"New Hope for Infertile Couples" By: Roy A. Brandell, M.D. - WAOW - Newsline 9, Wausau News, Weather, Sports

"New Hope for Infertile Couples" By: Roy A. Brandell, M.D.

July 2006

Roy A. Brandell M.D.

Fertility problems affect approximately 15% of couples trying to conceive. A male factor is entirely responsible for the fertility problem in 20% of these couples and is a contributing cause in another 30% of cases. Therefore, a male factor is present in at least one half of infertile couples.

A simple cost effective evaluation of both partners should be initiated at the time of presentation. The male partner is usually evaluated by a urologist, particularly if a screening semen analysis shows an abnormality. Increasingly, there is a tendency for some couples to proceed directly to assisted reproductive techniques (ART) like intra-uterine insemination (IUI) and even in vitro fertilization (IVF). This is a mistake, as significant diseases associated with male factor infertility may be overlooked (i.e. testicular cancer, pituitary tumors and neurologic disorders). In addition, it is now becoming clear that appropriate treatment of the male fertility problem may be simpler, safer and more cost effective than proceeding directly to ART.

For example, an oligospermic man with a large varicocele may see substantial improvements in his semen parameters after microsurgical inguinal varicocelectomy. Even if the improvement is not enough to achieve natural pregnancy, the surgery may "upgrade" the man from requiring IVF to being a candidate for IUI (a much less invasive and less costly approach). In addition to varicocele surgery, other urologic procedures may be beneficial to the infertile male including testis biopsy, relief of ejaculatory duct obstruction, and bypass of the obstructed vas deferens or epididymis.

The most common source of vasal obstruction is a history of previous vasectomy. There is a growing population of men, previously sterilized by vasectomy, who now wish to pursue biologic fatherhood again. Using microsurgical techniques, success rates approaching 95% can be achieved, even in men who had their vasectomy many years ago. Several studies have documented that vasectomy reversal is much more cost effective than IVF using sperm aspirated from the epididymis or testis.

Infertility is becoming more common as couples delay having children until later in life. This emotionally charged problem can have devastating consequences for affected couples. Thorough evaluation and appropriate treatment of the male partner is an important first step in the pursuit of pregnancy. Even when a medically or surgically correctable problem is not found, urologists can make recommendations for healthy lifestyle choices that optimize fertility. Now, more than ever before, infertile couples can be provided a realistic sense of hope.

Fertility problems affect approximately 15% of couples trying to conceive. A male factor is entirely responsible for the fertility problem in 20% of these couples and is a contributing cause in another 30% of cases. Therefore, a male factor is present in at least one half of infertile couples.

A simple cost effective evaluation of both partners should be initiated at the time of presentation. The male partner is usually evaluated by a urologist, particularly if a screening semen analysis shows an abnormality. Increasingly, there is a tendency for some couples to proceed directly to assisted reproductive techniques (ART) like intra-uterine insemination (IUI) and even in vitro fertilization (IVF). This is a mistake, as significant diseases associated with male factor infertility may be overlooked (i.e. testicular cancer, pituitary tumors and neurologic disorders). In addition, it is now becoming clear that appropriate treatment of the male fertility problem may be simpler, safer and more cost effective than proceeding directly to ART.

For example, an oligospermic man with a large varicocele may see substantial improvements in his semen parameters after microsurgical inguinal varicocelectomy. Even if the improvement is not enough to achieve natural pregnancy, the surgery may "upgrade" the man from requiring IVF to being a candidate for IUI (a much less invasive and less costly approach). In addition to varicocele surgery, other urologic procedures may be beneficial to the infertile male including testis biopsy, relief of ejaculatory duct obstruction, and bypass of the obstructed vas deferens or epididymis.

The most common source of vasal obstruction is a history of previous vasectomy. There is a growing population of men, previously sterilized by vasectomy, who now wish to pursue biologic fatherhood again. Using microsurgical techniques, success rates approaching 95% can be achieved, even in men who had their vasectomy many years ago. Several studies have documented that vasectomy reversal is much more cost effective than IVF using sperm aspirated from the epididymis or testis.

Infertility is becoming more common as couples delay having children until later in life. This emotionally charged problem can have devastating consequences for affected couples. Thorough evaluation and appropriate treatment of the male partner is an important first step in the pursuit of pregnancy. Even when a medically or surgically correctable problem is not found, urologists can make recommendations for healthy lifestyle choices that optimize fertility. Now, more than ever before, infertile couples can be provided a realistic sense of hope.

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