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Male Infertility

The North Texas Center for Male Infertility

Infertility has traditionally been defined as 'failure to conceive after one year of unprotected intercourse'. Statistics show that a male infertility factor is involved in nearly half of all infertility cases, sometimes exclusively, sometimes as a contributing factor. There are, however, a variety of treatment options and advanced reproductive technologies available to couples who wish to have a child but for some medical reason, cannot.

Here at USMD|UANT, the subspecialty of male infertility is dedicated to the medical and surgical treatment of abnormalities of male fertility and spermatogenesis, with the goal of helping a couple conceive a child in as natural a way as possible. Our program is led by one of the elite fellowship trained male infertility specialists in North Texas, Weber W. Chuang, M.D.

"Our goal," says Dr. Chuang, "is to help a couple experiencing infertility to achieve a pregnancy as naturally as possible. The first step is an evaluation of the male partner to identify the possible male factors involved." This evaluation begins with a thorough medical history and physical examination, to reveal possible causes of infertility, such as a hernia repair, trauma, or a urinary tract infection. In addition, extensive laboratory tests are conducted, including a reproductive hormone profile and at least two semen analyses, with advanced sperm tests such as an antisperm antibody assay, a white blood cell count and strict morphology.

Conditions contributing to infertility:



Varicocele

A varicocele is defined as a dilation of the veins that drain the testicle. It is present in about 15% of the general population but is diagnosed in 40% of the men who are evaluated for infertility.

A varicocele develops when valves in the internal spermatic veins fail, allowing blood to flow back towards the testicle from the abdomen. A varicocele, it is believed, can impede the development of normal sperm by elevating testicular temperature, causing abnormal concentrations of adrenal and renal substances, increasing metabolic waste products, or reducing the availability of oxygen and nutrients.

Fortunately, the varicocele is one of the most treatable causes of male infertility. A microsurgical repair, involving meticulous ligation of the dilated vessels under microscopic visualization and doppler guidance, can improve semen parameters and pregnancy rates.



Hypogonadism

Low levels of testosterone (the male hormone) can lead to symptoms of low energy, low libido, and poor erections.. Testosterone replacement can relieve those symptoms and is available in many forms, including intramuscular injections as well as more convenient daily gels or patches. While under treatment, the patient should be monitored closely with regular blood work and physical exams. While treatment may increase libido and, subsequently, the frequency of intercourse, men with low testosterone who are trying to have children should not receive testosterone replacement as doing so may actually reduce their sperm counts significantly. Other forms of treatment to help these men maintain their testosterone levels, while improving their sperm counts, are available and should be used instead.



Azoospermia

Azoospermia is defined as the absence of sperm in the ejaculate (azoospermia). In some instances, the reproductive ducts may be absent or blocked; this condition is referred to as obstructive azoospermia or OA. In other individuals with normal anatomy, where there is no sperm production, the condition is called non-obstructive azoospermia or NOA.

The diagnosis of no sperm in the ejaculate should be thoroughly investigated with a complete physical exam and a battery of tests including hormone and possibly genetic evaluation, as well as radiological studies, such as scrotal, renal, and transrectal ultrasound. Ultimately, a testicular biopsy may be performed, with the goal of determining the cause of azospermia, and if necessary and/or possible, of retrieving sperm for use in assisted reproductive techniques.



Vasectomy Reversal

Vasectomy reversal is a procedure in which reconstructive sperm duct microsurgery is employed with the goal of returning sperm to the ejaculate. Two procedures may be performed in a vasectomy reversal: a straight-forward reversal called a vasovasostomy (VV) or procedure that involves connecting the vas deferens to the ducts closer to the testicle (epididymis) called an epididymovasostomy (EV). The choice of procedure is dependent upon the nature and length of time of the obstruction, the quality of the testis, and the quality of the intravasal fluid. The process begins with a patient history and physical examination, which will provide some indication of the required procedure; however, the determining information is provided by an examination of the vasal fluid. Success of the vasectomy reversal depends on several factors including the required procedure (vasovasostomy vs. epididymovasostomy), the length of time of the obstruction, as well as the post-operative healing.

Operating time for a vasovasostomy or epididymovasostomy is approximately 4 to 5 hours under a general anesthetic. Postoperative care includes an evaluation of wound healing at 2 weeks and a first semen analysis at 6 weeks. Semen analyses are then obtained at 2 month intervals until the semen analysis stabilizes or pregnancy is achieved. Routine follow up semen testing and visits will provide the best success rates.

In addition, sperm can be retrieved during the procedure and through cryopreservation, frozen for future use should the procedure not lead to pregnancy.



Advanced Reproductive Techniques

Although there are numerous factors that can contribute to the problem of infertility, reproductive medicine continues to meet each obstacle to conception with a solution that improves the odds of conception. As Dr. Chuang notes, "We begin with the most natural, least complex approach; but if that fails, we can turn to advanced techniques to help couples achieve a pregnancy.

"Nature provides multiple barriers to conception that advanced reproductive techniques can help overcome," Dr. Chuang explains. The various techniques are available to help sperm overcome these barriers by placing the sperm closer to the egg, including intrauterine insemination (IUI), in vitro fertilization (IVF), and IVF with intracytoplasmic sperm injection (ICSI). These advances in reproductive technology have offered many couples the possibility of conception who would not otherwise have been able to conceive."

For a great start to creating that family you have always dreamed of schedule your consult with Dr. Chuang today!


Weber W. Chuang, M.D.

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