male%20infertility
MALE INFERTILITY

Infertility is the inability to conceive despite regular unprotected sexual intercourse for one year.

Male infertility as the sole cause accounts for 20% & 30-40% as a contributory factor to infertility in couples.

Causes include: hypothalamic pituitary disease, primary testicular disease, disorders of sperm transport, genetic disorders, idiopathic infertility, infections, immune system disorders, iatrogenic causes, and chronic illness.

Surgical Intervention

  • Should be considered in men w/ obstructive azoospermia, as studies have shown that surgical management offers restoration of patency
Procedures recommended for epididymal obstruction
  • Vasectomy reversal
  • Tubulovastomy
  • Scrotal exploration w/ microsurgical epididymal sperm aspiration & cryopreservation
  • Microsurgical reconstruction
    • Microsurgical intussusception tubulovasectomy is preferred for epididymal obstruction
Varicocelectomy
  • Considered for patients w/ varicocele w/ oligozoospermia, infertility of >2 years duration, or unexplained infertility
  • May be able to reverse sperm DNA damage, prevent further testicular function damage & androgen deficiency, improve spermatogenesis & semen quality, & enhance Leydig cell function
  • Studies have shown significant improvements in sperm analysis by as much as 60-80% after varicocelectomy, w/ confirmed pregnancy rate of 35-44% 1 year post-procedure
Sclerotherapy
  • Antegrade & retrograde sclerotherapy may be considered for patients w/ varicocele
Transurethral Resection of the Ejaculatory Ducts (TURED)
  • Used for large post-inflammatory obstruction & ducts emptying into an intraprostatic midline cyst
  • For obstructions due to intraprostatic midline cysts, intraoperative transrectal ultrasound may be used to incise or unroof the cyst
Orchidopexy/Orchiopexy
  • Surgical procedure used to treat undescended testis in both adults & children
  • Studies have shown that this procedure can successfully induce spermatogenesis in previously azoospermic men
  • Treatment w/in the first 2 year of life results in better spermatogenesis
Vasectomy Reversal
  • Involves reanastomoses of the vas to reverse vasectomy
  • Produces better results than MESA w/ IVF or ICSI in men w/ previous vasectomy
  • Microsurgical vasectomy reversal is required in patients w/ post-vasectomy proximal vasa obstruction
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