Early evaluation of the man allows timely treatment and limits the necessity for expensive testing of his partner. This also permits any serious underlying disorders to be detected and treated appropriately. Treatments focus on improving the quality of sperm, and may be as easy as avoiding certain environmental exposures or optimizing the timing of intercourse.

Most subfertile men can be helped after a proper evaluation with a male infertility specialist. Even men with no sperm in their ejaculate can often initiate a pregnancy.

Do I need an infertility specialist?
While most urologists receive some instruction concerning the evaluation of subfertile men, the vast majority of urology training programs do not emphasize infertility in their curriculum. In addition, the microsurgical skills necessary to treat many urological conditions associated with infertility require intensive and meticulous training. For this reason several male infertility fellowships have been established around the country. Candidates who are accepted into these programs receive a year or two of additional training specifically in the evaluation and treatment of subfertile men. Due to the relatively few physicians who complete male infertility fellowship training, these specialists represent a small, tightly knit medical community. Active participation in the infertility community ensures state of the art care for patients in the rapidly changing world of infertility evaluation and treatment. For more information about concerning our male infertility specialist please refer to the section About Dr. Daitch.

How will I be evaluated?
Upon making an appointment, you will receive an information packet and detailed questionnaire. Answering the questionnaire helps direct your office evaluation. Men are encouraged to bring their partners with them to their appointment. This facilitates the evaluation and permits any female fertility factors to be addressed. Once the history and physical examination are complete, a semen sample is often requested. Men whom have had recent, properly performed semen analyses may not need to supply another sample. The initial appointment usually takes about one hour. Further evaluation, often with hormonal or genetic testing, is the then initiated as indicated.

Semen Analysis
The semen analysis is the cornerstone of the male infertility evaluation. While it only takes one sperm to fertilize the egg, millions of sperm are necessary for proper sperm functioning. Semen samples can vary extensively from one time to another. To accurately assess the quality of semen, at least two samples separated by several weeks are required. A properly performed semen analysis requires special equipment and technical expertise. Most laboratories do not own this equipment or may not employ appropriately trained technologists. Our laboratory technologist, Kathy Fink, MT, has over 15 years of experience in semen analysis and 6 years of experience in sperm processing techniques and infertility. Our lab is certified with CLIA as a high performance laboratory facility. To make an appointment for a semen analysis, please call Kathy Fink at (602) 264-4431, ext - 2637.

I Have Low Sperm Counts
Many subfertile men have low sperm counts. Sometimes this is only transient, or an artifact due to improper semen analysis. When low counts (called oligospermia) are truly present, they are often associated with dilated veins in the scrotum, called varicoceles. Varicoceles are present in about 30% of all men undergoing infertility evaluations. Varicoceles appear to impair sperm production and function by increasing the temperature of the testicles. The vast majority of well-performed studies have demonstrated significant improvement in semen quality and pregnancy rates after varicocele repair. Varicocele repair is performed as an outpatient procedure. While there are many methods of varicocele repair, Dr. Daitch utilizes the microsurgical technique. This technique has a better success rate and a lower complication rate than the standard techniques for varicocele repair. In addition, it is performed through a one to two inch incision and there is no need to cut across muscle. This allows much quicker recovery and less post-procedural discomfort.

Low sperm counts can also be caused by subtle hormonal abnormalities or environmental exposures such as medications, tobacco, pesticides or solvents. Identification of these abnormalities/exposures and proper treatment can help to improve sperm counts.

Finally, very low counts may be due to underlying subtle genetic abnormalities. Accurate diagnosis is made with genetic testing from cells obtained with a swab of the inner cheek. These men often require advanced techniques such as in vitro fertilization (test tube baby) to father children. However, with proper testing the success rates and risks of passing any genetic abnormalities on to their offspring can be determined.

I Have Low Sperm Motility
Decreased sperm motility (asthenospermia) is common. As is the case with low sperm counts, low motility is often a transient phenomena, or due to an improperly performed semen analysis. However, among men with true low motility, many will have dilated veins in scrotum called varicoceles. Please refer to the I have low sperm counts section for more information about varicoceles.

Low motility can also be due to various environmental exposures such as tobacco, pesticides and solvents. Sometimes, antisperm antibodies cause low motility. Antibodies normally fight infection in the body; however, in some men these antibodies attack their own sperm. If this is suspected, special testing for antibodies is performed. When sperm counts are normal, the antibodies can be washed off the sperm and the sperm used to inseminate their partners.

Finally, white blood cells in the semen can impair motility. Like antibodies, white blood cells usually fight infection. When they are in the semen, however, they often damage sperm. Treatment can be as simple as a short course of antibiotics.

I Have No Sperm in my Semen
The most common cause of having semen containing no sperm is vasectomy. Vasectomies can be reversed with very high success rates. For more information, please see the Vasectomy Reversal section.

About 10% of all infertile men have no sperm in their semen (azoospermia). Many of these men have normally functioning testicles, but the ducts which transport the sperm from the testicles are blocked. Using microsurgical techniques, these ducts can be unblocked and couples can then have children naturally.

Occasionally, men are born with healthy testicles, but without the ducts that transport sperm from the testicles. This is diagnosed on physical examination. For such men, hormonal and genetic testing is usually performed to rule out any underlying abnormalities. Then, sperm can be obtained from the testicles with a minimally invasive procedure performed in the office. The sperm are then used together with in vitro fertilization techniques (test tube baby) to obtain a pregnancy.

Men with no sperm in their semen who do not have a blockage require hormonal testing. Occasionally, hormone replacement will return sperm to the semen. Other men simply do not make enough sperm to reach the semen. Genetic testing can reveal any underlying causes. Even though these men have no sperm in their semen, with careful microscopic testicular dissection, small islands of sperm can often be found. These sperm are then used together with in vitro fertilization techniques (test tube baby) to obtain a pregnancy.

Vasectomy Reversal
Over 500,000 vasectomies are performed each year in the United States. About 3 per 1,000 of these men request a reversal. The success of vasectomy reversal is dependent on two main factors: the amount of time since the vasectomy and the technique of the surgeon. A microsurgical technique is crucial to success.

Studies evaluating microsurgical vasectomy reversal techniques have demonstrated decreased success rates as the interval between vasectomy and vasectomy reversal increases. The most highly regarded study involved over 1,400 men at five different centers. This demonstrated that among men undergoing microsurgical reversals within 3 years of their vasectomy, 97% will have sperm return to their semen, and 76% will initiate a pregnancy. At 3-8 years, 88% have sperm and 53% initiate a pregnancy. From 9-14 years, 79% have sperm and 44% get pregnant. Finally, among men undergoing vasectomy reversal 15 years or more after their vasectomy, 71% have sperm return to their ejaculate and 30% initiate a pregnancy.

The success rates with vasectomy reversal compare very favorably to in vitro fertilization (test tube baby) pregnancy rates, which are typically around 40%. In addition, vasectomy reversal is less expensive than in vitro fertilization, and eliminates female complications from hormonal manipulation which can occur during in vitro fertilization. Finally, the twin or triplet birth rate (around 40% with in vitro fertilization) is not increased with vasectomy reversal.

Vasectomy reversal is performed as an outpatient surgical procedure. Dr. Daitch performs the procedure using an operative microscope and extremely small sutures (9-0 and 10-0). This allows a water-tight connection between the two previously cut ends of the vas deferens. The procedure usually takes about 3-4 hours. During the procedure, fluid from the vas deferens is examined under the microscope to confirm that no additional blockages are present. When an additional blockage is present, it usually occurs in the epididymis. The epididymis is an extremely small and delicate tube that transports sperm from the testicle to the vas deferens. If the epididymis is blocked, Dr. Daitch connects the vas directly to the unblocked portion of the epididymis, thereby bypassing the blockage. This procedure requires additional operative time and microsurgical skill, but success rates still remain around 70% when the vas is connected to the epididymis.

Although microsurgical vasectomy reversal success rates are very high, occasionally a reversal is not successful. In such cases, it is helpful to have preserved sperm available. As a fellowship trained male infertility specialist, Dr. Daitch possesses honed microsurgical skills, and works closely with embryologists located in central Phoenix, Scottsdale, and the West and East Valley. Sperm obtained during the vasectomy reversal can be preserved by the embryologist and used in the future if necessary.

About Dr. Daitch
Dr. Daitch is board certified by the American Board of Urology. He received his medical degree from Harvard Medical School and subsequently trained in urology at the world-renowned Cleveland Clinic Foundation. During his final year of training, Dr. Daitch was selected as the outstanding surgical resident across all surgical specialties and was awarded a traveling fellowship. He completed an additional year of subspecialty fellowship training in male infertility at the Cleveland Clinic Foundation, and also studied at Cornell University/New York Hospital for his traveling fellowship. He joined Urology Associates in July, 1999.
Dr. Daitch is an active member of the infertility community. In addition to publishing several manuscripts on male infertility and erectile dysfunction, Dr. Daitch is a member of the Society for the Study of Male Reproduction, the American Society for Reproductive Medicine, the American Urological Association, the Maricopa County Medical Society, and the Phoenix Urological Society. He is an editor of the American Urological Associations best practice policies for the optimal evaluation of the infertile male, the evaluation of the azoospermic male, the management of obstructive azoospermia, and the impact of varicoceles on fertility. For an appointment with Dr. Daitch, please call (602) 264-4431.