Male Fertility

 

Surgical Options for Male Infertility


Midwest Reproductive Center treats infertility in both men and women, and offers semen analysis for men when warranted. Dr. Dan Gehlbach, a reproductive endocrinologist, provides referrals to a urologist for surgical intervention.

A diagnosis of male infertility is not uncommon, as about half of all cases of infertility involve male factors. Dr. Gehlbach has extensive experience in correcting issues with sperm production through a series of escalating fertility treatment options:

    • For men with a low sperm count, Dr. Gehlbach will likely recommend intrauterine insemination (IUI), or prescribe the fertility drug clomiphene citrate (Clomid) to increase sperm counts.

    • A very low sperm count will likely require in-vitro fertilization (IVF) or IVF with intracytoplasmic sperm injection (ICSI, pronounced icksy). This advanced fertility treatment involves injecting one single sperm directly into an egg for fertilization.

    • In some cases, Dr. Gehlbach will refer men to a urologist for the surgical recovery of sperm.

In your initial visit to a fertility clinic, you can expect to discuss your medical history. It’s common for a reproductive endocrinologist to order a semen analysis at this point. You will not have a physical exam.

Dr. Gehlbach will review semen analysis results, and recommend a course of male infertility treatment.

Who is a candidate for the surgical retrieval of sperm?


When your fertility specialist finds a complete absence of sperm, you will be diagnosed with azoospermia. Dr. Gehlbach reassures his male clients that the absence of sperm in the ejaculate does not rule out the possibility that sperm exists in the testes, or that you can father a child.

Intracytoplasmic sperm injection (ICSI) has made it possible for men to avoid having surgery, even when very few sperm are present. However, certain red flags in the medical history will necessitate more invasive action:

• No sperm is present in the ejaculate
• Previous vasectomy
• Infection or surgery of the testicles
• Hernia repair
• Hormonal abnormalities
• Genetic diseases such as cystic fibrosis
• Paralysis

When the above conditions are present, the male infertility treatment plan will involve a partner urologist to extract, or “harvest” sperm in surgery called Testicular Sperm Aspiration (TSA) or Microscopic Epididymal Sperm Extraction (MESA). Harvested sperm can then be used in an IVF cycle.

MESA (Microscopic Epididymal Sperm Extraction)


This procedure is performed with a surgical microscope, and benefits men that produce sperm in the testes. The fertility surgeon will open blocked tubes called the epididymis found on each testicle. The epididymis stores and transports sperm.

TESE (Testicular Sperm Extraction)


A secondary approach to male infertility surgery involves a similar surgical microscope. In TESE, however, sperm are removed directly from the testicles.

 

Dr. Gehlbach will prepare a male fertility treatment plan that can circumvent even the most severe cases of male infertility.

Contact the Olathe office of Midwest Reproductive Center to schedule a consultation with a board certified reproductive endocrinologist specializing in male infertility.