M. Nagler, MD
S. Stember, MD
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
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
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
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
- Antibiotics to treat an infection that is interfering with
- 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
- 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 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.
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.