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Frequently Asked Questions About Male Infertility

What are possible explanations for a man’s sperm count dropping to zero after a vasectomy reversal procedure, and what are the next steps in that case?

We typically check semen tests every three months after a reversal. If sperm count starts low and then decreases to zero, it suggests that the reversal site has scarred off. However, there could be less likely problems, including poor sperm production, as well. It is possible that they could return, but that would be unusual. Physical exam, blood tests or possibly a biopsy could help determine the best next course of action.

How does a man present with a varicocele?

Most commonly, he has a completely asymptomatic varicocele found during evaluation for infertility. Young men (or their primary doctors) sometimes find a mass in the scrotum either during self-exam or routine exam. Less commonly, a varicocele is found when evaluating a man suffering from pain in the scrotum.

What are the options for men who discover they have a b+c microdeletion on their Y chromosome, resulting in azoospermia, if a man and his female partner want to achieve pregnancy together without donor sperm?

For patients with azoospermia factor c (AZFc) mutations alone, the chance of finding sperm in the testis with surgery is decent (greater than 50 percent). It is much lower, however, and not well-defined in patients with AZFa or AZFb mutations. So while it is often recommended that a couple use donor sperm or pursue adoption, it is certainly an option to look for sperm using microsurgical testicular sperm extraction, although the success rate should be expected to be quite low.

What are some causes of sperm not maturing? What are treatments for this situation?

Some treatable conditions that can cause maturation arrest include varicoceles or hormonal problems. In many cases, though, it might be an undetectable genetic defect.

In vitro maturation has been done in mice, but it is still in the experimental phase in humans. Making germ cells (sperm) from other body cells is still experimental. We are not able to transfer the supporting cells for spermatogenesis at this time. Similarly, we cannot transfer sperm precursor cells from one person to another. Also, if we did this, the recipient’s sperm would likely have DNA from the donor, so the children would not truly be biologically related to the recipient.

For someone with maturation arrest on biopsy and no obvious treatable causes, we would usually perform microdissection testicular sperm extraction, which would carry an approximately 60 percent chance of finding sperm that could then be used for IVF/ICSI.

Often, at the time of surgery, we will harvest the tissue that we use for many research studies designed to better understand male infertility. We can explain a number of these to patients when they come and visit our facility.

Is it possible to go back and perform a second testicular sperm extraction and find normal sperm in cases where the original procedure does not locate sperm that can be frozen?

Doing more than one testicular sperm extraction is definitely a possibility. It is known that there can be different production in different areas of the testes, so it is important to explore the entire testis, as with microsurgical testicular sperm extraction. Uncommonly, some patients undergo a repeat microsurgical testicular sperm extraction for each cycle of in vitro fertilization. Hormone modulatory treatments might play a role in optimizing sperm production for certain patients.

What can a man do to improve the morphology (shape) and motility (movement) of his sperm?

Semen morphology is thought to have the least effect on fertility of all of the parameters. Unfortunately, in most cases, there is no clear or specific treatment.

The most important things would be to check at least two semen tests to confirm findings, and to have a male infertility specialist perform a detailed history and physical exam that might identify potential treatable causes. The most common cause detected would be a varicocele.

In rare cases, there may be a genetic/production problem causing the sperm shape defect. This is usually not treatable.

When nothing else is found, patients can consider various vitamins, such as 200 milligrams of CoQ10 twice a day, though there is little data to support this. In general, we recommend a healthy lifestyle with lots of vegetables and a balanced diet with exercise.

What are some options for men with low sperm count and a lack of sperm shape?

Start with a complete evaluation by a male infertility specialist. For people with semen parameter abnormalities, we can identify possible causes in around 60 to 75 percent of men. However, in the other 25 to 40 percent, the cause may be elusive. We call this idiopathic infertility. Studies are underway to try to find genes that might be responsible for idiopathic infertility.

What can be done in the case of low sperm motility and pus cells?

Low motility and pus cells can be from multiple causes. Patients should have a physical exam, hormonal testing by a fertility specialist and possibly specific testing to quantify pus cells. Based on the findings, treatment may include one or more of many routes, including medicines, vitamins, antibiotics, anti-inflammatory medications or surgery.

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