About 15% of couples suffer from infertility, defined as the inability to conceive through unprotected intercourse for one year. Evaluation of the infertile male, which includes a history and physical examination and at least two semen analyses, is recommended at the time of presentation – despite less than one year of unprotected intercourse – in the case of advanced female age (greater than 35 years), presence of known male infertility risk factors (such as an undescended testicle) or if a man questions his fertility potential.1
Approximately 20-30% of infertility is caused exclusively by a male factor, and another 30-40% is the result of both male and female factors.2 Therefore, at least 50% of the time, a male factor contributes to the couple’s infertility. Based on this, as well as significant medical conditions and genetic abnormalities that have been shown to be diagnosed during infertility evaluations, leading management of a couple’s infertility involves simultaneous evaluation of the male and female partners.3,4 The goal of the male infertility evaluation is to identify any and all factors that may be compromising a man’s full fertility potential. This is only possible through a complete history and physical examination of the male.
Varicoceles are dilated veins in the scrotum, similar to varicose veins in the legs. Varicoceles may be found in up to 41 percent of infertile men and are the most common treatable form of male infertility. The surgical approach to treating varicoceles is tying off the veins in the scrotum close to the testicle.
Microsurgical Vasectomy Reversal
Vasectomy is a common and effective method of contraception. However, vasectomy reversal resulting in return of sperm back into the ejaculate and/or natural biologic pregnancies is possible. Successful vasectomy reversal rates depend upon the years since vasectomy. So the chance of natural pregnancy following reversal is greater if the patient had his vasectomy less than 3 years ago compared to 15 years ago. However, even if a patient had a vasectomy more than 20 years ago, vasectomy reversal may still afford the best chance of a biologic pregnancy.
The Infertility and Reproductive Medicine Center provides facilities for sperm banking. At present, sperm banking remains the only proven method of preserving testicular function. Sperm may be retrieved by ejaculation or with a minor surgical procedure to harvest sperm from the epididymis or testicle, which may be frozen and saved for assisted productive techniques. These samples may be saved (cryopreserved) indefinitely. Blood tests are needed prior to banking. Results usually are available within three working days.
Infertility and Reproductive Medicine Center
4444 Forest Park Avenue; Suite 3100
St. Louis, MO 63108
- Jarow JP, et al. Best practice policies for male infertility. Journal of Urology. 2002;167(5):2138-2144.
- Thonneau P, et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988-1989). Human Reproduction. 1991; 6(6):811-816.
- Honig SC, Lipshultz LI, and Jarow J. Significant medical pathology uncovered by a comprehensive male infertility evaluation. Fertility and Sterility. 1994;62(5):1028-1034.
- Kolettis PN, Sabanegh ES. Significant medical pathology discovered during a male infertility evaluation. Journal of Urology. 2001;166(1):178-180.