Male Fertility

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Male Fertility Evaluation and Treatment

Significant advances have been made in our ability to evaluate and treat the subfertile male. We now appreciate that subfertility is a couples dilemma. This is, in part, due to our increased knowledge of factors associated with male subfertility as well as recent advancements in tests and diagnostic equipment. In addition, the availability of sophisticated reproductive technology has enabled us to offer even men without sperm present in their ejaculate, the opportunity to father a biologic child.

Male factor is the primary or contributing cause in 40 to 60% of the couples presenting for a fertility evaluation. Therefore, both the male and female partner need to be evaluated concurrently. It is no longer sufficient to state that the male is "normal" because the semen parameters are "within the normal range". Many factors, other than semen quality are also important. It is the Urologist's unique ability to provide a comprehensive evaluation of the subfertile that has allowed us to diagnosis and ultimately treat an increased number of male factor disorders.

The following examples selected from our patient population highlight a few treatable disorders of male fertility:

  1. A 30 year old man presents without sperm in his ejaculate is diagnosed with absence of the vas deferens. Surgical exploration and retrieval of fluid from the remnant epididymis was used for microinsemination of oocytes retrieved from his wife using the technique of IVF with ICSI. The couple now has a healthy one year old son. Sophistication of assisted reproductive technologies has refined the definition of male sterility. Fertility is possible as long as even one spermatozoa can be isolated from the testis.
  2. A 37 year old gentlemen presents four years after the birth of his first child with a year and a half of secondary subfertility. He had been treated for prostatitis two years prior. Transrectal ultrasound demonstrated enlarged seminal vesicles with an increased echogenicity at the level of the ejaculatory ducts bilaterally. Preoperatively his semen quality was poor with few sperm, impaired motility and a low volume ejaculate. Transurethral resection of the ejaculatory ducts resulted in normalization of semen quality. A spontaneous pregnancy resulted three months postoperatively. Transrectal ultrasound has become an important adjunct to the clinical examination.
  3. A pediatrician trying to conceive his second child presented for evaluation. A decreased number of effectively motile and normal appearing sperm were found on his evaluation. His wife had had a normal evaluation. Repair of his large left varicocele (Varicoceles are abnormally enlarged veins draining the testicles) resulted in a doubling of his total sperm count and a four and one half times increase in the number of progressively motile and morphologically normal spermatozoa (44 million preoperatively to 206 million postoperatively). A pregnancy occurred 7 months post operatively. Over 80% of men with secondary subfertility have been found to have varicoceles that impair the couple's fertility.

The best first step is diagnosis. Using the most current and technologically advanced evaluative tools available, we first thoroughly evaluate you to determine the cause and extent of the disorder. We recognize that your time is precious. We have all advanced diagnostic testing available on-site and available, if indicated, for your examination.