Prolonged use of marijuana, or other recreational drugs and chronic alcohol abuse
Anabolic steroid use
Overly intense exercise
Inadequate vitamin C and Zinc in the diet
Exposure to toxins such as pesticides, lead, paint, radiation, mercury, benzene, boron, and heavy metals
Malnutrition and anemia
Varicocele - an enlargement of the spermatic veins, varicoceles are present in 40% of infertile men
Damaged sperm ducts
Torsion - The supportive tissue twists inside the scrotum.
Infection and Disease - Mumps, TB, brucellosis, gonorrhea, typhoid, and syphilis
Kleinfelter's Syndrome - A genetic condition in which men have an extra X chromosome
Retrograde Ejaculation - Semen is ejaculated into the bladder rather than through the urethra because the bladder sphincter does not close during ejaculation
HOPE FOR INFERTILE COUPLES
Approximately 15-20% of couples have difficulty initiating a pregnancy. These numbers are increasing as couples defer parenthood until later in life. While much emphasis is placed on the evaluation and treatment of the female partner, male factors impact fertility in 50% of infertile couples.
Early evaluation of the man allows timely treatment and limits the necessity for expensive testing of his partner. This also permits any serious underlying disorders to be detected and treated appropriately. Treatments focus on improving the quality of sperm, and may be as easy as avoiding certain environmental exposures or optimizing the timing of intercourse.
Most subfertile men can be helped after proper evaluation with a male infertility specialists. Even men with no sperm in the ejaculate can often initiate a pregnancy.
WHY DO I NEED AN INFERTILITY SPECIALIST?
While most urologists receive some instruction concerning the evaluation of subfertile men, the vast majority of urology training programs do not emphasize infertility in their curriculum. In addition, the micro-surgical skills necessary to treat many urological conditions associated with infertility require intensive and meticulous training. For this reason several male infertility fellowships have been established around the country. Candidates who are accepted into these programs receive an additional year or two of specific training in the evaluation and treatment of subfertile men. Our specialists have had comprehensive training in male infertility and microsurgery.
HOW WILL I BE EVALUATED?
Upon making an appointment, you will receive an information packet and detailed questionnaire. Answering the questionnaire helps direct your office evaluation. Men are encouraged to bring their partners with them to their appointment. This facilitates the evaluation and permits any female fertility factors to be addressed. Once history and physical examination are complete, a semen sample is often requested. Men who have had recent, properly performed semen analysis may not need to supply another sample. The initial appointment usually takes about one hour. Further evaluation, often with hormonal or genetic testing, is then initiated as indicated.
The semen analysis is the cornerstone of male infertility evaluation. While it only takes one sperm to fertilize an egg, millions of sperm are necessary for proper sperm functioning. Semen samples can vary extensively from one time to another. To accurately assess the quality of semen, at least two samples separated by several weeks are required. A properly performed semen analysis requires special equipment and technical expertise. Most laboratories do not own this equipment or may not employ appropriately trained technologists. Our laboratory technologist has years of experience in semen analysis and sperm processing techniques. Our lab is certified with CLIA as a high performance laboratory facility. To make an appointment for semen analysis, please contact us.
LOW SPERM COUNTS
Many subfertile men have low sperm counts. Sometimes this is only transient or an artifact due to improper semen analysis. When low counts (called oligospermia) are truly present, they are often associated with dilated veins in the scrotum, called varicoceles. Varicoceles are present in about 30% of all men undergoing infertility evaluations. Varicoceles appear to impair sperm production and function by increasing the temperature of the testicles. The vast majority of well-performed studies have demonstrated significant improvement in the semen quality and pregnancy rates after varicocele repair. Varicocele repair is performed as an outpatient procedure. While there are many methods of varicocele repair, Dr.Daitch utilizes the microsurgical technique. This technique has a better success rate and lower complication rate than the standard techniques for varicocele repair. In addition, it is performed through a one to two inch incision and there is no need to cut across muscle. This allows much quicker recovery and less post-procedural discomfort.
Low sperm counts can also be caused by subtle hormonal abnormalities or environmental exposures such as medications, tobacco, pesticides or solvents. Identification of these abnormalities/exposures and proper treatment can help to improve sperm counts.
Finally, very low sperm counts may be due to underlying subtle genetic abnormalities. Accurate diagnosis is made with genetic testing from cells obtained with a swab of the inner cheek. These men often require advanced techniques such as in vitro fertilization (IVF or test tube baby) to father children. However, with proper testing and administration, the success rates and risks of passing any genetic abnormalities to their offspring can be determined.
LOW SPERM MOTILITY
Decreased sperm motility (asthenospermia), or the ability of sperm to move spontaneously, is common. As is the case with low sperm counts, low motility is often a transient phenomena, or due to an improperly performed semen analysis. However, among men with true low motility, many will have dilated veins in the scrotum called varicoceles. Please refer to the Low Sperm Count section for more information about varicoceles.
Low motility can also be due to various environmental exposures such as tobacco, pesticides and solvents. Sometimes, antisperm antibodies cause low motility. Antibodies normally fight infection in the body, however, in some men these antibodies attach their own sperm. If this is suspected, special testing for antibodies is performed. When sperm counts are normal, the antibodies can be washed off the sperm and the sperm used to inseminate their partners.
Finally, white blood cells in the semen can impair motility. Like antibodies, white blood cells usually fight infection. When they are in the semen, however, they often damage sperm. Treatment can be as simple as a course of antibiotics.
NO SPERM COUNT
The most common cause of semen containing no sperm is a vasectomy. Vasectomies can be reversed with very high success rates. For more information, please see the "Vasectomy Reversal" section.
About 10% of all infertile men have no sperm in the semen. Many of these men have normally functioning testicles, but the ducts which transport the sperm from the testicle are blocked. Using microsurgical techniques these ducts can be unblocked and couples can then have children naturally.
Occasionally, men are born with healthy testicles, but without the ducts that transport sperm from the testicles. This is diagnosed on physical examination. For such men, hormonal and genetic testing is usually performed to rule out any underlying abnormalities. Then, sperm can be obtained from the testicles with a minimally invasive procedure performed in the office. The sperm are then used together with in vitro fertilization techniques (test-tube baby) to obtain a pregnancy.
Men with no sperm in their semen who do not have a blockage require hormonal testing. Occasionally, hormone replacement will return sperm to the semen. Other men simply do not make enough sperm to reach the semen. Genetic testing can reveal any underlying causes. Even though these men have no sperm in their semen, with careful microscopic testicular dissection, small islands of sperm can often be found. These sperm are then used together with in vitro fertilization techniques to obtain a pregnancy.
Arizona Urology Specialists — Locations
Glendale5750 W. Thunderbird Rd. Suite B-200 | Glendale, AZ 85306 602.222.1900More Info
Glendale — Arrowhead6320 W. Union Hills Drive Suite B-2600 | Glendale, AZ 85308 602.222.1900More Info
Glendale — Peoria7747 W. Deer Valley Rd. Suite 235 | Peoria, AZ 85382 602.222.1900More Info
Phoenix — Deer Valley19841 N 27th Ave. Suite 201 | Phoenix, AZ 85027 602.222.1900More Info
Phoenix — Downtown1313 East Osborn Rd. Suite B150 | Phoenix, AZ 85014 602.222.1900More Info
Scottsdale — 92nd Street10301 North 92nd Street Suite 101 | Scottsdale, AZ 85258 602.222.1900More Info
Scottsdale — Grayhawk20401 N. 73rd St. Suite 105 | Scottsdale, AZ 85255 602.222.1900More Info
Scottsdale — South3501 N Scottsdale Rd. Suite 250 | Scottsdale, AZ 85251 602.222.1900More Info
Mesa5058 E Southern Ave. Suite 102 | Mesa, AZ 85206 602.222.1900More Info
Fountain Hills16838 East Palisades Blvd. Bldg C | Fountain Hills, AZ 85268 602.222.1900More Info
Arizona Prostate Cancer Center20601 North 19th Ave. Suite 115 | Phoenix, AZ 85027 602.557.0055More Info