Here’s how it works:
Male infertility is often caused by more than one factor.
Male infertility can be caused by medical or environmental factors. Some of the more common causes include:
You might be able to make some changes that will improve your chances of fathering a child.
Infertility is a temporary condition in most cases. But it could be caused by a medical problem that needs to be treated.
Treating infertility depends on a number of factors – the cause, the length of time you’ve been infertile, your age, and the way you are most comfortable approaching the problem.
This means that the first step your urologist will take is to gather information about your medical history to rule out or treat any underlying medical condition. In most cases though, infertility is a temporary condition, so your urologist may recommend a wait-and-watch approach.
Treatment can be non-surgical or surgical depending on your condition.
Zero Sperm Count (Azoospermia)
Some men are found to have a zero sperm count. Men with azoospermia are divided into two separate categories: Obstructive Azoospermia and non-Obstructive Azoospermia. Appropriate tests will be determined to determine which group each patient falls into, so they can be treated appropriately. Blood tests are very helpful in determining if the cause is Obstructive or Non-Obstructive Azoospermia. A testicle biopsy is needed to make a definitive diagnosis.
In men with Obstructive Azoospermia, the testicle is making sperm normally, but there is a blockage in the sperm transport system, so that no sperm appear in the semen. A vasectomy is an example of obstructive azoospermia, but there are many other causes. For many cases of obstructive azoospermia, the cause of the obstruction can be identified and repaired, using microsurgical techniques or endoscopic techniques. If it cannot be repaired, sperm can be removed directly form the testicle and used for Intracytoplasmic Sperm Injection (ICSI). The methods to obtain sperm include Microepididimal Sperm Aspiration (MESA), Percutaneous Epididimal Sperm Aspiration (PESA), Testicular Sperm Aspiration (TESA), Testes Biopsy, and Extended Testes Biopsy.
ICSI is an advanced reproductive technique where sperm are obtained from the man and injected directly into the women’s egg (one sperm injected into each egg) to achieve fertilization. The fertilized egg is then placed directly into the women’s uterus in order to achieve a pregnancy.
For patients with non-obstructive azoospermia, the task of the urologist is to determine the cause and find out is there are treatment options. Sometimes the testicle is not making sperm, and there is nothing that can be done. Sometimes there is a hormonal imbalance which can be treated. Sometimes, even when the sperm count is zero, we can still find a few sperm for Intracytoplasmic Sperm Injection (ICSI).
A surgical procedure called a varicocelectomy can correct problems caused by swelling in the veins. Two different procedures are used:
When you and your partner have made the decision not to have children at any time in the future, permanent birth control might be right for you.
Permanent contraception, or sterilization, is meant only for men who have made the decision – along with their partner – not to father any children now or in the future.
This is the most common method of permanent contraception. It ensures that sperm do not leave the penis during ejaculation.
During a vasectomy, the muscular tubes, called the vas deferens, that carry sperm from the testicles into the urethra are cut and sealed off, or blocked. The procedure involves making two small openings in the scrotum. After a vasectomy, you might feel some tenderness or bruising around the incisions.
A vasectomy does not interfere with a man’s ability to have an erection or the amount of semen released. After a vasectomy, you should use a second form of birth control until your semen is tested by your urologist to make sure it is free of sperm. This usually takes 10 to 20 ejaculations.
A vasectomy should be considered a permanent form of birth control. Reversal is possible, but not guaranteed.
Doctors have estimated that 10 percent of men who have a vasectomy change their minds and want their vasectomy reversed.
A microsurgical vasectomy reversal is performed as an outpatient in an outpatient surgery center. The procedure can take three to five hours, depending on the complexity of the reversal. It is usually performed under general anesthesia, but in some cases it can be performed under local anesthesia. The risks are quite small, but include bleeding or infection in less than 1 percent of patients.
It helps to have a urologist from John Muir Health who knows your health history and can help you get the treatment that’s right for you more quickly.
For more information about our urology services, please call (925) 937-7740.