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Treatment for Male Infertility



Treatments for Male Infertility


The trauma of infertility afflicts approximately 4.5 million couples in the US today. One in ten couples who are trying to have a baby cannot conceive.


Fortunately, couples can improve their chances for conception if they are evaluated and treated appropriately by a urologist and a gynecologist.


When a couple has difficulty conceiving a child, many people assume that the problem is due to a female factor.  This misconception may be rooted in the fact that fertilization and fetal development occur within the female reproductive tract.  However, in 50% of all infertility cases, male factors account for or contribute to the problem.  Therefore it is paramount that if a couple is having difficulty becoming pregnant, both the man and the woman visit the doctor.


An evaluation for male infertility begins with a directed history and physical.  The urologist should ask about your past history of non-descended testicles, hernia, mumps, testicular or venereal disease, tobacco, alcohol, and medication use, and other potential factors. He should also examine your body, hair distribution, and external genitalia.


If the cause of infertility appears to be lifestyle-related, your doctor may recommend that you make some basic changes to your daily habits. For instance, if you smoke or drink, he will advise you to stop these behaviors.  He may also counsel you to take a nutritional supplement if he feels that you are not getting the vitamins and minerals that your body needs to function effectively. Zinc, for example, is crucial to sperm development and motility (movement), yet many American men do not absorb adequate levels of this mineral through diet alone.


In addition, the doctor may conduct laboratory tests including semen analysis and hormone studies. Abnormal sperm count, shape, or motility can all decrease fertility. Blood hormone levels of LH, FSH, and testosterone also indicate whether or not the body is functioning properly.


Varicoceole, an enlarged testicular vein, is the most common and most treatable cause of decreased fertility. Normally, blood drains away from the testicle via the testicular vein to the renal (kidney) vein. Forty percent of sub-fertile men suffer from varicoceole, engorgement and impaired drainage through this vein. Most urologists believe that the engorged vein interferes with testicular temperature regulation.  This causes a decrease in sperm motility and concentration, and results in abnormal shape.  A surgical procedure improves semen quality in 71% of cases and results in a 40-60% pregnancy rate after one year.


Another cause of infertility is obstruction of the tubes, called ejaculatory ducts, which drain the testicle to the prostate. Complete obstruction of these ducts results in total lack of sperm in the semen. Partial obstruction causes low sperm count, decreased volume, and impaired motility.  The urologist can resect the junction of the prostate and the ducts to restore fertility in many cases.


In my opinion, the most exciting work on infertility is in the arena of assisted reproductive technologies. Sperm from the man is washed, concentrated, and placed in the womb by artificial insemination. With in vitro fertilization, doctors fertilize harvested eggs from the woman's womb and sperm from the man in a test tube. The fertilized egg is then implanted in the womb. The pregnancy rate with this procedure is 20%.  Finally, fertilization of the harvested egg can be further enhanced by inserting the sperm directly into the egg cell, thereby increasing the chances of conception.  All of these procedures can prove quite expensive, however. 


Many men are infertile because they chose to be. In a procedure called a vasectomy, a form of birth control, the doctor severs the tube that delivers sperm to the semen so that the man can no longer impregnate a woman. The good news for men who now want to become fathers is that this procedure can be reversed. Urologists can use a microscope and reconnect the divided ends of the tube (vasovasotomy). The return of fertility rate is good as long as the repair is done within five years of the initial procedure. Unfortunately, the success rate drops dramatically after five years


Semenex, which boosts semen volume, has been known to increase fertility in men who ejaculate low quantities of semen.




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