Dr. Michael A. Werner, M.D talks about male infertility.
Many men are coming to see me because they have had a semen analysis done which shows no sperm in their ejaculate. They have of course devastated by this diagnosis. But just because that there is no sperm in the ejaculate does not mean that they cannot go on to have biological children.
So 60% of the couples who experience infertility will have a male factor issue which needs to be addressed. A recent study showed that even if a couple is undergoing in vitro fertilization with taking the sperm and injecting it directly into the egg, their results will be better if a treatable condition for male infertility has already been taken care of.
So it is very important in these situations that the men be evaluated, and his fertility capacity be maximized.
The first thing that has to be done is a really sophisticated semen analysis. Because sometimes men have very low levels of sperm in their ejaculate that are not seeing by semen analysis done at a conventional lab.
If a man has no sperm in the ejaculate, it could be that he makes good levels of sperm, but they cannot get out, they are blocked in some way, so we call this obstructive azoospermia (no sperm in the ejaculate). Some of the reasons for this can be genetic.
Another option is to try to figure out in advance which man will actually have sperm in the testis. There is a relatively new technique called sperm mapping, where a test that can be mapped to see whether or not there any sperm there. The advantage of this is that if sperm is found in certain locations then later we can go back to those locations, look for sperm and use those for in vitro fertilization and injecting the sperm directly into the eggs.
One of the main causes of male infertility is varicoceles. Varicoceles is a dilated vein in the scrotum. The way veins work is they bring the blood back up to the heart. And the way they do that is the they have a series of one-way valves, which allows the blood to go back up but not go down into whatever area it is draining. If those valves are not working than the blood collects in the lowest area.