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Male Reproductive Services


Harris M. Nagler, MD
Doron S. Stember, MD

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MALE INFERTILITY
It has been estimated that there are approximately 2.25 million infertile men in the United States, and the demand for infertility services has increased 100 percent in the last ten years. If a couple is having difficulty conceiving, it is imperative that the male partner of an infertile couple be properly evaluated, as therapy directed at correctable causes of male infertility are more effective than ever. Recent advances in assisted reproductive technologies have enabled successful treatment of couples who previously had no hope of childbearing. These advances have engendered great excitement and have stimulated many patients to seek treatment for infertility.

The Berger Department of Urology at Mount Sinai Beth Israel has nationally renowned experts in male infertility and provides the most advanced techniques available to treat this condition. Our goal is to help couples realize their dream of having children.

The department also provides a full spectrum of diagnostic tests for male infertility through our state-of-the-art Andrology Laboratory. The laboratory’s facilities are private and comfortable, and the staff is particularly sensitive to the personal nature of their services. Its singular focus improves the level of patient testing, centralizes diagnostic services and expedites reporting of results to the referring physician in the most accurate and efficient manner. Semen analysis results can be provided by fax and are mailed to your referring physician within one business day.

Causes for Male Infertility
There are numerous causes for male infertility, such as varicoceles, hormonal dysfunction, physical trauma, obstructions, diseases (sexually transmitted diseases, cancer, anemia) and side effects from certain drugs.

Varicoceles are the most common cause of male infertility. Varicoceles are abnormal veins that surround the testicles, and are similar to varicose veins in the leg. Normally the blood drains from the testicle upwards into the abdominal cavity. When patients have varicoceles, the blood does not drain normally and flows back towards the testicles.

Varicoceles are present in nearly 15% of all men, and up to 40% of men visiting infertility clinics. However, varicoceles do not always lead to fertility problems, nor do all require treatment. Varicoceles are primarily diagnosed by a physical exam or by ultrasound, and may be treated surgically, laparoscopically or percutaneously (venographic embolization). We employ a microscopic technique which results in high success rates with minimal complications.

Treatments for Male Infertility
The Berger Department of Urology at Mount Sinai Beth Israel has extensive experience in treating male infertility, with an expertise in microsurgical repair and reconstruction should your treatment require it. Treatment options include:

  • Antibiotics to treat an infection that is interfering with sperm function
  • Drug or hormone therapy to increase sperm production in men with low sperm counts
  • Surgery to remove obstructions or repair abnormalities in the male reproductive tract, such as obstructions or varicoceles.

Evaluation for infertility begins with obtaining a thorough history, including:

  • A sexual history, which includes the duration of infertility (determines primary or secondary infertility), sexual habits (using lubricants that may interfere with sperm motility), instances of sexual dysfunction, and intercourse timing.
  • A developmental history, which determines the normalcy of development during puberty (possible physical or hormonal abnormality).
  • A medical history, which covers risk factors such as childhood illnesses, hereditary conditions, genitourinary infections, environmental exposure, and past surgeries.

This is followed by:

  • A physical examination, including examination of the penis, scrotum, testicles, and epididymis and vas deferens (the tubes that carry sperm).
  • Laboratory semen analysis (done at our in-house andrology lab), which is usually the first test performed upon the male partner of an infertile couple. There are many variables that factor into producing the best quality sample for analysis, and these will be discussed with you in detail.

VASECTOMY
Vasectomy should be thought of as a permanent surgical form of contraception. This simple surgical procedure is generally performed in the doctor’s office. The surgeons in the Berger Department of Urology perform vasectomy utilizing a no scalpel technique, which minimizes discomfort and risks. Vasectomy should only be performed if an individual is convinced that surgical and permanent contraception is the best alternative for him.

VASECTOMY REVERSAL
The Berger Department of Urology at Mount Sinai Beth Israel also specializes in microsurgical vasectomy reversal, or vasovasostomy. Although most people who undergo vasectomy are pleased with their decision for permanent sterilization, a significant number wish to undergo restoration of fertility. This can be successfully achieved utilizing microsurgical techniques, in which the department has an internationally recognized expert.


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