We Can Help You Optimize Your Fertility

Male fertility plays a crucial role in starting a family. For couples unable to conceive, male infertility is the sole cause of approximately 30% of cases and a co-contributor to an estimated additional 20% of cases.

But male fertility is also an indicator of a man's overall health. A low sperm count could be a sign of underlying health issues, such as hormonal imbalances, nutrient deficiencies, or even chronic diseases like diabetes or heart disease.

At the UHealth Center for Reproductive Medicine, we can help you optimize your fertility and plan for the family and life you want.

Your First Step: An Infertility Evaluation

Your first step towards optimizing your fertility is to come to UHealth for an infertility evaluation. It's a simple, straightforward process that can provide valuable insights into your reproductive health and help you make informed decisions about your future.

Here’s what you can expect during a male infertility exam:

• A physical exam to assess your health
• A complete review of your medical and reproductive history
• A semen analysis to check sperm count, shape, volume, and mobility

Your semen provides important information about the quality and quantity of your sperm. To provide a sample, you’ll need to self-stimulate and ejaculate into a sterile glass jar while in our office.

If masturbation is culturally unacceptable for you, we can provide instructions to collect semen at home.

In either case, your semen sample needs to be tested within an hour of collection, and you’ll likely need to provide two separate samples six weeks apart because samples can be different at different times.

Leading-Edge Diagnostic Tests for Male Factor Infertility

Semen tests cannot predict fertility, but if your semen analysis shows that something isn’t normal, your doctor may recommend more tests. This might include hormone testing and/or genetic testing if your sperm count is less than optimal.

Your doctor might also recommend specific sperm tests, including:

• Vital staining to determine if enough sperm in the semen sample are alive.
• Anti-sperm antibodies test to see if antibodies are attached to sperm, which makes it hard for them to move properly.
• Peroxidase staining and semen culture to detect infection or inflammation.
• Sperm DNA testing to detect if your sperm are damaged or have fragile DNA.

Genetic testing can help determine if there is something in your genes that makes it impossible to produce sperm or if there is an issue that you might pass on to a child. If your doctor decides more in-depth genetic testing is necessary, these tests might include:

• Chromosome analysis
• Y-chromosome deletion testing
• Cystic fibrosis testing

Hormonal tests may include:

• Follicle-stimulating hormone (FSH) testing
• Luteinizing hormone (LH) levels testing
• Thyroid stimulating hormone testing
• Estradiol testing
• Total and free testosterone testing
• Prolactin level (PRL) testing

Testicular biopsy is an important tool in diagnosing male infertility. However, it is not the first step. For the initial phase of a fertility evaluation, your doctor will take a health history and order blood tests and a semen analysis. Testicular biopsy can help:

• Determine whether a blockage is causing sperm production problems.
• Retrieve sperm for use in IVF. This is done if sperm are being made in the testicles but are not present in the semen.
• Determine the cause of a lump in the testicles.
• Diagnose testicular cancer.

The Male Infertility Algorithm

At UHealth, we use the male fertility algorithm to make personalized and evidence-based recommendations about how to manage your fertility. Using everything we learn from your infertility evaluation, we create a personalized fertility profile and determine the best course of treatment for you.

Comprehensive Care for Male Fertility Conditions

At the UHealth Center for Reproductive Medicine, we work with patients to address the full spectrum of male fertility conditions, including semen analysis abnormalities and genetic conditions.

Semen Analysis Abnormalities

Oligospermia
Oligospermia is a condition characterized by a low sperm count. To impregnate a woman, a man must have a healthy amount of sperm in his semen. According to WHO, if the sperm count is less than 15 million sperm per milliliter (mL), it is considered oligospermia. Oligospermia can be classified into three categories:

• Mild oligospermia: a sperm count between 10 to 15 million sperm per mL.
• Moderate oligospermia: a sperm count between 5 to 10 million sperm per mL.
• Severe oligospermia: a sperm count between 0 and 5 million sperm per mL.

Asthenospermia
Asthenospermia is a condition that affects sperm motility. It is commonly referred to as slow-moving sperm or lazy sperm. When a man has a high percentage of sperm that do not move adequately, it may be difficult to achieve pregnancy naturally and an assisted reproductive technique may be necessary.

Azoospermia
This condition refers to a lack of sperm in the ejaculate. Azoospermia can be obstructive (caused by a blockage that prevents sperm from entering the ejaculate) or nonobstructive (caused by absent sperm production). Azoospermia can be the result of medical treatments, including chemotherapy, radiation and vasectomies, as well as factors like substance abuse, certain genetic conditions and anatomical abnormalities. It is estimated that 1% of all men experience azoospermia, and depending on the cause, treatment can range from lifestyle changes to surgical procedures.

Teratospermia
Defined as abnormal sperm morphology, teratospermia is a sperm disorder that causes males to produce abnormally shaped sperm. The pregnancy rate in men affected by teratospermia depends on the severity, and its causes are varied and many times unknown. There are various treatment options to help conceive with abnormal sperm morphology and the chances of success depend on the overall health of the sperm, as teratospermia may occur with other issues like sperm count or sperm motility.

Genetic Causes of Infertility

Inherited conditions such as Y chromosome infertility and Klinefelter's syndrome — in which a male is born with two X chromosomes and one Y chromosome instead of one X and one Y — affect the development of the male reproductive organs.

Most cases of Y chromosome infertility result from new deletions on the Y chromosome that occur during the formation of sperm cells in a man’s father who is not himself infertile and with no family history of the disorder. If a man with Y chromosome infertility does father children (naturally or via fertility treatment), they pass the genetic changes on the Y chromosome to all their sons, who will then also have Y chromosome infertility. Daughters do not inherit Y chromosome infertility.

Congenital absence of the vas deferens is another genetic condition where the vas deferens are absent, and therefore, sperm cannot be ejaculated.

Anatomical Conditions that Affect Fertility

Varicocele is an anatomical variation first found during puberty in which veins in the scrotum are enlarged and sometimes even visible. It isn’t harmful, but it can cause pain and reduce fertility. While its cause is not known, varicocele is common and occurs in approximately 15% of adult men. We can diagnose most varicocele during a physical exam, and if we suspect varicocele but it isn’t visible, we may recommend an ultrasound.

Advanced Male Fertility Procedures

If you are diagnosed with azoospermia that is caused by a blockage or low sperm production, your doctor may recommend surgical sperm retrieval.

Using the latest surgical techniques that minimize injury to the testicle and reproductive tract, sperm retrieval procedures can help:

• Obtain the best quality sperm
• Obtain sperm that can be used immediately or frozen

There are a variety of procedures available for sperm harvesting, including:

• Testicular sperm aspiration (TESA)
• Percutaneous epididymal sperm aspiration (PESA)
• Testicular sperm extraction (TESE)
• Microepididymal sperm aspiration (MESA)
• Microdissection TESE (microTESE)
• Testicle biopsy procedure to remove a small sample of the testicle tissue via an incision to be examined.

To determine the best sperm retrieval technique for you, your doctor will consider:

• If the procedure can be done through the skin or requires an incision (percutaneous vs. open)
• The amount of tissue needed and the best method to retrieve it (biopsy vs. aspiration)
• The location (testicle, epididymis, or vas deferens)
• Whether microsurgical or conventional instruments are required

Multiple Options for Fertility After Vasectomy

Vasectomy is one of the most popular sterilization methods in the United States. But what if you have one and then decide you want children later? You have two options to consider: a vasectomy reversal or sperm aspiration prior to IVF.

Your provider can help you decide which procedure is better for you and your partner. They’ll make a recommendation based on:

• Time since your vasectomy
• How many children you want
• How quickly you want to conceive
• Whether you want to conceive naturally or through IVF
• Your partner’s age
• Cost

Reverse Vasectomies

If you decide a vasectomy reversal is right for you, there are two types:

• Vasovasostomy to reconnect the two ends of the vas deferens that were cut during your vasectomy.
• Vasoepididymostomy to reconnect the vas deferens with the epididymis, which is done when a vasovasostomy is not possible because of blockages caused by your vasectomy.

Your doctor will determine which type of vasectomy reversal you need during the operation.

Sperm Aspiration

Sperm aspiration is less expensive than a reverse vasectomy, and it may be the right choice if your female partner is older than 37, you want to get pregnant quickly, and you want a less-invasive procedure. However, it requires a more invasive procedure for your female partner.

How Age Affects Male Fertility

Men’s sperm quality deteriorates with age, but it usually does not become a problem until a man reaches his 60s. Men’s testes tend to get smaller and softer, and sperm shape and mobility decline. They also have a slightly higher risk of gene defects in their sperm, and men may develop illnesses as they age that adversely affect their sexual and reproductive function. However, not all men experience significant changes in reproductive or sexual functioning as they age, especially men who maintain good health over the years.

Despite this, there is no maximum age for a man to father a child. Not all men experience significant changes in their sexual or reproductive functions as they age, especially men who maintain good health. But if you experience problems with libido or erections, talk to your primary care provider or your urologist or andrologist.

Ask About Our Pregnancy Rates

Our closely-knit team is guided by faculty members at the University of Miami Health Miller School of Medicine, a nationally recognized research institution committed to ensuring patients receive the most accurate diagnostic tests and advanced fertility treatments available.

We have some of the highest pregnancy rates in South Florida, as well as the entire United States, and our success stories include even the most challenging cases.

With cost-effective treatments and financing options that make male fertility treatments as affordable as possible, we are prepared to help you and your partner conceive.