbor foci of sperm. Many men are finding themselves remarried after a previous divorce as well. Often the idea of having a child together is limited by the man having had a previous vasectomy. We offer patients the opportunity for vasectomy reversal (vasovasostomy or vasoepididymostomy) for future conception. Other patients are found to have a varicocele that may inhibit testicular growth. This is easily correctable with a simple microscopic operation after which the patient is able to return to normal activities in 4-5 days. Finally, it is important for men to be evaluated if there are fertility problems as this can identify long-term health problems for the male partner.
Common causes of male infertility:
- Varicocele (abnormal collection of veins around the testicle)
- Vasectomy or obstruction of vas deferens
- Testicular cancer (even before treatment)
- Chemotherapy
- Undescended (not dropped into scrotum) testicles at birth
- Hormonal/low testosterone
- Drugs
- Prior radiation treatment
- Trouble with ejaculation (common in spinal cord injury)
- Genetic causes
- Infection
- Testicular failure
Even after a complete evaluation, up to 30% of men have unexplained infertility.
How is male infertility evaluated?
A complete history and physical exam is necessary to identify potentially correctable factors. The most frequent test to evaluate male fertility is a semen analysis. In this test, a man provides a semen specimen after 2-3 days of sexual abstinence. The number of sperm, the concentration of sperm, the sperm movement and sperm shape are all evaluated to provide information. Even in normal men, these levels can vary dramatically so it is often important to obtain more than one semen analysis. A basic hormonal evaluation is performed including a blood testosterone and follicle stimulating hormone (FSH) level.
Based on the findings of the above tests, further testing is directed at identifying reversible and irreversible causes. A transrectal ultrasound may be performed. At times, an evaluation of chromosomes is important. A testicular biopsy may be used and a vasogram can provide further information in the appropriate patient. The sperm can be evaluated for DNA damage or antibodies directed at the sperm can be identified as the problem.
Are there treatments for male infertility?
There are a number of treatments that can successfully improved a man’s fertility and lead to pregnancy. One of these is vasectomy reversal (vasovasostomy), a procedure where the healthy ends of the vas deferens are re-connected to allow the transport of sperm again after prior blockage. For men with cancer, it is important to understand the goals of cancer treatment and efforts can be undertaken to maintain fertility options. A varicocele can be treated with a simple microsurgical procedure (varicocelectomy) to decrease the backflow of blood toward the testicle. Sexual problems or ejaculation disorders can be corrected. Hormone levels can be returned to normal with the use of medications. Even men with some genetic disorders, prior chemotherapy, or testicular failure can be found to have sperm in the testicle with microsurgical sperm extraction techniques. With the success of assisted reproductive techniques (in-vitro fertilization and intracytoplasmic sperm injection), only a few sperm are needed for the possibility of a pregnancy.
Varicocelectomy
Varicocelectomy is a surgical procedure during which a small 1-2 cm incision is created in the groin. The blood vessels and vas deferens leading to the testicle are brought to the skin level. The veins are tied off individually to prevent the backflow of blood. Using a microscope for this procedure limits the risk to the testicular artery and makes a hydrocele (accumulation of fluid around the testicle) less likely. Most men notice an improvement in the semen sample after approximately 70-90 days. Even for men who ultimately undergo assisted reproductive techniques, varicocele repair has been shown to be beneficial.
Vitamins/Antioxidants recommended to improve sperm motility and quality:
Recommended infertility antioxidants:
1. Co-enzyme Q10 (or Ubiquinol) 200-300 mg taken once daily
2. L-carnitine 1 gram taken once daily
If you are a smoker, consider adding glutathione 600 mg once daily
OTHER SPECIALTIES AT LOWE UROLOGY