Infertility—the inability to conceive a child after one year or more of unprotected sexual intercourse– affects about 15 percent of couples. Male infertility plays a role in about half these cases. The problem may be a result of low or poor quality sperm production, blockages in the urinary tract that prevent the passage of sperm, and a range of chronic conditions, illnesses, infections, injuries, and environmental and lifestyle factors. One of the most common conditions causing infertility is blockage of the vas deferens from a prior vasectomy. A vasectomy reversal performed by skilled microsurgeons is a highly effective means of restoring fertility. In many other cases, male infertility can be treated successfully through medical and surgical therapies.
Diagnosing male infertility involves a general physical examination and detailed medical history. A semen analysis is performed to measure the number of sperm present and to look for any abnormalities in their shape or movement, or signs of infection.
In about a third of cases, both male and female factors contribute to fertility problems, so both partners are often examined during a fertility work-up. In cases where there does not appear to be a problem with female fertility, doctors may recommend additional testing of the male partner. Common tests include scrotal and transrectal ultrasound to detect abnormalities of the reproductive tract, hormone testing, post-ejaculation urinalysis to see whether sperm are entering the bladder (retrograde ejaculation), antisperm antibody tests to detect abnormal immune reactions to sperm, specialized tests of sperm function, and genetic tests for chromosomal abnormalities such as Klinefelter syndrome, which can affect sperm production.
For some patients cancer treatments can significantly affect a man’s ability to father children. Protecting this ability to father children is called “Fertility Preservation.” The simplest and most cost-effective approach is to bank sperm prior to cancer treatment. In some cases, this isn’t possible and a minor surgical procedure (TeSE) may be necessary to obtain sperm for banking before cancer treatment.
A range of treatments is available to treat fertility issues. Some causes of male infertility can be corrected with minimally invasive surgery. UCSF surgeons are fellowship-trained microsurgeons highly skilled in performing all infertility surgeries including minimally-invasive vasectomy reversal, sperm retrieval procedures (MESA, PESA, TeSE, TeSA), and varicocelectomy. In cases where sperm production is related to a hormone imbalance, hormone treatments may be useful.