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Patient Question

How is male infertility defined and what are the treatment options?


Associate Professor of Urology
Director, Male Infertility & Microsurgery

Expert Answer

Infertility is defined as couple's inability to achieve pregnancy following one year of unprotected intercourse. It has been estimated that 15-20% of couples attempting to achieve pregnancy are unable to do so. A male factor is contributory in more than 50% of couples presenting for fertility evaluation. Therefore, evaluation of the male partner should be performed at the same time as the female evaluation. It has been shown that the longer couples remain infertile, the worse their chance for an effective treatment. Initial screening of the male partner should be considered whenever a couple is concerned regardless of the length of infertility. The male infertility and microsurgery program at Stony Brook University Medical Center provides complete, comprehensive and compassionate care for infertile couples. The program serves as clinical research and educational source for physicians, residents in training, medical students and patients. For additional information please see the links below.

Common Causes

  • Varicocele: Dilated and tortuous scrotal veins, associated with a progressive and duration-dependent decline in testicular function. The most common factor associated with male infertility, present in 35% of infertile men who have never fathered a child, and in up to 81% of men who were once fertile but are now infertile.
  • Genetic Disorders: Chromosomal abnormalities, congenital absence of the vas deferens.
  • Ductal Obstruction: Vasectomy, previous surgeries, infection.
  • Infection: Urethritis, Epididymitis, sexually transmitted diseases.
  • Ejaculatory Failure: Inability to ejaculate, retrograde ejaculation.
  • Immunologic Abnormalities: Presence of antisperm antibodies.
  • Systemic Diseases: Renal failure, diabetes, liver disease, malignancies.
  • Hormonal Deficiency: Disorder of hormonal production by testes, pituitary gland.
  • Environmental Toxins and Recreational Drugs: Possible exposure to heavy metals, solvents, pesticides or heat, smoking, use of alcohol, anabolic steroids, cocaine, marijuana, heroin, etc.
  • Medications, Chemotherapy and Radiation: Cancer chemo therapy, radiation, anticonvulsants, barbiturates, digoxin, cimetidine, sulfasalazine, some antibiotics and antihypertensive drugs.
  • Unexplained Infertility: No causes have been identified.

Evaluation & Diagnosis
The most important part of the evaluation of an infertile male is the history and physical examination. Prior to arrival to the office, the patient is asked to fill out a detailed fertility questionnaire. Physical examination is performed in a warm room by an examiner with warm-gloved hands. Diagnostic evaluation includes:

  • Complete Semen Analysis: Two semen analyses done 3-4 weeks apart are usually required.
  • Hormonal Testing: Endocrine evaluation includes basic hormonal testing.
  • Additional Testing: May include semen culture, antisperm antibodies, post ejaculation urine analysis, transrectal ultrasound to evaluate seminal vesicles and prostate.
  • Genetic Testing: (Karyotpe, Cystic Fibrosis, Y-chromosome micro deletions): Blood tests recommended in patients with absent sperm or very low sperm count.
  • Transrectal And Scrotal Ultrasound: Sonographic evaluation of seminal vesicles and prostate.
  • Aspiration of Seminal Vesicles: Performed under ultrasound control to look for possible obstruction of the ejaculatory ducts or to retrieve sperm.
  • Microscopic Testicular Biopsy: Important ambulatory surgical procedure to differentiate between sperm failure of sperm production and obstruction of sperm passage.
  • Vasography: Intraoperative procedure to evaluate patency of the vas deferens and ejaculatory ducts.

Treatment & Procedures

  • Microsurgical Varicocelectomy: Microsurgical technique enables a surgeon to preserve the tiny arteries and lymphatic ducts, reducing the risk of hydrocele (bag of water forming around testis). The procedure is less invasive and performed through small incisions (one inch or less).
  • Reconstructive Procedures: Microsurgical vasectomy reversal, and microsurgical vasovasostomy and microsurgical vasoepididymostomy. Performed to restore the continuity of excurrent duct system and enable natural passage of sperm.
  • Microsurgical Treatment of Chronic Testicular Pain: Testicular denervation. Vasectomy reversal in post-vasectomy pain syndrome.
  • Sperm Retrieval Techniques: Microsurgical epididymal sperm aspiration, testicular sperm extraction, percutaneous epididymal sperm aspiration, percutaneous testicular sperm aspiration and sperm cryopreservation. Indicated for irreparable obstruction or sperm production failure. Sperm can be obtained from testis or epididymis for cryopreservation or immediate use for assisted reproduction.
  • Transurethral Resection of Ejaculatory Ducts: Endoscopic ambulatory procedure to open obstructed ejaculatory ducts allowing sperm release during ejaculation.
  • Medical Treatments: Non-specific (hormones, vitamins, amino acids, microelements). Specific treatment is available for retrograde ejaculation.
  • Sperm Retrieval For Assisted Reproductive Technologies: Sperm retrieval procedures are indicated for patients with absence or extremely low number of sperm in the ejaculate who want to be treated with assisted reproduction (Invitro fertilization with intracytoplasmic sperm injection-IVF/ICSI).
  • MESA=Microsurgical Epididymal Sperm Aspiration: Ambulatory open microsurgical procedure to retrieve sperm from the epididymis using special micropipettes. Sperm can be cryopreserved (frozen) for future use.
  • PESA=Percutaneous Epididymal Sperm Aspiration: Ambulatory or office procedure to retrieve sperm from the epididymis with a needle.
  • TESA-Testicular Sperm Aspiration: Ambulatory or office procedure to retrieve sperm from the testis with a needle.
  • TESE-Testicular Sperm Extraction: Ambulatory open microsurgical procedure to extract sperm from testis. May require single or multiple tissue specimens.
  • Percutaneous Testicular Biopsy: Ambulatory or office procedure to retrieve sperm from the testis with biopsy gun.

For Additional Information Contact (631) 444-4000

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