Treatment Options for Male Infertility
Two Types of Male Infertility
The key to treatment of male infertility is a thorough diagnostic investigation to pinpoint the exact cause of infertility.
In general, male infertility can be conceptually broken down into two categories, (1) obstructive, and (2) nonobstructive causes.
Obstructive Causes of Male Infertility
In general obstructive causes of male infertility are more amenable to treatment as relief of obstruction will usually lead to the restoration of fertility. Common causes of obstruction of the reproductive tract in males include prior vasectomy, prior scrotal or inguinal surgery such as inguinal hernia repair, hydrocelectomy, and varicocelectomy.
In men with nonobstructive causes of infertility evaluation is more involved as the causes are more varied. Causes can range from anatomical and hormonal problems to genetic and autoimmune disorders.
In general, whenever possible fixing the underlying problem is the preferred approach to treating male infertility. In men with varicoceles, we usually perform microscopic varicocelectomy. In men with a history of vasectomy, we will consider performing bilateral vasectomy reversal.
However other factors need to be taken into consideration. It can take many months after surgical correction of the underlying problem for good-quality sperm to appear in the ejaculate. In couples where timing is important, in particular, if the woman is close to age 35 or older, a different approach with testicular sperm retrieval (TESA, TESE, microTESE) and in vitro fertilization (IVF) may be more appropriate. Likewise, if the female partner has fertility problems of her own, in vitro fertilization may be a better option for some couples with combined infertility.
Varicocele is a common cause of male infertility. Usually, varicoceles result in suboptimal quality of sperm. Semen analysis typically shows the presence of sperm but impaired morphology and decreased sperm count. Men with scrotal varicoceles that contribute to infertility can be treated with microscopic varicocelectomy which offers good success rates in improving semen quality in men with varicoceles and infertility. Usually, it takes about 6 months to see improvement in semen quality after microscopic varicocelectomy. It is important to recognize that not all men with varicoceles will have problems with fertility. In fact, only a small minority of men with varicoceles will experience any problem with fertility. Most men with scrotal varicoceles are able to have children without any problems.
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.
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.