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Male Infertility Clinic

Male fertility issues play a role in about 50 percent of all couples facing fertility problems. Moshe Wald, MD, a male infertility specialist and urologist, who works hand-in-hand with the University of Iowa Center for Reproductive Endocrinology so that a team approach is used to determine the best options for each couple, talks infertility:

What are the causes of male infertility?

We’re looking, actually, at a wide range of possible problems that could cause this. For example, it could be:

• A problem with hormones, like a problem with testosterone or other hormones that are involved in the fertility access
• A genetic problem, something that runs in the family or something that just occurred in a particular patient
• An anatomical problem, for example a vericocele, a vericocele is a condition that is quite common, present in up to 40 percent of all men, where the veins draining the testicles are abnormally dilated
• Secondary to previous surgery, obviously a gentleman who had a vasectomy in the past, or other surgeries that caused interruption of sperm flow out of the testicle.

Does age affect males who want to father a child?

Not as much as we know for women. There have been some reports that sperm quality, specifically the motility of sperm, is decreasing with age, but overall men still have fertility capability, even in older age.

When should a couple experiencing difficulty becoming pregnant seek help?

We recommend waiting a year of attempts at conception before we start formal evaluation. However, if there’s a reason to suspect a problem, then we could do that earlier. Let me give you a few examples: if there is a known surgery in the past that involved the genital tract, obviously a vasectomy, but also hernia repair; if there is a problem with erections; or the sex drive; or ejaculations, I do not think that we need to wait a year. We can definitely start the evaluation sooner than that.

Why is it just as important for the female and male to be evaluated?

That is because, as you’ve mentioned before, we know now that a male factor for itself or combined with a female factor is present in up to 50 percent in all infertility cases, so if we can either find a problem that is correctable, we can allow this couple to conceive naturally; or if we can find out that this is not a correctable problem, we can direct the couple in the appropriate way, if they need to seek assistance by IVF, for example; or sometimes the fertility problem is just a marker for a more serious, underlying problem. These are just the main reasons why evaluation of the male partner is important.

When a man comes to your infertility clinic, what should they expect at that first visit?

Obviously the first thing would be a detailed interview where we will take a detailed history. In fact, we use a questionnaire that is handed to a couple when they check in so they have time to fill it out. This will help us in the interview process.

We will then proceed with the physical examination that will focus on the reproductive organs, but will also include a more general physical examination, and finally, a semen analysis. Based on the information and the findings that we gather with these first three, we will decide how to proceed. This could involve further blood work, looking at hormones or certain genetic testing, and sometimes imaging, typically an ultrasound, but not always are these necessary, we just base the decision on the medical interview, physical exam, and the semen analysis.

What treatment options are available for men with fertility problems?

This really depends on the underlying cause, so we need to establish a diagnosis.

If we’re looking at a hormone problem, for example a low testosterone, then we can address that medically and we have certain ways to approach that.

If the problem is an anatomic problem, for example, a man who has a vericocele, a condition that we mentioned earlier, then we can surgically address that.

If we are dealing with a problem of obstruction after a vasectomy that was done in the past, then we can reverse that. For men who have complete absence of sperm in their ejaculate, we can attempt retrieval of sperm directly from the testicle using some advanced microsurgical techniques.

So we have a variety of either medical or surgical procedures that we can do. And also, as we’ve mentioned before, we work in very close collaboration with our female fertility colleagues. So, for example, if we are doing a sperm retrieval procedure and we’re able to find sperm in a man who otherwise has no sperm in his ejaculate, we can have the sperm processed and banked and then used later on – or simultaneously – for individual fertilization done by the female fertility team.

What percentage of your patients achieves a pregnancy after treatment?

This is another great question and it depends on the type of the problem, so it’s difficult to just throw a general number, but I would say, for example, if we look at a vericocele, which is the most common cause of correctable male infertility, then successful repair can restore sperm parameters to the normal range in up to 70 percent and allow for a pregnancy through normal intercourse in 50 to 60 percent, and this is without any intervention involving the woman – this is just an example.

If someone wanted to learn more or make an appointment – who could they call?

The best way would be to call our office at 319-356-2421.