Men's Health Manhattan
115 East 57th Street, 4th Floor New York, NY 10022 +1 212-434-4650

Male Infertility

At Men’s Health Manhattan, we are one of the premier centers in New York with fellowship trained, subspecialty expertise in the management of male factor infertility and subfertility.  We work closely with, and have long standing, direct relationships with a number of the larger in vitro fertilization (IVF) and female fertility centers in New York. As the management of fertility is a team effort, these relationships foster direct and frequent communication between our center and the IVF teams, and generally help to lead to better overall outcomes. 

Infertility is defined as the persistent failure to conceive despite directed attempts over the course of at least one year. It is a fairly common condition, and is known to affect approximately 10% of couples. The field of infertility is plagued by numerous myths and misconceptions, with the most important being that the woman accounts for the majority of the issue when there is a failure to conceive. Twenty to 30% of all couples presenting with infertility will have a pure male factor component, while an additional 20 to 30% of couples will present with a mixed male and female factor issue. In total, this means that half of all couples presenting with infertility will have at least some form of male factor issue playing a role. 

Given this fact, it remains very important that couples with a male factor component undergo a complete evaluation in order to determine the potential causes of the fertility issue. As most couples will start this journey at the female partner’s gynecologist office, the male factor will often be overlooked completely and ignored, or the couple will be referred for expensive and difficult IVF as a “work-around” for a male factor issue that can often be corrected to aid in natural conception.

What is Male Infertility?

Male infertility generally comes in two groups, which are then further broken down into other subgroups. One group consists of men with either a low sperm count (oligospermia) or abnormal sperm quality (asthenospermia or teratospermia). The other group are men with a zero sperm count (azoospermia), either due to a blockage or a failure of production.

What causes low sperm count (oligospermia) or abnormal sperm quality (asthenospermia or teratospermia)?

There are a number of potential causes of a low sperm count. They include hormone production issues, such as men with a low testosterone. In some men, a varicocele can affect their production. Other factors include genetics and lifestyle issues, such as dietary indiscretions or substance abuse.

Can you cure low sperm count?

Those patients presenting with lower sperm counts or abnormal sperm quality are thought of as presenting with “less severe” fertility issues, and as such, are often “managed” directly by the female fertility specialists using assisted reproductive technologies, including IUI (intrauterine insemination) and IVF (in vitro fertilization). This is a shame! Very often these are the men who can be treated most effectively by Dr. Berookhim and can lead to improvements in sperm quality to get to natural conception and to CURE the underlying issue.

What is Varicocele?

Varicoceles are a common finding and are considered a normal variant of anatomy, presenting in about 15% of all men. This is a swelling and dilation in the veins which are used to drain the testicle. A simple way to think about this is to call it a varicose vein of the testicle. In some men, this can be the source of a sperm production abnormality, leading to either a low/abnormal sperm count or even a zero sperm count. While there are a few ways to treat this, the overwhelming data demonstrates superior outcomes and lower risks with the microsurgical subinguinal approach. Dr. Berookhim is a highly experienced microsurgeon and is the director of urologic microsurgery at one of the most respected hospitals in New York. He is one of the highest volume fertility microsurgeons in the New York area. He performs over 80 microsurgical varicocelectomies per year. For more information on this, please see the textbook chapter that we have written on this topic. Boback M Berookhim. “The Role of Varicocele in Male Factor Subfertility.” Current urology reports vol. 18,9 (2017): 73. doi:10.1007/s11934-017-0713-8.

What Causes a Zero Sperm Count: Azoospermia due to Production Failure?

Clearly a more severe form of male factor infertility, patients presenting with azoospermia due to production failure still have a number of treatment options to allow them to father a biological child. At Men’s Health Manhattan, we have a distinct academic and clinical expertise in the management of these men. Using evidence based medicine, we will do a complete workup and evaluation and will address all treatable factors as possible. In men who will continue to present with azoospermia despite these treatments, surgical sperm retrieval becomes the primary management option.

What Causes a Zero Sperm Count: Azoospermia due to Blockage/Obstruction?

There are a number of causes of potential obstruction in the ducts which carry sperm out from the body. One is in patients who have previously undergone vasectomy and have had a change of heart. Others include men with a genetic condition where some or all of the ducts are missing, while in others it can be due to a previous infection. At Men’s Health Manhattan, we have a robust experience in the management of these patients. Management is generally surgical, and includes surgical sperm retrieval procedures and microsurgical vasectomy reversal.

You May Be Able to Avoid IVF

Low sperm count can be treated most effectively by Dr. Berookhim and lead to improvements in sperm quality to get to natural conception and to CURE the underlying issue.

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