Infertility is a common yet complex problem affecting approximately 15 percent of couples attempting to conceive a baby.
In up to 50 percent of couples having difficulty getting pregnant, the problem is at least in part related to male reproductive issues. It is essential that men be assessed to pinpoint the treatable or untreatable causes of this heartbreaking health issue.
Fortunately, with today’s high-tech procedures and medications, a diagnosis of infertility may simply mean the road to parenthood may be challenging, but not impossible.
Dr. Shaw is proud to work with some of the finest obstetricians, gynecologists, and reproductive endocrinolgists in Austin to achieve optimum results. Dr. Shaw and Dr. Law have treated many couples over the last decade with infertility, which he sees on an increasingly frequent basis as more couples delay pregnancy to later in life.
Dr. Shaw and Law encourage both husband and wife to attend all visits so as to get the most complete history possible. After a physician exam, labs are ordered to check various hormonal and testosterone levels to make sure there is an adequate hormonal balance present. Finally, a semen analysis is important to make a precise treatment plan.
Dr. Shaw and Dr. Law are also one of the few surgeons in the Austin area to offer Laparoscopic Varicocelectomy, a simple, outpatient surgery to treat a simple, common condition of the testicles where excess veins around the testicles possibly affect sperm production.
Fertility Issues Affect Many Americans
Male Infertility Information
Management of Male Infertility
What happens under normal conditions?
What is male infertility?
What causes male infertility?
How is male infertility diagnosed?
How is male infertility treated?
What diseases can cause male factor infertility?
Can cigarette smoke affect semen?
Can the use of steroids for body building cause infertility?
Do abnormal semen analyses or sperm lead to children with birth defects?
What is the most important thing I should remember about male infertility?
Where can I get more information?
What occurs under normal conditions?
How is male infertility diagnosed?
What are some treatment options?
- you and your partner are trying to conceive a child, but thus far have been unsuccessful
- you have been diagnosed with a varicocele that can be felt
- your semen analysis or sperm function tests are abnormal
- your partner has normal fertility or treatable infertility
- you are contending with a varicocele and abnormal semen
- you are an adolescent male with a varicocele and reduced testicle size
If you fit the profile, your doctor can correct your varicocele with any number of surgical options, all of which can be performed in an outpatient center under anesthesia. Some of these approaches include: Retroperitoneal (or abdominal) approach: This conventional “open” varicocelectomy is best suited to men whose previously attempted varicocele or hernia repair resulted in significant groin scarring. Complications, which occur at a rate of 5 to 30 percent, include hydroceles, testicular atrophy and injury to the vas deferens. Laparoscopic varicocelectomy: Three small incisions are used to perform this outpatient procedure, where the enlarged veins to the testicle are clipped, thereby improving fertility. Outcomes in experienced hands approximate that of the microsurgical varicocelectomy. Microsurgical varicocelectomy: This operation uses the optical magnification of a high-powered microscope to provide direct visual access to veins and arteries. Through a mini-incision in the groin, the doctor can reliably separate and preserve testicular arteries, while identifying and ligating both large and small veins that could dilate in the future. Also, while technically demanding, microsurgical varicocelectomy virtually eliminates hydroceles, the most common surgical complications. In fact, microsurgical techniques have significantly reduced recurrence rates to less than 2 percent and complications rates to less than 5 percent while increasing fertility. The effectiveness of this procedure has been reported in the scientific literature to be as high as a 43 percent pregnancy rate for couples after one year and 69 percent after two years. Percutaneous embolization: This non-surgical approach is aimed at occluding the varicocele after it is viewed with a specialized X-ray technique. The procedure itself uses a flexible tube inserted into the groin to place a blocking agent that helps obstruct the center of the vessel. This minimally invasive technique is often less painful than surgery, but it requires a physician with experience in interventional radiologic techniques. As such, it is performed in the radiology department. There is no evidence to suggest that any approach is the best for correcting varicoceles.While surgery removes more than 90 percent of the swollen vein, percutaneous embolization gets rid of 80 to 85 percent. After repair, about 60 percent of men show improved sperm counts and/or motility. The effects of either treatment on fertility, however, are much less clear. While some studies show improvement, others suggest no significant change. Regardless, many infertile couples still choose varicocele repair because it improves semen in many men and may improve fertility, both at little risk. If your semen lacks sperm (azoospermia) as a result of blockage: there are several surgical treatment options at your disposal: Microsurgical vasovasostomy: Is designed to restore fertility by reconnecting the severed vas deferens in each testicle. The procedure, which should clear the way for sperm to leave the body, can be accomplished through various approaches, all performed in outpatient hospital or ambulatory surgical settings under general anesthesia, spinal epidurals or sometimes with localized numbing and sedation.In more than 90 percent of patients, sperm returns in the semen, yielding pregnancy in more than 50 percent of cases. Transurethral resection of the ejaculatory duct (TURED): When properly diagnosed, ejaculatory duct obstructions can be managed surgically by passing a cystoscope into the urethra and opening the offending blockages. Resecting the duct triggers release of sperm into the ejaculate in about 50 to 75 percent of men. But there can be complications — recurrent blockages, incontinence and even retrograde ejaculation due to bladder injuries. Also, pregnancy rates are only about 25 percent. Vasoepididymostomy: The most common microsurgical procedure for treating epididymal obstructions, vasoepididymostomy is also one of the most difficult of all treatments for male infertility. Surgeons must have excellent skills and extensive experience to perform this procedure, a surgical joining of the vas deferens and epididymis to facilitate the transport of fluid. The approach relies on the precise positioning and tying of sutures to secure tissue layers between the structures. When successful, however, an opened channel is restored in 50 to 70 percent of cases; pregnancy rates vary from 25 to 57 percent.
What can I expect after treatment?
How are specific male infertility conditions treated without surgery?
How are non-specific (idiopathic) male infertility conditions treated without surgery?
What is assisted reproductive techniques (ART)?
How are sperm surgically retrieved?
If I am suffering from obstructive azoospermia, when should my partner and I consider sperm retrieval with an assisted reproductive technique rather than surgery?
If I am suffering from a varicocele, when should my partner and I consider an assisted reproductive technique (ART) rather than surgery?
- the wife’s age and assessment of ovarian function
- the possibility that a varicocele repair will not definitely restore your infertility
- the fact that ART is needed for each try at pregnancy
Varicocele repair should remain the treatment of choice, however, if you do not have ideal semen but your partner is normal. Conversely, IVF, with or without ICSI, should be considered the primary option when there is a special need for such methods to treat a female factor.