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Infertility is a common issue faced by men as well as women. Fifteen percent of American couples experience infertility, and 50 percent of infertile couples have a male component to infertility.
Fortunately, most causes of male infertility can be treated. Our treatments target conditions men experience that may not only impact fertility but also quality of life, such as low sperm count, low testosterone and erectile dysfunction.
We believe having a family is one of life’s greatest joys. By offering patients a multidisciplinary team of caring medical professionals as well as the most cutting-edge innovations, we at the USC Institute of Urology strive to make paternity a possibility for every couple.
We work very closely with our reproductive gynecology colleagues. Because we’re all located on same campus, we make it easy for couples to have both male and female factors addressed.
- Sperm production issues – low sperm count or no sperm
- Sperm motility issues – sperm do not swim properly
- Sperm morphology – sperm do not look or function properly
- Blockage in the organs that the sperm swim through, such as after vasectomy
Production issues can result from chemotherapy for cancer, infection, some genetic conditions, testosterone or other medication use, hormonal issues or age. Male infertility also can arise from varicoceles, or dilated veins around the testicle.
Blockage issues can be seen with some congenital conditions, after vasectomy, after infections or prior to surgeries.
Other causes include being overweight or underweight, STDs and unhealthy lifestyle choices, such as smoking or being too sedentary.
- Eat healthy
- Limit alcohol, cigarette and drug intake
- Take nutritional supplements with antioxidants
- Exercise regularly
- Get adequate sleep
- Reduce stress
To determine the cause of infertility, we compile a comprehensive medical history and perform a physical exam, hormone evaluation and semen analysis. We will potentially also perform an ultrasound and blood testing.
Treatment depends on the underlying cause of male infertility. We generally approach medical treatments with the goal of helping couples have children on their own, without the use of assisted reproductive techniques.
If the cause of male infertility is due to a blockage, USC surgeons will treat it with surgery.
Microsurgical vasectomy reversal
Vasectomy reversal is the reconnecting of the two ends of the vas deferens that were cut and blocked during the vasectomy procedure. After a vasectomy, the sperm are still being made in the testicle, but they are not released into the ejaculate fluid. A vasectomy reversal returns continuity to the testicular region to restore sperm to the ejaculate.
The procedure is performed in the operating room, under a general anesthetic to maximize comfort and minimize movement. The operation is performed using an operative microscope, with 20 times the magnification of the human eye, which has been shown to improve the outcome of this surgery.
Sperm retrieval techniques
For men who do not have sperm in the ejaculate fluid, this cutting-edge microsurgical technique involves looking for small areas of sperm production in the testicle. Multiple areas can be sampled at once, and any sperm found can be collected and used for in vitro fertilization (IVF).
We also have special expertise in dealing with men whose sperm count has been impacted by a spinal cord injury (SCI). Approximately 90 percent of men with a spinal cord injury have male fertility issues. We are one of the only centers in the greater Los Angeles area to have electroejaculation equipment for sperm sample collection, and Dr. Samplaski is specially trained in male fertility and the SCI population.
Varicoceles are abnormally enlarged veins in the testicular region, similar to varicose veins of the legs. In some men, these dilated veins will negatively impact sperm production because they can cause a pooling of blood in the testicles, which can heat up the testicles or cause toxins to build.
Surgical varicocele repair (varicocelectomy) can stop further deterioration of sperm production and will often improve sperm quality to fertile levels. It is performed under an operative microscope, allowing doctors to operate only on the veins that are dilated and minimizing the risk of complications.
The surgery is performed under a general anesthetic and takes about two hours. Approximately two-thirds of men will show an improvement in their semen production after varicocele repair.
How long should a couple try to conceive before seeking help from a specialist or being tested?
Couples should seek medical attention from a fertility specialist after a year of unprotected intercourse that has not resulted in a pregnancy. If the female partner is older than 35 or there are concerns in either partner, it may be wise to be evaluated after six months of trying.
What can I do to improve our chances of conception?
- Quit smoking. Men who smoke cigarettes and marijuana have lower sperm counts. It takes smokers longer to conceive, and smoking (even secondhand smoke) may lead to genetic abnormalities.
- Lose weight. Overweight and obese men have worse sperm quality compared with men of healthy weight.
- Don’t use testosterone supplements. Testosterone supplementation will shut down sperm production.
Are hot tubs a culprit?
Hot tubs and saunas are well known to be harmful to sperm. The purpose of the testicles being outside of the body is for them to be slightly cooler, which promotes sperm production.
Can cancer and cancer treatment affect my fertility?
Yes. Cancer-related fertility problems include effects related to the malignancy itself and the effects of treatments such as chemotherapy, radiation, surgery and certain cancer-fighting drugs. It is crucial that male cancer patients undergo a discussion of sperm-preservation options prior to the start of cancer treatments. Freezing sperm (cryopreservation) is often recommended.
My sperm count is normal. Why am I experiencing fertility problems?
One reason could be DNA fragmentation, or breaks in the DNA strands of sperm. Intact sperm DNA is needed for regular egg fertilization. But this is not tested in standard sperm analyses. By testing for DNA fragmentation and looking at its potential causes, we can determine an appropriate solution.