Male Fertility
1 in 6 couples are dealing with infertility and in 50% of these couples there is a contributing factor from the male partner.
Our Approach
- We encourage both you and your partner meet with Dr. Miller. This allows both partners to be informed on the plan.
- Dr. Miller will work with you to define the etiology of infertility. This will include an in depth review of your medical history, family history, and lifestyle factors that may be playing a role in the issue.
- Testing including hormones and semen analysis will be obtained.
- Based on the results of the testing and exam Dr. Miller may prescribe medications or discuss if a surgical procedure is necessary.
- Dr. Miller will coordinate with additional specialists such as Reproductive Endocrinologists to accomplish your fertility goals.
Common causes of male factor infertility
Varicocele
The most common cause of male factor infertility is enlarged veins leaving the testicle on one or both sides. They can be found in about 20% of all men and 40% of those with infertility. Fixing them with a minor surgical procedure can improve sperm quality, count, and motility.
Hormone Imbalances
Hormones from the brain and testicle act in perfect concert to maintain a balance that promotes optimal testosterone production and sperm production. Occasionally however, these hormones can be thrown out of balance affecting both. If present we can prescribe medications to correct these imbalances and improve sperm counts and testosterone levels.
Absence of sperm in the ejaculate
Around 1% of all men will have absence of sperm in their ejaculate, known as azoospermia, making up about 15% of all men dealing with infertility. There are two pathways or reasons for lack of sperm in the ejaculate, defined as either obstructive and non-obstructive azoospermia.
Obstructive azoospermia
Some men will have an obstruction, this could be from prior vasectomy, lack of vas deferens at birth, infections, trauma, or previous surgeries. Treatment options for obstructive azoospermia are surgical. This may involve microsurgical reconstruction of the male reproductive tract, sperm extraction via testicular sperm aspiration (TESA), percutaneous epididymal sperm aspiration (PESA), or microscopic epididymal sperm aspiration (MESA). For men who have blocked ejaculatory ducts at the urethra can undergo an incisionless procedure known as transurethral resection of ejaculatory ducts (TURED).
Non-obstructive azoospermia
Non-obstructive azoospermia occurs when there is a failure of spermatogenesis to produce enough sperm to be present in the ejaculate. This condition can occur in men who are taking exogenous testosterone, specific genetic conditions, or for unknown reasons.
Treatments for non-obstructive azoospermia may be either medical or surgical. If testosterone, luteinizing hormone (LH), and/or follicle stimulating hormone (FSH) are found to be low, medications will be used to boost your own testosterone to produce more sperm. These medications will take a minimum of 3 months to have an effect which is how long it takes for a sperm cell to mature.
Once any potential medical or hormonal reasons have been ruled out, surgical microscopic testicular sperm extraction (mTESE) is the gold standard. This procedure has around a ~50% chance of finding sperm that can be used for IVF.
FAQ'S
What to expect after varicocelectomy?
Men will have a small incision in their lower groin on the same side as the varicocele that is being repaired, the sutures are beneath the skin and will dissolve on their own. Men are usually able to return to fairly normal activity after 48 hours. Patients should avoid lifting greater than 10 pounds for 2 weeks following the procedure.
What to expect after sperm retrieval?
Men will have a small incision on their scrotum, the sutures will be visible and will dissolve on their own. Men are usually able to return to fairly normal activity after 48 hours. Patients should avoid lifting greater than 10 pounds for 2 weeks following the procedure.
Is this covered by my insurance?
Insurance usually covers varicocelectomy. Unfortunately, most insurance companies do not cover sperm retrieval procedures. However, at Las Vegas Urology we strive to keep costs as low as possible for patients. Pricing will be discussed at your appointment with Dr. Miller
Get in touch with Dr. Miller
