Clinical Specialties : Male Urologic Health

Male Infertility

The male reproductive system is designed to manufacture, store and transport sperm — the microscopic genetic cells that fertilize a woman’s ovum. A number of hormones, the most important of which are testosterone and follicle-stimulating hormone (FSH), regulate this process. Like sperm, testosterone is also produced in the testicles. Sperm production begins when immature cells grow and develop within a network of delicate ducts — microscopic seminiferous tubules — inside the testicles. Because these new sperm cannot move initially on their own, they are dependent on adjacent organs to become functional. They mature while traveling through the epididymis, a coiled channel located behind each testicle. When climax, or orgasm, occurs, sperm are carried out of the body via semen, a fluid composed of secretions from various male reproductive glands, most notably the prostate and paired seminal vesicles.

Causes of Male Infertility

For starters, your infertility may be caused by a diminished output of sperm by your testicles. Abnormal sperm production can also be triggered by genetic factors and a number of lifestyle choices (e.g., smoking, alcohol, and certain medications), all of which can impair the normal production of sperm cells resulting in a decreased sperm count. Long-term illnesses (e.g., kidney failure), childhood infections (e.g., mumps), and hormonal or chromosomal deficiencies (e.g., insufficient testosterone) can also account for abnormal sperm numbers.

Perhaps the most prevalent sperm production problem, however, is linked to structural abnormalities, most notably varicoceles. A worm-like bundle of enlarged or dilated varicose veins around the testicles; varicoceles are the most common identifiable cause of male infertility. They are found in about 15 percent of normal males and in approximately 40 percent of infertile men, most often on the left side or simultaneously on both sides. Evidence suggests that by creating an abnormal backflow of blood from the abdomen into the scrotum, triggering a rise in testicular temperature, varicoceles hinder sperm production and cause low sperm count.

Dr. Ramasamy is an expert in male infertility in Miami, Florida and has published about two different techniques of microsurgical varicocelectomy with and without testicular delivery. For more information click here.

Diagnosis of Male Infertility

Unlike female infertility, the cause of which is often easily identified, diagnosing male factors can be difficult. The problems, however, usually fall in one of two areas — sperm production or delivery. In some cases, both sperm production and sperm delivery can be faulty.

Because male infertility results from such varied factors, you will need to see your physician to discuss the possibilities. You will most likely need evaluation by a urologist or reproductive specialist year to get pregnant.

In any case, the evaluation usually includes questions about your medical and surgical histories. The doctor will want to know about childhood diseases (e.g., mumps), current health problems (e.g., diabetes), or even medications (e.g., anabolic steroids) that might interfere with the formation of sperm. Your healthcare provider will also ask about your use of alcohol, marijuana, and other recreational drugs as well as your exposure to the occupational hazards of ionizing radiation, heavy metals, or pesticides. All of these factors can affect fertility.

Every evaluation will also include an assessment of your sexual performance, along with you and your partner’s joint efforts to achieve pregnancy. For instance, your doctor will ask whether you have had difficulty with erections and if your ejaculate has sufficient quality and volume. Such factors can adversely affect your sperm’s effectiveness for pregnancy.

In addition to conducting a general exam, your doctor will look for any abnormalities of the penis, epididymis, vas deferens, and testicles during the genital exam. Your healthcare provider will check specifically for varicoceles, some of which can be identified easily in the scrotum when the patient is standing because they feel like a “bag of worms.”

During your visit, you will most likely be asked to provide a semen sample. The semen analysis is the most important lab indicator for male infertility. Your doctor will most likely ask you to come back for a second visit so that a second semen sample can be analyzed. These two samples help urologists define each factor and its severity. Performed by examining ejaculate within an hour of masturbation, a semen analysis provides important information about semen volume and content. It also measures the amount, motility (movement), and appearance (shape) of individual sperm. Each factor tells you and your doctor much about your ability to conceive. For more information about semen analysis and instructions, please click here

Click here to watch a different approach that helped the couple overcome their fertility issues and delivery a healthy baby.

Azoospermia (Zero Sperm Count)

Another issue that would lead to infertility would be a lack of sperm in the semen. Azoospermia, which accounts for 10 to 15 percent of all Male Infertility, refers to a complete absence of sperm in your ejaculate. Azoospermia can be due to a production defect that can be triggered by various hormonal or genetic defects often linked to testicular failure. Azoospermia can also be due to obstruction of the sperm transport. In a majority of men, physical exam of the testes and blood test (FSH) can help diagnose whether zero sperm count is to due to a production or a transport problem. In some men, a testis biopsy is necessary to confirm the diagnosis.

In its “non-obstructive” form, azoospermia can be triggered by various hormonal or genetic defects often linked to testicular failure. Dr. Ramasamy has a special expertise in treating men with nonobstructive azoospermia – men who do not have sperm in the ejaculate due to testicular failure. He published one of the largest studies comparing the conventional testis biopsy with microdissection testicular sperm extraction (micro-TESE). Micro-TESE uses an operating microscope to identify areas of spermatogenesis within the testis.

He also published the successful microdissection TESE outcomes in the largest series of men with Klinefelter syndrome.

For commonly asked questions, please see answers provided by Dr. Ramasamy.

Make an appointment

Ranjith Ramasamy, MD
Director of Male Reproductive Medicine and Surgery
Call: (305) 243-6090
e-mail or make an online appointment.