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Male Infertility

Male Infertility

When the word “infertility” is used most people think about female infertility. Infertility affects 15% of couples attempting pregnancy in the United States. In half of these cases, couples will have a male factor of infertility of about 25%.

Male infertility is due to low sperm count, blockages that prevent the delivery of sperm or abnormal sperm function. Illnesses, chronic health problems, injuries, lifestyle choices, and other factors can also be a factor in male infertility.


The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms. However, in some cases an underlying problem such as a hormonal imbalance, an inherited disorder or dilated veins around the testicle causes signs and symptoms.

Although most men with male infertility do not notice symptoms here are some signs and symptoms associated with male infertility:

  • Difficulty with ejaculation or small volumes of fluid ejaculated
  • Pain, swelling or a lump in the testicle area
  • Reduced sexual desire
  • Recurrent respiratory infections
  • Abnormal breast growth (gynecomastia)
  • Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
  • Erectile dysfunction
  • A lower than normal sperm count

Medical Causes

Male infertility can be caused by a number of different health issues and medical treatments. Some may include:

  • Varicocele. A varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of male infertility. Varicoceles result in reduced quality of the sperm.
  • Ejaculation issues. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis.
  • Certain medications. Long-term anabolic steroid use, cancer medications, certain antifungal medications, and other medications can impair sperm production and decrease male fertility.
  • Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.

When to See a Doctor

You should see a doctor after one year of being unable to conceive a child with unprotected intercourse or if you start noticing signs and symptoms.

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Men who are in need of in vitro fertilization (IVF) fall into two general categories: Obstructed and Non-Obstructed patients. Obstruction is caused either by prior vasectomy or by conditions in which the outflow tubing of the testicles has been damaged or failed to form properly from birth.

Below is a list of common procedures done.

Testicular Sperm Extraction (TESE) and Micro Dissection TESE

In some cases, sperm is taken directly from the testicle for IVF. This occurs in men with very low sperm production who have no sperm in the ejaculation in which the cause is not from a blockage, called nonobstructive azoospermia. It also occurs in some men with epididymal scarring, previously failed vasectomy reversal and in some men with congenial blockages of the sperm ducts. TESE can be done with local anesthesia in an office or in a surgery center with many other anesthesia options.

Tissue that is extracted is immediately examined to determine the presence or absence of sperm. In so instances, multiple areas of the testis will need to be sampled in order to find adequate numbers of healthy sperm. In cases where only small “pockets” of sperm production may exist within the testis, a technique known as microdissection TESE would be performed. This procedure has been shown to allow for the detection of visible sperm in many previously untreatable men.

Microscopic Epididymal Sperm Aspiration (MESA)

In obstructed patients, sperm may be harvested surgically from the epididymis in the high numbers with high motility. This can be done in two ways. One way it can be done is through the skin, percutaneously or it can be done open surgically with the operating microscope. Usually, the open technique allows for a much greater harvest of sperm to be frozen but requires a minor surgery with a small scrotal incision. Recovery time, however, is very brief. The surgery takes about 30 minutes and is done as an outpatient. Once the sperm is cryopreserved, it can be used at any fertility center in the country.

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Surgical Treatment for Infertility in Men

Surgical Treatment for Infertility in Men: Varicocele Ligation, Vasectomy Reversal, Transurethral Resection of the Ejaculatory Duct, Sperm Retrieval and IVF/ICSI techniques


Surgery is  an option to treat male Infertility and is sometimes required to treat conditions associated with infertility.  Following are surgical treatments available to men for who are experiencing infertility problems that are preventing them from successfully conceiving a child with their partner.


Varicocele Ligation


Surgical ligation is one of the most common treatments for the treatment of male infertility and repairing the varicocele is a relatively simple surgical procedure.  Usually done by a Urologist, a Varicocele Ligation begins with an incision being made in the skin above the scrotum, down to the testicular veins and then tied off with sutures. Patients can leave the hospital the same day but about 20 percent of surgical ligation patients have an overnight stay at the hospital.  Recovery period for a surgical ligation is two to three weeks.


Vasectomy Reversal


Vasectomies are considered a permanent form of contraception however,  advances in microsurgery have improved the success of vasectomy reversal procedures.  A Vasectomy Reversal Surgery reconnects the male reproductive tract after a vasectomy.  Vasovasostomy, also known as Vasectomy Reversal, is a procedure where the cut ends of the vas deferens are stitched back together in two layers.  When the epididymis is inflamed or scarred and is blocking the sperm from reaching the vas deferens, a patient may need a Vasoepididymostomy.  In this procedure, the surgeon will bypass the blockage and stitch the vas deferens to the epididymis in two layers.


Transurethral Resection of the Ejaculatory Duct


Transurethral Resection of the Ejaculatory Duct  is a method to treat ejaculatory duct obstruction and this procedure may help couples who want to conceive naturally and avoid assisted reproductive technologies such as IVF/ICSI.  This procedure is usually done on an outpatient basis.  It is performed endoscopically by inserting instruments into the patient’s penis.  Dye is injected into the seminal vesicle, the surgeon resets the duct, removes the obstruction, and reconnect.  The dye will flow freely through the duct if the procedure is successful.  The procedure removes the ejaculatory duct obstruction and opens the ejaculatory ducts which allows for the normal flow of ejaculate and improvement of semen parameters.


Sperm Retrieval and IVF/ICSI Techniques


There are several methods available for Sperm Retrieval also known as Sperm Extraction.  Depending on the reasons why a patient does not have enough sperm in their ejaculate will determine the right method for them.. Once the patient meets with their doctor to discuss their fertility problems,the doctor will determine the best method based on the patients individual case.


Following are some of the most common methods available for Sperm Retrieval for In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI):


Percutaneous Epididymal Sperm Aspiration (PESA)


PESA requires a needle to be inserted into the epididymis and sperm is withdrawn.  This procedure is used to find sperm when there is no sperm found in the male partners ejaculate.  The procedure can be performed using a local anesthetic with a quick recovery time.


Testicular Sperm Extraction (TESE)


TESE is a surgical biopsy of the testis.  The surgery is performed using a local anesthetic and a small cut is made in the scrotum where a small portion of the tissue is removed to extract a few viable sperm cells  This method is usually used when there is evidence of an obstruction.


Microsurgical testicular sperm extraction (Micro-TESE)


Micro-TESE surgery is the opening of the outer cover of the testicle and examining the inside of the testis under an operating microscope.  This procedure is performed in an operating room under local anesthesia.  More of the testis is examined however, less testicular tissue is removed.  Also this procedure causes less damage to the structure inside the testicle and causes fewer blood supply problems caused by tiny blood vessels being cut. This procedure appears to increase the number of sperm that can be retrieved.



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Do you suffer from Erectile Dysfunction?

* Erectile Dysfunction – how it is related to infertility, treatment options, symptoms.


Erectile Dysfunction, also known as impotence, is the inability of a man to achieve and sustain an erection in order to have intercourse. Erectile Dysfunction(ED) is common and it is treatable.

If a couple is trying to get pregnant and the male partner is experiencing Erectile Dysfunction, which is causing low sexual desire and performance anxiety, Erectile Dysfunction will only exacerbate infertility problems. If a couple must have sex at a certain time and Erectile Dysfunction is preventing this from happening, the chances of pregnancy occurring decrease even more.

Infertility treatments are a huge stressor for couples emotionally and financially and this stress can lead to a man having performance problems.  You may need to have sex even if you don’t want to in order to try and conceive and Erectile Dysfunction makes this virtually impossible.   Also, medications you may have to take may make it harder for you to have sex.  Emotional vulnerability, performance anxiety, and scheduled intercourse are stressors for a couple trying to conceive and can lead to the male partner experiencing Erectile Dysfunction.   Fertility stressors that lead to a man being unable to ejaculate on demand and the pressure to do so is a contributor to ED and infertility.

One of the biggest indicators of ED is the inability of a male to sustain an erection or even have an erection during sexual intercourse.  Another symptom of ED occurs occasionally and when this is the case, it is not serious concern.  Yet another symptom of Erectile Dysfunction occurs when a male experiences erections in the morning or only when masturbating.  At some point in their lives, all males experience this.  While alarming and possibly embarrassing, it is very common.

Luckily, ED is treatable and many treatment options exist.  These treatment options make it possible for male patients to address infertility problems with their partners as well as have an enjoyable sex life.  ED can be treated at any age and the overall health of the patient is addressed immediately when treating the condition.

It is important for patients to discuss any issues they are experiencing with their doctor.  That is the first step in getting help for the problem.  In some cases,  ED can be addressed by making lifestyle changes.  Losing weight, decreasing alcohol consumption, and smoking are all changes that can be made to treat Erectile Dysfunction.  Medications a patient is taking may be the source of ED and if so, speak with your doctor about changing or decreasing the medications that may be contributing to the problem.  If a patient is experiencing Erectile Dysfunction, they also have the option of getting a penis pump, penile implant, or surgery to improve the blood flow to the penis.  Psychotherapy and drug therapy are additional options available to patients who want to address and eliminate such problems.





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Male Fertility

What You Don’t Know About Male Fertility But Should

Male fertility is seldom over-looked at. Most people believe that when fertility is a problem with a couple, it is the woman who has the fertility issue. However, in 60% of the cases, it is the male fertility that is contributing to a couple’s infertility. When it comes to fertility, both the man and the woman must be evaluated in order to ascertain the cause of infertility.

What is male infertility?

Male infertility is the inability to get a woman pregnant. Low sperm production, low sperm count, abnormal sperm function, was well as illness, injury, chronic health problems, and lifestyle choice are all factors that can cause male infertility. Male infertility occurs when a male is unable to conceive a child with his partner.


There are many symptoms associated with male infertility with the most important one being the inability of a male to impregnate his female partner after regular intercourse for an entire year without using contraception. If this is a case, a doctor must evaluate both partners. Men are tested on their sperm count and if they have a low sperm count, than this is considered a serious symptom of infertility.

Other symptoms are a decrease in sperm motility and abnormally shaped sperm. Other common symptoms include the following:

  • Serious illness such as cancer or diabetes
  • Sexually transmitted diseases
  • Sexual history
  • Frequency of sexual intercourse
  • Medications
  • Health history

These factors and more contribute to infertility problems in men and they may one or more symptoms present.


By now, you are asking what can cause problems with my fertility. There are a variety of reasons you are not fertile. Are you leading a healthy lifestyle? Men who are living a healthy lifestyle have a much better chance of producing healthy sperm. Some factors that can have a negative impact on male infertility include the following:

  • Smoking
  • Alchohol abuse
  • Steroid use
  • Tight underwear
  • Malnutrition
  • Anemia
  • Prolonged use of marijuana and other recreational drugs
  • Stress
  • Intense exercise

If you are trying to conceive a child, consider leading a healthier lifestyle and eliminating or at least changing behaviors that impact your chances of conceiving.

Other things to consider to boost male fertility are physical problems, hormonal imbalances, behavioral problems, and psychological problems; these can be contributing factors to male infertility.

Risk Factors

Exposure to toxic substances and chemicals can lead to reduced sperm counts and malformations in male genitalia. Research has found a connection between toxic substances and fertility. While it may not be possible to totally eliminate all substances that are toxic from our everyday lives such as chemicals found in plastics, pesticides, and

non-stick products, if you are trying to conceive, try to eliminate as many as possible.

Regular use of whirl pools, steam rooms, and hot baths should be avoided. They lead to impaired sperm production and motility. However, research has shown that stopping your exposure to this kind of heat can have positive results.

Cigarette use, marijuana, recreational drug use, and heavy alcohol consumption are all risk factors associated with infertility. Good news is that the damage caused by excessive use of theses substances can be reversed and possibly eliminated if you cut them out of your life.


Infertility is stressful and not being able to conceive can cause relationship difficulties. Besides stress, the time and financial cost associated with infertility, as well as the failure to impregnate can lead to frustration, feelings of inadequacy, anger, and guilt.

Additional complications are increased risk of inherited syndromes such as cystic fibrosis and klinefelter syndrome, hormonal abnormalities, and an increased risk of cancer including testicular and prostate cancer.

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