Male Causes

Obstructive, in which the ejaculatory ducts are blocked.

Non-obstructive, in which sperm production is severely impaired.

Diagnosis:

Infertility is a problem that affects both men and women. One in three couples has difficulty conceiving because of male-factor infertility. Another one in three infertile couples has conditions that affect both the man and the woman. Therefore, an initial evaluation of every infertile couple begins with a routine semen analysis. Semen analysis measures these factors:

Concentration (sperm count)

Morphology (sperm shape; normal structure associated with sperm health)

Motility (or mobility; sperm should be moving rapidly and easily)

Standard semen fluid test (thickness, color)

Total motile count (total number of moving sperm)

Volume (total volume of ejaculate)

The total motile sperm count should be about 40 million.
Azoospermia is detected during this routine analysis. A simple physical examination and medical history, with a full hormone profile, is usually all that is necessary to determine whether the condition is obstructive or non-obstructive azoospermia.

After a diagnosis of non-obstructive azoospermia has been established, it may still be possible to harvest sperm from the testicles to use for in vitro fertilization (IVF). Genetic testing and testicular mapping through a sequence of fine needle biopsies can be used to discover whether it is possible to harvest enough mature sperm to make IVF a possibility. Testicular mapping is a minimally invasive, low-cost, and accurate diagnostic tool.

Treatment
Insemination:

When at least a million motile sperm can be harvested from semen, insemination is a possible treatment. In this procedure, the semen is centrifuged to concentrate the sperm cells and then resuspended in a small amount of liquid. This concentrated mixture is then placed into the wife's uterus with a small catheter at a specific time of the cycle when the egg(s) is being released.

In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI):
When sperm quality is poor, IVF with ICSI gives the best chance of achieving a pregnancy. This procedure injects a single sperm directly into a mature egg. Only one sperm is needed per egg.

IVF and ICSI using Testicular Sperm:
In cases of azoospermia, it is often possible to extract sperm directly from the testicle with a minor surgical procedure. Because the amount of sperm recovered by this technique is small, IVF with ICSI is necessary to give a chance of pregnancy.

Spinal cord injuries:
Our reproductive urologists have experience inducing ejaculation in men who have spinal cord injuries. Often this will yield enough sperm so that insemination is possible.
Other services that are available include long-term storage of sperm (freezing) from men who are about to undergo either chemotherapy or radiation treatment for cancer. These sperm can be used later for insemination or for IVF with ICSI depending on the number of sperm available.

VASECTOMY REVERSAL SPECIALISTS
We are partnering with Vasectomy Reversal Specialists (Dr. Spitz and Dr. Phan)