Male Infertility Evaluation and Treatment

by Alex Shteynshlyuger MD

If you have any questions, to schedule a consultation, please contact us or call/text: 1-212-204-6300.

We have excellent reviews from patients and their partners.  Information for out-of-state and international patients.  Find out our office hours or directions to our office. 

We offer affordable appointment prices with or without insurance.  Same-day virtual video appointments and in-person appointments are available.

Infertility in Men: What You Need to Know

Infertility refers to the inability to conceive or to get the female partner pregnant.  Pregnancies are complex events that require the coordination of male and female reproductive systems.

Among couples that experience difficulty with fertility, about 40% experience these problems because of female reproductive difficulties, and about 20-30% of couples experienced difficulty getting pregnant because of male reproductive difficulties.  In many couples, both male and female reproductive systems contribute to infertility or difficulty with conceiving a child.

In general, a couple is considered infertile if they cannot 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 the 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 who cannot achieve pregnancy after one year of trying should have a thorough infertility evaluation.

As a general rule, both male and female partners should be evaluated when a couple faces infertility.

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 separated by distance do not achieve pregnancy because of infrequent sex, it is still advisable to evaluate couples who live apart, as prolonged waiting will 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, 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 a 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 a history of infertility in a previous relationship, early testing is advisable to determine if partners have infertility problems.  Early diagnosis will allow the issue to be addressed if present promptly.

Prompt evaluation for infertility is important because infertility potential decreases exponentially in women around age 35 every year.

Male partners who are older than age 45-50 may also need to have a urological evaluation, especially if the volume of ejaculation is low, which may suggest BPH.  Men who are taking medications for enlarged prostate, hair loss, or testosterone supplements require evaluation. These medications can affect fertility and may need to be stopped before attempting pregnancy.

Special Situation: History of Testosterone Use or Steroid Use for Bodybuilding

The use of testosterone or testosterone analogs used for bodybuilding can lead to severe infertility.  Men with a history of steroid use are advised to get evaluated for fertility as soon as possible so that treatment can start promptly.

Causes Of Male Infertility

Male infertility is caused by contributions from multiple factors.  Sperm health depends on the microenvironment within the testicle, including scrotal temperature, blood flow, hormonal factors, good nutrition, and genetic factors.

In general, testicular maturation and development are impaired when the testes are exposed to higher-than-normal temperatures.  Normally, the temperature within the 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 saunas, 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 have an infection.  Febrile infections also impair fertility for 3-6 months.

Adequate nutrition and intake of proper nutrients also affect 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
• Varicoceles
• 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
• Unejaculation
• BPH
• Smoking, tobacco, marijuana use

Evaluation of Men for Infertility

Infertility evaluation and management involve taking a detailed history, checking vital signs, including blood pressure, a 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 two different occasions a few weeks apart to get a good idea of semen quality.  There is some variability with each ejaculation.  For this reason, two semen analyses are desirable.  For best results, it is advisable to abstain from sex and ejaculation for 2-3 days before semen analysis to produce an adequately large sample of semen. Semen should be evaluated within 1 hour of ejaculation by an experienced cytopathologist.

The 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, and the presence or absence of inflammatory cells.

What We Treat:

• Male Subfertility
• Obstructive Azoospermia
• Non-obstructive Azoospermia
• Oligospermia
• 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
• TESA (Testicular Sperm Aspiration)
• Testicular Mapping
• Other treatment options are available on an as-needed basis by individual patients\
• IVF / ICSI (in conjunction with reproductive endocrinologists)
• Vasectomy reversal

Did you know? Dr. Shteynshlyuger has performed over 1,000 penile, scrotal, testicular, kidney, bladder, and prostate surgeries, including testicular implants, hydrocelectomy, varicocelectomy, scrotoplasty, circumcisions, circumcision revisions, frenuloplasty, penile implants, Urolift, prostate enucleation, correction of Peyronie’s disease, and congenital penile curvature.  He performs 150-200 penile surgeries a year.

Where to Get Male Infertility Treatment in NYC?

At New York Urology Specialists, we offer treatment for male-factor infertility.  Same-day virtual video appointments and in-person appointments are available.

Call/text today: 1-212-204-6300 or make an appointment online.  

We perform penile procedures, varicocele and hydrocele repair, vasectomy reversal, and cosmetic circumcision.  We offer treatment for missing testis, low testosterone, low sperm count, testicular pain, premature ejaculation, and male infertility. We treat sexual and erection problems and offer comprehensive STD testing for infections. We offer confidential appointments.

Our appointment costs are affordable with or without insurance.  We offer free insurance verification.

We perform testicular ultrasound examinations in our office.  We offer testosterone replacement therapy, vasectomy, Urolift procedure, Rezum water-vapor procedure in our office.   We treat urinary and erection problems. We offer confidential appointments.

Cost of Male Infertility Treatment without Insurance

At New York Urology Specialists, we offer affordable treatment for men. Our prices are low for patients without insurance and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs. 

At New York Urology Specialists, we offer flat-fee, ‘all-costs-included’ procedures such as scrotal and testicular surgery, circumcision, no-scalpel vasectomy, testicular implant, vasectomy reversal, hydrocelectomy, varicocelectomy, and many more.  The procedures are performed in our office under local anesthesia or sedation. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment.  Please contact us for current prices and discounts for patients without insurance or with high insurance deductibles.

Cost of Treatment and Insurance

At New York Urology Specialists, we offer affordable treatment for men. Our prices are low for patients without insurance and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs. 

We accept many health insurance plans.  We would be happy to verify your eligibility and benefits and provide you with detailed information on your health plan’s coverage.  Financing options and credit options are available to help you pay for medical care.

Why Choose New York Urology Specialists for Male Infertility Evaluation and Treatment?

• All treatment is performed by a board-certified urologist experienced in treating men with male infertility, low sperm count, and idiopathic male infertility.  We treat symptoms of erectile dysfunction, low testosterone, scrotal and testicular problems, premature ejaculation, testicular pain, and urinary problems using medical therapy, minimally invasive therapies, lasers, and surgery.  
• We are one of the few practices in the region to offer a full range of options for the treatment of sexual, urinary, and erection problems in men.
• 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.
• Freedom to Choose Reproductive Endocrinologists – As an independent practice, you’re not forced to use a reproductive endocrinologist for the female partner that works with us.  You are free to choose a reproductive endocrinologist of your choosing.
• We offer treatment options for testicular pain, penile problems, male infertility, Peyronie’s disease, prostatitis, enlarged prostate, frequent urination, overactive bladder, and prostate cancer in our office.  Office procedures avoid the risks, costs, and recovery from general anesthesia.  
• We offer diagnostic testing in our office, which avoids hospital costs.
• Extensive experience: Thousands of men have been treated successfully with varicocelectomy, hydrocelectomy, testicular implants, orchiectomy, epididymal cyst removal, scrotoplasty, circumcision, penoscrotal web correction, spermatic cord denervation.
• 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.
• We are conveniently located within a 30-60 minute commute to men who are seeking treatment for scrotal swelling, testicular and penile problems, erectile dysfunction, enlarged prostate, urinary, and cancer treatment in Manhattan, Brooklyn, Queens, Staten Island, Westchester, Long Island, Bronx, and New Jersey.

What do Testicular Problems Look Like?

You can find pictures of testicular problems as well as before and after treatment images in our image gallery.

Scheduling Appointments for Treatment of Infertility in Men at New York Urology Specialists

If you have any questions, to schedule a consultation, please contact us or call/text: 1-212-204-6300.

We have excellent reviews from patients and their partners.  Information for out-of-state and international patients.  Find out our office hours or directions to our office. 

We offer affordable appointment prices with or without insurance.  Same-day virtual video appointments and in-person appointments are available.

Dr. Shteynshlyuger MD is a board-certified urologist in NYC who specializes in treating sexual, testicular, hormonal, urinary, and sexual problems in men.   He has performed hundreds of penile and testicular surgeries, including testicular implants, penile implants, varicocelectomy, hydrocelectomy, adult circumcision, circumcision revision, vasectomy, surgery for enlarged prostate, and many other procedures.  

Treatment for Men With Fast Recovery at New York Urology Specialists

At New York Urology Specialists, our urologists are specially trained in evaluating and treating men’s health concerns, including infertility and low sperm problems, sexual problems, and urinary problems in men.  We understand the challenges that penile problems and testicular problems create for our patients, their relationships, and their self-esteem.  We help you find a treatment for penile problems and testicular problems, including appearance concerns, foreskin problems, premature ejaculation, testicular pain, and erectile dysfunction that fit your needs, lifestyle, and preferences.

Urologists are doctors specializing in treating men with sexual problems that include penis problems, scrotal problems, and erectile dysfunction. By virtue of our experience and skill, we can offer an effective treatment option for nearly every man who desires an effective treatment for any problem that affects the penis.  We offer medical and surgical treatment for men’s sexual problems.

We Treat Some of the Most Complex Men’s Health Problems Including:

• Erectile dysfunction in men for whom oral pills do not work.
• Enlarged prostate
• Penile skin adhesions 
• Phimosis Treatment
• Penile Pain During Sex
• Impotence in men with diabetes.
• Vasectomy
• Premature Ejaculation
• Prostate Cancer.
• Infertility and low sperm count
• Peyronie’s Disease
• Burning during urination
• Premature Ejaculation
• Frequent urination
• Urinary retention

If you have any questions, to schedule a consultation, please contact us or call/text: 1-212-204-6300.

We have excellent reviews from patients and their partners.  Information for out-of-state and international patients.  Find out our office hours or directions to our office. 

We offer affordable appointment prices with or without insurance.  Same-day virtual video appointments and in-person appointments are available.

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