Specialists in Evaluation and Treatment of Male Infertility in New York City
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What Is Infertility?
Infertility refers to the inability to conceive or to get the female partner pregnant. Pregnancies are complex events that require coordination of male and female reproductive systems.
Among couples that experience difficulty with fertility, about 40% experience these problems because of the female reproductive difficulties, about 20-30% of couples experienced difficulty getting pregnant because of the male reproductive difficulties. In many couples a contribution of both male and female reproductive systems leads to infertility or difficulty with conceiving a child.
In general, a couple is considered to be in infertile if they are unable to become pregnant within 1 year of trying. In this situation, we consider that a couple is trying to conceive if they have unprotected vaginal intercourse with fair regularity over a course of 1 year. More than 90% of couples will conceive spontaneously within 1 year of trying. In fact, many couples will conceive within the first 3 months. Any couple that is unable to achieve pregnancy after one year of trying should have a thorough infertility evaluation.
As a general rule, when a couple faces infertility, both male and female partners should be evaluated.
Special Situations: Couples Living Apart / Distance Relationships
The situation becomes a bit more complex in couples who do not live together for one reason or another (work/family issues/military service, visa or immigration problems, etc) and as a result have sexual intercourse only infrequently. While many couples that are separated by distance do not achieve pregnancy because of infrequent sex, it is still advisable to evaluate couples that live apart as prolonged waiting will only make the situation worse if one of the partners has suboptimal fertility. As time goes on and you get older, pregnancy becomes increasingly difficult – therefore it is prudent to get evaluated for possible infertility early on especially if you live afar which precludes frequent sexual activity.
Special Situations: Female Partner Close or Older than 35 Years Old
Because the inability to conceive decreases exponentially in women over age 35, if the female partner is close or over age 35, usually infertility evaluation is recommended as soon as the couple decides to have children or after unprotected sex for 3-6 months with no pregnancy. In couples with female partner close to age 35 or older, evaluation is reasonable after 3-6 months of trying to achieve spontaneous pregnancy through sexual intercourse.
Special Situations: Infertility History with a Prior Partner
In couples who have history of infertility in a previous relationship, early testing is advisable to determine if you have infertility problems so that they can be addressed if present.
Prompt evaluation for infertility is important because infertility potential decreases exponentially in women around age 35 with every year.
Male partners who are older than age 45-50 may also need to have urological evaluation especially if the volume of ejaculate is low, which may suggest BPH. Men who are taking medications for enlarged prostate, hair loss or testosterone supplements require evaluation as these medications can affect fertility and may need to be stopped prior to attempting pregnancy.
Causes Of Male Infertility
Male infertility is caused by contributions from multiple factors. Sperm health is dependent on the micro-environment within the testicle including scrotal temperature, blood flow, hormonal factors, good nutrition as well as genetic factors.
In general, testicular maturation and development is impaired when the testes are exposed to higher than normal temperature. Normally, the temperature within testis is about 2° lower than the rest of the body. In men whose testis are exposed to heat such as cooks, workers in metallurgic factories, and men who frequent sauna, testicular maturation may be impaired. Similarly men with large varicoceles may have impaired sperm quality.
Inflammation is known to decrease fertility as well, as evidenced by decreased sperm quality in men who had infection. Febrile infections also impair fertility for 3-6 months.
Adequate nutrition and intake of proper nutrients also affects sperm quality. In fact, studies have shown that sperm quality can be improved by supplemental nutrients and vitamins.
Common Causes of Male Infertility:
- Exposure to Heat
- Hormonal problems
- Prior surgery (hernia, varicocele repair, hydrocelectomy, epididymectomy, orchiectomy, prostatectomy, TURP, Greenlight laser of the prostate)
- Neurological problems
- Obstructive azoospermia
- Non-obstructive azoospermia
- Y chromosome microdeletion
- Ejaculatory problems
- Retrograde ejaculation
Evaluation of Men for Infertility
Infertility evaluation and management involves taking a detailed history, checking vital signs including blood pressure, physical exam to look for vas deferens, testicular volume and any prostate abnormalities. Blood tests typically performed as part of the initial evaluation include testosterone levels, thyroid levels, kidney function tests and blood counts. Semen analysis is performed.
Semen analysis: The key to Infertility Evaluation in Men.
Typically semen analysis is performed on 2 different occasions preferably a few weeks apart to get a good idea of semen quality. There is some variability with each ejaculation. For this reason, 2 semen analyses are desirable. For best results, it is advisable to abstain from ejaculation for 2-3 days before semen analysis in order to produce an adequately large sample of semen. Semen should be evaluated within 1 hour of ejaculation by an experienced cytopathologist.
Most common abnormalities are low semen volume and low sperm count.
While total semen volume and sperm count are important, other less commonly recognized characteristics, are just as important such as sperm motility, percent normal sperm as well as presence or absence of inflammatory cells.
What We Treat:
- Male Subfertility
- Obstructive Azoospermia
- Non-obstructive Azoospermia
- Scrotal Varicoceles (cause of abnormal sperm counts and quality in some men)
Treatment Options for Infertility Offered at New York Urology Specialists:
- Infertility Evaluation including semen analysis
- Genetic evaluation and testing
- Microscopic varicocelectomy (varicocele repair).
- Testicular Biopsy
- TESE / MicroTESE
- Testicular Mapping
- Other treatment options are available on as needed basis by individual patients\
- IVF / ICSI (in conjunction with reproductive endocrinologists)
- Vasectomy reversal
Why Choose New York Urology Specialists for Your Infertility Evaluation and Treatment:
1. Experience – we see and treat many infertile men and couples. You are treated by board certified urologists who are up-to-date on the latest advances in the field.
2. Freedom to Choose Reproductive Endocrinologists – As an independent practice, you’re not forced to use reproductive endocrinologist for the female partner that work with us. You are free to choose a reproductive endocrinologist of your choosing.
3. Confidential and Understanding Care. We understand that most of our patients desire privacy. We see patients with a variety of urological problems. Your reason for visiting us is entirely confidential.
Dr. Alex Shteynshlyuger is a board certified urologist in NYC. He specializes in sexual and reproductive issues that affect men. He helps men with infertility to achieve pregnancy. He is a specialist in interpreting semen analysis in men with infertility. He performs testicular biopsy, MicroTESE, TESA, as well as varicocele repair.
We see patients from all parts of New York City (Manhattan, Brooklyn, Queens, Bronx, Staten Island), Long Island, Westchester and New Jersey as well as other parts of the USA. We also see international patients from Canada, Japan, South America, Russia, Asia, Europe, Middle East, Africa, the Caribbean and other parts of the world.