Urology:
Conditions & Treatments

Infertility is a disease defined by the failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse. Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after 6 months for women over age 35 years. Ten to fifteen percent of couples will experience infertility. A male factor is present in up to half of cases of infertility and often can be treated.

There are number of known causes of male infertility including genetic abnormalities, previous testicular surgery, varicocele, testicular trauma, ejaculatory dysfunction to name just a few. Unfortunately, in half of men with infertility evaluation reveals “idiopathic” infertility, of infertility due to an, as of yet, unknown cause.

Male factor infertility is initially evaluated by obtaining a semen analysis and simply blood testing. A semen analysis is a microscopic examination of the ejaculate after a man ejaculates into a specimen cup. It will tell you a number of factors including the sperm count, how well the sperm move, and how healthy the sperm look under a microscope. The semen analysis and blood testing for an endocrine evaluation constitute the initial evaluation of an infertile man.

Treatments

Treatment of male infertility depends on the cause of infertility and should only be determined after a complete evaluation by a urologist. Treatment options may include simple lifestyle changes, medications, and/or surgery. Most surgeries for male infertility are optimally performed with the use of an operating microscope, which requires specialized training for the surgeon for best results. Treatment options include:

• Intracytoplasmic Sperm Injection (ICSI) is the treatment of men with non-obstructive azoospermia, or poor sperm production. While just over 20 years ago, the only chance for paternity for men with poor sperm production included the use of donor sperm or adoption, the development of intracytoplasmic sperm injection (ICSI) has revolutionized the field of male infertility. With the ICSI technique, it is possible to use very few sperm to fertilize an oocyte. Even in men with exceedingly low levels of sperm production, ICSI enables us to offer these men a chance at paternity.
• Micro-dissection Testicular Sperm Extraction is a surgery in which the entire testis is examined under an operating microscope at 25 times magnification while the patient is under general anesthesia. Tubules that are larger are more likely to harbor sperm production and thus these tubules are specifically targeted for biopsy in order to use the sperm with intracytoplasmic sperm injection. Using microdissection testicular sperm extraction, up to 60% of men with non-obstructive azoospermia will have sperm found at the time of surgery and, therefore, have a chance at biological paternity.