Male Infertility
Approximately 15% of couples suffer from infertility, defined as the inability to conceive through unprotected intercourse for one year. In the past, couples were advised not to seek an infertility evaluation unless they had been practicing regular unprotected intercourse for at least one year. However, evaluation of the infertile couple, is recommended at the time of presentation despite less than one year of unprotected intercourse, as many couples delay starting a family resulting in advanced female age and the presence of known or unknown male infertility risk factors, such as hernia surgery, infection of the prostate and/or epididymis, testicular trauma, among others. Approximately 20% of infertility is caused by exclusive male-factor, and another 30-40% is due to both male and female factors. Therefore, at least 50% of the time, a male factor is contributing to the couple’s infertility. Based on this, as well as, significant medical conditions and genetic abnormalities that have been shown to be diagnosed during infertility evaluations, the state-of-the-art management of a couple’s infertility is simultaneous evaluation of the male and female partners.
The goal of the male infertility evaluation is to identify any and all factors that may be compromising a man’s full fertility potential. This is only possible through a complete history and physical examination of the male, as well as pertinent fertility assessment of the female partner.
The couple is typically seen together in the office. The evaluation is initially focused on the female partner, capturing pertinent history details, including female age, past and present pregnancy and delivery history, recent assessment of ovulatory function, ovarian reserve status, documentation of anatomic abnormalities, history of endometriosis, and pelvic inflammatory diseases.
The specifics of the couple’s sexual history are critical to make a fair assessment of the actual time interval devoted to timed-intercourse. Directed questions include the length of time the couple has practiced unprotected intercourse, coital frequency and timing, and the use of any lubricants. Any difficulties with libido, erection, and effective ejaculation are addressed. If the patient has previously established a spontaneous pregnancy, it is important to determine if any changes in the man’s history has occurred since that conception, such as, recent hospitalizations, trauma, surgery, infections, and use of new medications.
A developmental history is taken to determine if normal puberty was achieved. A thorough medical and surgical history is attained to identify conditions or risk factors that may contribute to the couple’s infertility. This assessment includes documentation of any gonadotoxin exposure within the previous 3 months. For example, if a patient has a history of cancer, past and present exposure to radiation and/or chemotherapy and time since treatment is questioned. It is critical to not only obtain a present prescription medication list, but also determine use of any over-the-counter substances, energy supplements, testosterone “boosters,” and herbal remedies. Occasionally, young men utilize anabolic steroids as performance enhancers for bodybuilding and other sports. These substances cause increased circulating testosterone, resulting in an imbalance in hormone levels and actually suppress sperm production. These men may have increased muscle bulk; but may have small testicles and no sperm in their ejaculate. Similarly, older men with a history of testosterone therapy for fatigue and a slightly low total testosterone level have compromised sperm production due to the identical mechanism described for anabolic steroid use. Occupational exposures such as lead and certain agricultural pesticides have been linked to decreased sperm production. Other potential gonadotoxic exposures include nicotine, alcohol, and marijuana. The history includes any allergies to medications, a review of systems, and family history of genetic diseases, such as cystic fibrosis.
In summary, the goal of the male infertility evaluation is the identification of any and all factors that may be compromising a man’s full fertility potential. What is necessary to accomplish this goal is a complete and thorough history and physical examination with at least 2 properly collected and performed semen analyses.
The state-of-the-art treatment for infertility is couple-directed, with simultaneous evaluations of both males and female partners.
Document Checklist
The success of vasectomy reversal depends upon the years since you have had your vasectomy. However, even men who have had their vasectomies over 20 years ago may be candidates for successful reversal.
Insurance coverage for vasectomy reversals depends upon your type of plan. Our office will work with you to determine if your particular insurance plan covers this procedure.
Yes. Studies show that even after a failed vasectomy reversal, it is still cost effective to perform another reversal operation. The first procedure may not have been performed microsurgically or by a fellowship-trained expert.
Typically, there is minimal discomfort following the surgery. Most patients require only non-narcotic pain medication after the procedure.
Most men require 5-10 days off work after the procedure.
It is important to choose a urologist who has completed additional fellowship training and has expertise in microsurgery.
