Doctors in the Columbia University Department of Urology at NewYork-Presbyterian Hospital are specially trained in basic to advanced infertility procedures and can help you choose which medical or surgical solution is appropriate for you and your partner. We work closely with the infertility specialists at Columbia's Center for Women's Reproductive Care (CWRC) to deliver unparalleled care to both partners in an infertile couple.
Medical Treatment for Male Infertility
A man's sperm count is sometimes low for no known reason, or doctors may discover a specific hormonal abnormality during an evaluation—one that might have otherwise gone unnoticed. Our staff is knowledgeable about endocrine disorders in men and can help decide which medicines will be helpful or whether further testing is needed.
Surgical Treatment for Male Infertility
Varicoceles, enlarged veins in the scrotum, can raise the temperature and decrease blood circulation through the testicles, affecting sperm production and semen quality. Doctors at Columbia Urology at NYP use microsurgical procedures called varicocele ligation or varicocelectomy to remove these veins. Not all men with varicoceles are infertile, but most infertile men have improved semen levels after varicocelectomy or ligation and some infertile men are able to achieve conception.
A vasectomy is a procedure in which surgeons cut through the vas deferens, the vessel that connects the testicle to the urethra, then place a clip or suture around the cut ends to disrupt the flow of sperm. Men who have had vasectomies sometimes later decide that they want to have children. They may opt to undergo a vasectomy reversal, a surgical procedure that restores the flow of sperm through the vas deferens. At Columbia Urology this is performed by experienced microsurgeons using an operating microscope and other specialized instruments.
There are two types of vasectomy reversals. In a vasovasostomy, the most frequently performed vasectomy reversal, surgeons stitch the cut ends of the vas deferens together. If inflammation or scarring in another vessel, the epididymis, prevents sperm from getting to the vas deferens, surgeons perform a vasoepididymostomy, and connect the vas deferens directly to the epididymis. Surgeons who have microsurgical expertise, like those at Columbia Urology, can switch from a vasovasostomy to a more complicated vasoepididymostomy if necessary.
Following vasovasostomy sperm appears in the semen in 85% to 97% of men, and about half of couples achieve a pregnancy. Sperm appears in the semen in about 65% of men, and 20% of couples achieve a pregnancy after microsurgical vasoepididymostomy.
Transurethral Resection of the Ejaculatory Duct
In rare cases a blockage in the vessels that carry semen causes sperm to be absent in the semen. If the blockage is in the vas deferens, the tube leading from the testicle to the urethra, urologists may perform a microsurgical repair similar to a vasectomy reversal (see above).
Sometimes the obstruction is in the ejaculatory ducts. These ducts, located in the prostate gland, are the passageways through which sperm travels from the testicle. Doctors may cut into and repair these ducts, a relatively simple outpatient procedure with minimal postoperative pain. When performed by experienced surgeons, 50% to 75% of men have sperm in their ejaculate and pregnancy rates are about 25%.
Sperm Retrieval and Assisted Reproductive Techniques (IVF/ICSI)
To help couples achieve pregnancy, doctors sometimes fertilize the egg outside the woman's body, then place it in the uterus to complete gestation. This approach is called an assisted reproductive technique (ART). Two ARTs, in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), have revolutionized the treatment of infertile couples. Many are now able to conceive who would otherwise have been unable to achieve pregnancy. We work together with the physicians at the CWRC and their specially trained staff on these latest technologies.
IVF and ICSI are most successful when doctors collect and choose the man's healthiest sperm. Doctors may need to perform a biopsy to see if the testicles are producing sperm or to retrieve sperm for IVF or ICSI. This relatively simple procedure can be performed in the office using only local anesthetic. All patients of Columbia Urology undergo biopsy at the Center for Women's Reproductive Care (CWRC) and the specially-trained embryologists at the Center can provide rapid feedback on whether they have succeeded in retrieving sperm.