Services: Male Fertility
Significant advances have been made in our ability to evaluate and treat the subfertile male. We now appreciate that subfertility is a couples dilemma. This is in part due to our increased knowledge of factors associated with male subfertility as well as recent advancements in tests and diagnostic equipment. In addition, the availability of sophisticated reproductive technology has enabled us to offer even azoospermic patients the opportunity to father a biologic child.
Male factor is the primary or contributing cause in 40 to 60% of the couples presenting for a fertility evaluation. Therefore, The male and female need to be evaluated concurrently.
It is no longer sufficient to state that the male is “normal” because the semen parameters are “within the normal range”. It is the number of progressively motile, morphologically normal and functional normal spermatozoa that are important . In addition, these spermatozoa need to be in a seminal fluid of appropriate volume and composition. Then, this mixture of spermatozoa and seminal fluid must be placed in a physiologically and anatomically normal female genital tract. It is the ability to precisely define these parameters together with increased awareness of factors altering these parameters, that allow us to diagnosis and ultimately treat an increased number of male factor disorders.
The following examples selected from our patient population highlight some of these disorders:
- 1. A 30 year old man presents with fructose positive azoospermia, a normal hormonal profile, palpably absent vas deferens and a normal bilateral testis biopsy. Surgical exploration and retrieval of fluid from the remnant epididymis was used for microinsemination of oocytes retrieved from his wife. The couple now has a healthy one year old son. Sophistication of assisted reproductive technologies has refined the definition of male sterility. In 1992, fertility is possible as long as mature spermatozoa are present at the level of the rete testis/efferent ductules.
- A 37 year old gentlemen presents four years after the birth of his first child with a year and a half of secondary subfertility. He had been treated for prostatitis two years prior. Transrectal ultrasound demonstrated enlarged seminal vesicles with an increased echogenicity at the level of the ejaculatory ducts bilaterally. Preoperatively his total sperm count was 3.5 million with 7% motility in a volume of 0.35cc. Transurethral resection of the ejaculatory ducts resulted in an increase to 92 million total sperm and 53% motility with an increase in seminal fluid volume to 1.80cc. A spontaneous pregnancy resulted three months postoperatively. The concept of ‘partial obstruction’ has evolved. Transrectal ultrasound has become an important adjunct to the clinical examination.
- A pediatrician with over 200 million sperm and good progressive motility but with greater than 20% tapered heads presented with 2 years of secondary subfertility. His wife had a normal evaluation. Ligation of his large left varicocele resulted in a doubling of his total sperm count and a four and one half times increase in the number of progressively motile and morphologically normal spermatozoa (44 million preoperatively to 206 million postoperatively). A pregnancy occurred 7 months post operatively. Over 80% of men with secondary subfertility have been found to have varicoceles that impair the couple’s fertility.
If you would like more information please contact:
Bruce R.Gilbert, M.D., Ph.D. at 516-487-2700 or info@BruceGilbertMD.com