For approximately 1/3 of couples that have a fertility problem, the complication stems from male factor infertility. We a fortunate to have our own urologist on staff.
Infertility is defined as the inability to establish a pregnancy after trying to conceive for 1 year. Impotence or erectile dysfunction is the inability of a man to achieve or maintain an erection. Premature ejaculation is more difficult to define but is generally described as recurrent ejaculation with minimal stimulation before the person wishes. These conditions may be related in some patients or may occur independent of each other. Men experiencing fertility problems may be potent and men with erectile dysfunction may be fertile.
The old wives’ tale that tight underwear causes decreased fertility has, perhaps, some basis in the truth. The truth is that excess heat applied to the testicles can decrease sperm production. This has been shown in men using hot tubs. However, the type of increased heat produced by tight clothing and/or underclothing has not been shown to elevate scrotal temperature. Hence, tight underwear has not been shown scientifically to cause any increase in testicular heat and is not thought to have any effect on sperm production.
The quality of the semen analysis is highly dependent on the method of collection. The ideal number of days to wait after sex to give a semen analysis is three to five days. Giving a semen analysis in less than three days after an ejaculation produce a small volume low count semen sample. Giving a semen sample after greater than five days from ejaculation can cause the sperm to have decrease motility.
In the male, most sexual transmitted diseases cause irritating symptoms at the time the disease is active. Following the acute stage of the disease, long-term problems with male infertility is not common. However, untreated venereal disease can cause infection of some of the accessory sexual structures, such as the epididymis (the gland that collects the sperm) or the vas deferens (the tube that transmits the sperm). If these become infected by gonorrhea or Chlamydia (common sexually transmitted organisms) the result can be scarring which affects fertility by blocking the transport system. Sperm production should not be affected unless the disease process spreads to the testes.
The lower limit of normal sperm count is 20 million sperm per milliliter of semen. Many men with lower sperm counts have initiated pregnancies. The standard for low sperm count was derived from looking at the fertility history of thousands of men and whether they initiated a pregnancy. There was a modest break in fertility potential when the sperm count decreased below 20 million sperm per milliliter. Your semen quality has to be high enough to overcome whatever deficiencies in fertility your wife may have. Fertility potential is judged based on the deficiencies that exist within the couple.
Vasectomy reversal is not only possible but is highly successful when performed by an experienced infertility microsurgeon. We are fortunate to have urologist, John Gould MD, on staff who performs vasectomy reversals often and successfully. Studies have shown that the outcome of surgery is so dependent on the surgical technique and the surgeon that performs it that it is well worth making the extra effort in going to a specialized center. Dr. Gould is that doctor. Although failed vasectomy reversals can be repaired, the first attempt at reversal is the easiest and best opportunity for success.
In most cases a vasectomy reversal is the best available first option for a couple interested in having a child after the man has undergone a vasectomy. It is the most natural, least invasive and cost effective method of producing a pregnancy. If successful, the man’s sperm may be of adequate quantity to allow for natural conception. If this does not occur there may be adequate sperm for the ejaculate to be processed and placed inside the woman’s uterus (Intrauterine Insemination or IUI). This may be done without the woman taking fertility medications (either by mouth or injection). The alternative to vasectomy reversal is sperm retrieval combined with In Vitro Fertilization or IVF.