Overcoming Male Infertility

Helping couples realize their dreams is one of the most fulfilling things a urologist can do, professionally and personally.

After a couple has been trying to have a child for approximately a year without success, they’re considered, medically, to be an “infertile couple.” About 15 percent of couples fall into this category and about 50 percent of the time there is a male factor involved in the infertility.

When a man consults us on the problem the process begins with an infertility evaluation. “We take a history and do a physical examination,” says Dr. Jason Krumholtz, Premier’s infertility specialist, “but the cornerstone test for infertility involves a set of semen analyses.” The semen analysis is typically supplemented by blood tests which yield a hormonal profile: we look for low testosterone and elevation in some other types of hormones, factors which sometimes can provide a clue to the etiology of the fertility problem.

“We see one of three things in the semen analysis,” says Krumholtz. “The analysis may be completely normal, which means the patient has what is referred to as unexplained infertility. The second possibility is the presence of some moderate abnormality, such as a low sperm count or low motility or a problem with the morphology. The third possibility is that the analysis shows zero sperm, that the patient is what we call azoospermic. All three of these situations are treated differently.”

The main question, at this point, is whether there is something the urologist can do to improve the semen analysis and the couple’s probability of success. “We also evaluate whether, with or without improvement in the semen, the couple is a candidate for assisted reproduction, which would include intrauterine insemination or in vitro insemination,” says Krumholtz.

“Infertility is different from many other conditions in the way it’s treated,” Krumholtz says. “When physicians treat other problems, it’s very methodical. They go from answer A to answer B to answer C. In treating infertility, we often try several things at once. We give the patient and his spouse several options in terms of how to proceed: that is, we may be able to do one thing first and then try something else, or sometimes we can do both things at once. I create a list of different options the couple has depending upon how aggressive they want to be in solving the problem.”

Dr. Krumholtz tries to have both parties come in for the second visit, when he goes over the results of the testing. “At that time we can say with some certainty… these are the facts and here are the ways we can deal with them. It’s always easier to come to some agreement on which option is best when both the husband and wife are participating in the treatment planning,” he says. “Issue one is deciding if there is something we can do, medically or surgically, to improve the semen analysis. Issue two involves deciding whether we ought to pursue, simultaneously or later, the possibility of assisted reproduction.”

Assisted reproduction is a possibility for the majority of our patients with infertility. Even patients with zero sperm are able to achieve pregnancy through testicular sperm extraction (TESE). In this procedure, we remove testicular tissue and extract the sperm, sending it to a reproductive endocrinologist for in vitro fertilization. “The results have been excellent,” says Krumholtz. “We have gotten sperm in the overwhelming majority of patients, even patients with severe testicular failure.”