Common causes

The cause of infertility in men is often related to the number of sperm produced, the ability of the sperm to swim the right way, or for the sperm to reach your partner’s egg. Some medical diseases, genetic conditions, medications, or lubricants used during sex may cause fertility problems. Exposure of the testicles to enlarged veins in the scrotum, heat from hot-tubs, or other exposures (radiation, chemotherapy, drugs) can also change the number and function of sperm.

Diagnosis

A man being seen for fertility evaluation will be asked to produce a semen sample for analysis. This test is performed to check how many sperm are present and how healthy they are. Blood tests may be ordered to check for infections, hormone levels, and other disease processes. Ultrasound of the testes may be performed to evaluate this area and surrounding structures. Based on these results, further testing may be ordered.

First steps

The first test in evaluation of a man’s fertility potential is to produce a semen sample for analysis. General recommendations for couples trying to achieve pregnancy may include changing the lubricants you use during sex, how often you have sex, or the timing of sex. You will be asked to stop smoking, using any illicit drugs, or abusing of alcohol.

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Microsurgical Varicocele Ligation: correction of enlarged veins in the scrotum that raise the temperature of the testicles, affecting fertility.

Microsurgical Vasectomy Reversal: Utilizing a surgical microscope, the urologist removes the blockage created by a prior vasectomy and reconnects the two severed ends of the vas deferens (vaso-vasostomy) or connects the end of the vas to the epididymis (vasoepididymostomy). Success rates of vasectomy reversal vary, so it is important that you and your urologist discuss expectations.

Microdissection Testicular Exploration and Sperm Extraction (micro-TESE): sperm is retrieved directly from the testicle. The sperm is cryopreserved (sperm banked) for future use. Sperm retrieved via Micro-TESE can be used only for In Vitro Fertilization (IVF).

Microsurgical Epididymal Sperm Aspiration (MESA): retrieval of sperm from the duct that connects the testicles to the vas deferens. The sperm is sperm banked to be used for In Vitro Fertilization (IVF).

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