Medical Rounds with Dr. Jared Bieniek

Male infertility… it’s a topic you don’t often hear about, partly because most men are simply uncomfortable talking about it. But, did you know that male infertility accounts for half of the cases where couples are struggling to conceive? Dr. Jared Bieniek, a urologist with Hartford Healthcare’s Tallwood Urology and Kidney Institute explains the importance of men being evaluated and treatment options.

Q. WHAT IS MALE INFERTILITY/WHAT ARE THE FACTORS INVOLVED?
A.  Infertility is defined as the inability to conceive after one year of trying, or sooner for couples in which the female partner is a little older. This problem is not uncommon, affecting 15% of reproductive-aged couples – that’s nearly 7 million US couples. We may not hear about it much given the sensitivity of the issue. For those struggling to conceive, male factors may be identified in half of cases. These male factors may include issues with sperm production, transport, sexual function, or reproductive hormones.

Q.  WHAT HAPPENS DURING AN EVALUATION?
A.  The male evaluation is simple and is a critical component of the evaluation of the couple as a whole. Men typically will undergo a directed medical history and physical examination with focus on details including medical problems, past surgeries, medications, and toxic exposures. Additionally, men should complete at least two semen analyses to assess the sperm number and quality. In cases where additional information is needed, men may be asked to complete blood work and consult with a male fertility expert. It’s important to recognize that male fertility problems may also be a “canary in the coalmine” with evidence of increased rates of future diabetes, heart disease, and testis cancer in large population studies.

Q. WHAT ARE THE TREATMENT OPTIONS AVAILABLE TO MEN WITH INFERTILITY?
A. Treatment options vary based on any factors identified that may be contributing to reduced male fertility. A healthy lifestyle including a daily multivitamin is my first recommendation to any man trying to conceive. Medications may be helpful for some men with reduced sperm production or low testosterone to increase testicular function. It is important to remember that testosterone replacement therapy, however, has the opposite effect and actually shuts down sperm production. Surgical treatments also are recommended for some men found to have contributing conditions such as varicoceles, lack of sperm in the ejaculate, or prior vasectomy.

Q. WHAT ABOUT A VASECTOMY REVERSAL FOR MEN NOW INTERESTED IN HAVING MORE CHILDREN?
A. Vasectomy reversal is an option for having children after a prior vasectomy and has been shown to be more cost-effective than in vitro fertilization. The procedure can typically be performed through mini-incisions not much larger than the original vasectomy. While the reconstruction may be slightly simpler if it’s been a short amount of time, there is no time interval that is too long with some centers performing reversals up to 40 years later!

For more information

Visit: Tallwood Urology & Kidney Institute

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