Fertility Evaluation

Urologic Examination

If necessary, the male partner may be advised to receive a urological exam, as well as more specific sperm testing and evaluation of hormone levels. If a male partner is thought to have a sperm abnormality, we will recommend that he receive an exam from a urologist – a physician who focuses on the male urinary tract and reproductive organs. A urologist who specializes in andrology will have further expertise with the male reproductive system.

A urology exam will include:

• Assessment of kidney and bladder function to rule out infection or other problems

• Examination of testicles. Small size may be associated low hormone levels, which impact sperm development.

• Examination for a varicocele. A varicocele or dilated vein in the scrotum can overheat the testes, negatively impacting sperm production and quality.

A problematic semen analysis is often the result of defects in the male reproductive anatomy, which can sometimes be successfully addressed through surgery, medications or laboratory procedures. A genetic evaluation for chromosomes or DNA deletions in a specific area of the Y chromosome are sometimes recommended, especially for men with very low sperm counts or no sperm in the ejaculate (azoospermia).

Diagnosis and Treatment of Male Factor Infertility

Obstruction

A variety of conditions may block potentially normal sperm from traveling from the testes to the ejaculate:

• Obstruction in the vas deferens, or any of the other 'collecting tubes' that gather sperm from the testes may be a congenital condition, existing from birth

• Congenital Absence of the Vas Deferens (Obstructive Azoospermia) in which there is normal testicular sperm production, but no sperm in the ejaculate

• Vasectomy, an intentional contraceptive 'surgical obstruction' in which the vas deferens from each testicle is clamped shut, preventing sperm from reaching semen

• Obstruction may be caused by infection of the epididymis, the part of the anatomy that stores, matures and transports sperm between the vas deferens and the testes

Treating obstructions

Surgical treatment such as vasectomy reversal or cytoscopy, using a thin lighted instrument to clear a blocked ejaculatory duct, may clear a pathway for sperm.

Other successful treatments for male factor infertility involve a simple needle aspiration procedure (percutaneous epididymal sperm aspiration or PESA) that will often yield enough sperm to achieve fertilization with IVF, although usually just enough for one IVF cycle. Alternatively, a MESA (microsurgical epididymal sperm aspiration) surgery may be performed, yielding many vials of usable sperm.

When working with low sperm numbers, whether in the ejaculate or obtained by needle aspiration or biopsy, we consider the ideal treatment to be in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI), a laboratory procedure in which individual sperm are injected into an egg, optimizing the opportunity for fertilization. [Learn more) about IVF with ICSI.

Varicocele

A varicocele is a version of a varicose vein in the scrotum. Due to an otherwise harmless, anatomical flaw in the veins which circulate blood to and from the testicles, blood flow becomes backed up and veins become enlarged and elongated. The blood carried in these veins may elevate the scrotal temperature negatively affecting sperm production.

Treating varicocele

Varicocele may be treated by tying off or ligating the abnormally dilated veins. This surgery seems to be most effective in men whose varicocele is of significant size. In this surgery, about two thirds of patients will see some improvement in the sperm quality. IVF may also be recommended in this situation.

Non-obstructive Azoospermia

Men with very poor sperm production in the testicles and no sperm in the ejaculate often demonstrate high blood FSH levels and, at times, low testosterone levels. Small testicles and testicular failure are also common. Testicular biopsy or testicular mapping are diagnostic procedures that evaluate the extent of male factor infertility by determining if any sperm are being produced at all in the testicles.

Treating non-obstructive Azoospermia

Assuming that the biopsy or mapping have determined that testicular sperm are present, this condition is treated with TESE, or testicular biopsy. Infertility treatment, in which a small sample of tissue from one or both testicles is taken to harvest the sperm for IVF with ICSI treatment. Depending on the amount of sperm obtained, this treatment can be successful.

Unexplained low sperm count

If there is a mild decrease in the male partner's sperm count or motility, a urologist may prescribe Clomid, an infertility pill commonly used to treat women who fail to ovulate. Clomid can stimulate the hormones responsible for sperm production. Sperm counts are re-analyzed 3-6 months after medication is started to evaluate any improvement in sperm production.

Sertoli Cell Only Syndrome

In this rare male factor infertility condition, there is a complete absence of the cells that create sperm. For those seeking pregnancy, sperm donation is the only recommended option.