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Erectile Dysfunction

Dr. David Nudell – Male Infertility

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Infertility affects 15% of couples attempting pregnancy in the United States. Roughly speaking, about half of these couples will have a male factor involved, and a male factor will be the sole cause of infertility in about 25% of cases. Thus, all men should have at least a basic evaluation by a urologist early in the course of the female’s evaluation to avoid expensive and unnecessary female treatments. Infertility is defined as the inability to achieve pregnancy after 1 year of unprotected intercourse. Many couples seek medical attention prior to waiting a year, especially if the female partner is over 35 years old. Most couples who seek medical assistance for fertility do not require high technology, expensive treatments.

Male factor abnormalities are diverse, but generally include hormonal problems (pre- testicular), intrinsic testicular problems (testicular), and problems with ducts leading from the testes (post-testicular).

When a vasectomy is performed, sperm production does not stop but it blocks the entry of sperm into the urethra. Unlike women, men produce sperm their entire lives.  The body eventually breaks down the blocked sperm, it is reabsorbed and new sperm continues to be produced.  There are instances when pressure can build up in the tubes behind the vasectomy scar and in some cases, the pressure can build and cause a tiny tubule of the epididymis to rupture.  This is generally referred to as an epididymal “blow out.”   If an epididymal blow out occurs, scar tissue develops and this becomes a new level of sperm blockage.  This is neither painful nor dangerous, but it is significant in that for a vasectomy reversal to be successful, it must be performed in such a way that bypasses this new level of blockage at the epididymal blow out site.