Treatments for Male Infertility

At the Henry Ford Center for Reproductive Medicine, we understand that no couple wants an infertility issue to prevent them from having a child. Our experts are highly trained in diagnosing and treating various conditions that affect men, and are committed to working with you and your partner to find the best solution for your individual situation.

Why choose Henry Ford for infertility

When it comes to male fertility, accurate diagnosis can make all the difference. Our urologists have the technology and expertise to determine the cause of your reproductive problems, whether it’s a problem in sperm production, sperm delivery or hormonal factors. Your doctor can find the best combination of treatments and advanced procedures to free you and your partner from infertility.

Types of infertility we treat

Male infertility has several causes. Some of the conditions we treat include:

• Poor Sperm Count
• Poor Sperm Shape
• Poor Sperm Virility
• Azoospermia
• Varicocele

Azoospermia

There are two types of azoospermia, obstructive and non-obstructive. Our staff is experienced with treating both types with specific care plans based on your unique situation. The first step in proper treatment is proper diagnosis.

Diagnosing azoospermia

We will work with you and your partner to develop a treatment plan based on your specific diagnosis. Diagnostic testing may include:

• Physical exam
• Chromosomal testing
• Genetic studies to determine any predisposition (azoospermia factor, or AZF, refers to parts of the Y chromosome that, if missing, are markers of infertility)
• Testing hormone levels
• Testicular biopsy (ultimately, the only way to confirm NOA)
• Trans-rectal Ultrasound (TRUS)
• Vasography

Obstructive azoospermia (OA)

Obstructive azoospermia is a condition in which no sperm is found in a man’s semen due to an issue with sperm delivery to the urethra. There is often a problem with the genital tract in which sperm mature and then pass through during ejaculation. Less commonly, a blockage is found in the ejaculatory ducts, where the sperm leaves the body.

Obstructive azoospermia treatment

While surgery is the main treatment for obstructive azoospermia, we offer several options. The decision of which one is right for you is based on a number of factors:

• Age and possible infertility of your partner (if female)
• Financial situation
• Number of children desired
• Possibility for natural conception
• Prior fertility as a couple
• Prior surgical history of you or your partner
• Religious beliefs

We work with you to determine which treatment is best for you, given your unique needs.

Obstructive azoospermia: surgical reconstruction

We offer two types of surgical reconstruction:

• Vasovasostomy: reverses a vasectomy or relieve a blockage if it is present
• Vasoepididymostomy: also a surgical technique to relieve the blockage and then reattaches the vas deferens (the tube where sperm matures) to the epididymis (the tube that connects to the urethra), to form the best possible route

Both are safe treatments, with excellent outcomes that relieve obstruction, create “open pipes” without blockage and can ultimately lead to a successful pregnancy. These procedures are done under a microscope because of the extremely small size of the channels.

Obstructive azoospermia: alternative options

We also offer several effective alternatives if you want to avoid surgery:

• Microsurgical Epididymal sperm extraction for optimal quality sperm extraction
• Sperm Aspiration: takes sperm from the testicle or epididymis and closely with Henry Ford Center for Reproductive Medicine we will perform ART.
• Assisted Reproductive Technology (ART): techniques such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) use fresh, screened sperm to fertilize an egg. The resulting embryo is then implanted in the uterus.

These techniques can be safe and cost-effective in certain couple.

Non-obstructive azoospermia (NOA)

Non-obstructive azoospermia is a condition in which no sperm is found in the semen due to abnormal sperm production. This is usually because of a problem in the testicle (primary testicular failure) or hormonal production from the pituitary gland.

Non-obstructive azoospermia treatment

For men without an obstruction in the reproductive tract, first we rule out genetic cause and start treatment by correcting any hormonal imbalances. Low testosterone, for example, is raised with a number of possible medications.

In men with non-obstructive azoospermia sperm retrieval from the testicles is possible, using microdissection testicular sperm extraction (micro-TESE) the success rates can be as high at 70%. This procedure is performed by a specialized urologist using a microscope, who searches each testicle for the limited areas of sperm production and the presence of even one sperm. These procedures are performed by our infertility specialist that is highly trained with microsurgery.

The retrieved sperm is used to fertilize an egg through in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

Varicocele

Varicocele is an abnormal dilation or enlargement of testicular veins, with pooled blood causing the testicles to become hotter and not perform well. It is the most common cause of male infertility, affecting up to 15 percent of the general adult male population and up to 40 percent of those who are infertile.

Varicoceles are a problem if you have low testosterone, testicular pain or have had difficulty having children. If left untreated, they can cause:

• Abnormal sperm count, shape, movement and even sperm genetic code (DNA)
• Decreased testosterone in the blood

Varicocele treatment: surgery

Varicoceles are most commonly eliminated with a surgery called varicocelectomy, which pinches off the problematic veins to permanently block them. (Other veins continue the function of carrying away blood.)

Surgery often leads to improved semen quality and increased testosterone. We typically use a microsurgical approach, which provides the best results.

Diagnosing varicoceles

Testicle function continues to decrease as long as a varicocele is present, so early diagnosis is key. While it may not cause symptoms, our urologists can often detect them with a simple examination of the scrotum, then confirm the problem with an ultrasound.

Once a varicocele is confirmed, your physician may check for possible sperm abnormalities and testosterone levels. A varicocele is considered significant if it can be detected with a physical exam or if the veins are greater than 2.7 millimeters when viewed with ultrasound.