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All Posts in Category: Male Reproductive Urologist

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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How Health Affects Male Fertility

How Health Affects Male Fertility

 

Male fertility can be affected by your lifestyle.  If you have a healthy lifestyle, you are more likely to have healthy sperm.  Smoking, sexually transmitted diseases, alcohol, and your weight can also affect male fertility. To improve your chances of conceiving a child, make lifestyle changes and commit to living a healthy lifestyle.

 

Sexually transmitted diseases such as chlamydia and gonorrhea can be a cause for infertility.  To limit your exposure to these diseases, it is important for you to limit your sexual partners, practice safe sex, and commit to a monogamous relationship. Regular use of marijuana, tobacco, and illegal drugs can reduce the quality of your sperm and lead to abnormalities.  Stay clear of illegitimate drugs. Such as tobacco, medical marijuana can certainly reduce sperm movement along with result in sperm for being misshapen. Cocaine along with heroin furthermore obstruct healthy sperm.  Heavy alcohol consumption adversely affects male fertility.  Alcohol in moderation is fine but regularly consuming large quantities can significantly limit the quality and the quantity of your sperm.

 

Studies have found that lubricants such as KY Jelly and Astroglide can inhibit sperm movement and kill sperm.  If you are trying to conceive, it is best to stay from popular lubricants as well as using saliva as a lubricant.  If you must use a lubricant, try to use  Pre-Seed Intimate Moisturizer which is “sperm friendly.”  This product was developed for couples who are trying to conceive but may be experiencing vaginal dryness and not harm the sperm.

 

Adopting a healthy diet is another factor important to male fertility.  Studies have shown that being overweight influences the quality of your sperm and decreases sperm count.  To maximize male fertility and sperm health, consume a balanced and healthy diet that includes fruits, vegetables, and one that is rich in antioxidants.  When it comes to fertility, a healthy diet is just as important for men as it is for women.

 

When trying to conceive, men should avoid hot tubs, hot baths, and saunas.  Spending a significant amount of time in hot tubs, saunas, and hot baths with temperatures over 100 degrees can affect the number of normal sperm, interfere with sperm production, and increase the amount of abnormal sperm.  You should also avoid wearing tight clothing and use a mini-laptop desk instead of your lap when using your laptop computer.

 

Lastly, male fertility can be hampered by prescription medications.  Anabolic steroids can suppress testosterone, limit male fertility, and also cause harm to the male reproductive system which can lead to irreparable damage.  If you are taking prescription medication, it is advised that you speak with your physician and discuss if your medication may cause fertility issues. Prescription medications including antidepressants, antihypertensives, and antibiotics can inhibit sperm production.   If male fertility may be compromised due to prescription medication, discuss alternatives and let your doctor know that it is important for you to protect your fertility.  Also, prescription medication can affect your libido and cause you to lose interest in sexual relations with your partner.  Men who are undergoing chemotherapy and radiation should consider freezing their sperm because cancer treatment can cause damage to sperm cells.  If you have not yet started chemotherapy and radiation, your sperm can be frozen and preserved for future use.

 

 

 

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What Is Andrology? Male Reproductive

Andrology is the study of male diseases and male health, particularly relating to male reproductive problems and urological problems that are unique to men. Andrology addresses issues of infertility in males, erectile dysfunction, impotence, andropause, also know as male menopause, and male contraception. Although not as well known, Andrology is the male version of gynecology, which deals with medical issues of the female reproductive system.

An Andrologist, is a medical doctor who specializes in male reproductive issues and male sexual dysfunction. When treating patients with infertility issues, an Andrologist will devise a treatment plan that is best suited for the patient. Drugs, such as steroids or antibiotics, may be the preferred treatment plan to improve the quality of a patient’s semen. When blockages, that are affecting sperm production is the primary issue causing male infertility, surgery is the preferred method of treatment.

Many factors can have an influence on male infertility with most cases of infertility due to testicular damage and the inability to produce sperm. Additional issues include a low sperm count as well as the quality of the sperm produced, which is commonly referred to as sperm motility. When diagnosing male fertility, nearly 70% of the conditions causing the male patient to be infertile can be diagnosed by examining their medical history, through physical examination, testicular volume estimation, and hormonal and semen analysis.

People often mistakenly associate impotence, known as Erectile Dysfunction, with male infertility; these two conditions are not related. Impotence is the inability to get and maintain an erection, which prevents a male from having satisfactory sexual intercourse. The condition is quite common and it affects a large majority of men who are over the age of 40. Although unable to have an erection, a man who is impotent is still fertile and it is still possible for him to impregnate his female partner through insemination. Male infertility allows a man to have an erection and satisfactory sexual intercourse however, he cannot impregnate his female partner and produce children.
Andrologists treat male patients who are suffering from impotence. They can prescribe patient drugs such as Viagra, Levitra, and Cialis that can help the patient solve his erectile dysfunction issues. Another option is Hormone Replacement Therapy that will increase the testosterone in a male who has low testosterone levels. This may increase their sexual desire and their sexual libido. Andrologists also treat male menopause with testosterone replacement therapy. This treatment raises testosterone levels and restores hormone balance within the body of the male patients much as it does when used in patients who are afflicted with impotency.
Andrology is also used to assist men in family planning. Vasectomies are a form of male contraception that many men utilize when they do not want to have children and is the most effective form of male contraception. A vasectomy is a surgical procedure that blocks the path sperm take from the testicles to the penis. This is intended to be a permanent form of birth control. It can be reversed with a procedure called a vasovasostomy however, it is not always successful in restoring sperm flow.

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Erectile Dysfunction

Dr. David Nudell – Male Infertility

Contact Dr. David Nudell today!

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.

 

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