{"id":11,"date":"2013-09-06T20:51:33","date_gmt":"2013-09-06T20:51:33","guid":{"rendered":"http:\/\/www.dralexurology.com\/sexual-health\/?page_id=11"},"modified":"2013-10-05T23:23:24","modified_gmt":"2013-10-05T23:23:24","slug":"male-infertility-expert-urological-evaluation","status":"publish","type":"page","link":"http:\/\/www.dralexurology.com\/sexual-health\/male-infertility-expert-urological-evaluation\/","title":{"rendered":"Male Infertility &#8211; Expert Urological Evaluation in New York City"},"content":{"rendered":"<h1>Male Infertility Evaluation and Treatment<\/h1>\n<p>Males infertility or subfertility is a contributing factor in 50% of couples seeking evaluation and treatment for infertility.<\/p>\n<ul>\n<li>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 20% of infertility cases are caused by the male factor<\/li>\n<li>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 30-40% involve both male and female factors<\/li>\n<li>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 about 50% of infertility cases are attributable to female factors.<\/li>\n<\/ul>\n<h3>Useful Facts about Fertility and Infertility:<\/h3>\n<p>[col type=&#8221;one-fourth&#8221;]<a href=\"http:\/\/www.dralexurology.com\/sexual-health\/wp-content\/uploads\/sites\/4\/2013\/09\/infertily_shutterstock_463084481.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-81\" alt=\"infertily_shutterstock_46308448\" src=\"http:\/\/www.dralexurology.com\/sexual-health\/wp-content\/uploads\/sites\/4\/2013\/09\/infertily_shutterstock_463084481-222x300.jpg\" width=\"222\" height=\"300\" srcset=\"http:\/\/www.dralexurology.com\/sexual-health\/wp-content\/uploads\/sites\/4\/2013\/09\/infertily_shutterstock_463084481-222x300.jpg 222w, http:\/\/www.dralexurology.com\/sexual-health\/wp-content\/uploads\/sites\/4\/2013\/09\/infertily_shutterstock_463084481.jpg 370w\" sizes=\"auto, (max-width: 222px) 100vw, 222px\" \/><\/a><\/p>\n<p>[\/col]<\/p>\n<p>[col type=&#8221;three-fourth last&#8221;]<\/p>\n<ul>\n<li>Peak of fertility occurs in males and females at age 24. Fertility declines after that age in both sexes.<\/li>\n<li>Most conceptions occur when intercourse occurs 6 days prior to the day of ovulation. \u00a0 Dr. Shteynshlyuger advises patients to have vaginal intercourse every 2 days.\u00a0 Sperm lifespan is up to 5 days.<\/li>\n<li>Normal couple has 20-25% chance of conceiving within 1 month;\u00a0 75% conceive within 6 months; 90% conceive within 1 year.<\/li>\n<\/ul>\n<p>[\/col]<\/p>\n<p><strong style=\"font-size: 1em; line-height: 1.5;\">Infertility is classically defined as failure of pregnancy after 1 year of unprotected sex.\u00a0<\/strong><span style=\"font-size: 1em; line-height: 1.5;\"> About 15% of couples are infertile at 1 year. <strong>Usually, a urological evaluation is indicated in all couples who have not been able to conceive after one year of trying to conceive, even in the presence of a known problem in a female as many couples have a co-existing male problem.<\/strong><\/span><strong style=\"font-size: 1em; line-height: 1.5;\"><br \/>\n<\/strong><\/p>\n<blockquote><p><strong style=\"font-size: 1em; line-height: 1.5;\">Dr. Shteynshlyuger advises that in couples, in particular where the woman is close or over \u00a0age 35, earlier evaluation is indicated. It is unwise to wait 1 year as aging works against the odds of conceiving. \u00a0Ability to conceive naturally rapidly deteriorates in women after age 35 with each year.<\/strong><\/p><\/blockquote>\n<p>It is important to remember that fertility is a dynamic state. \u00a0Of all infertile couples (no conception at 1 year), 25-35% will conceive spontaneously without any treatment with time.\u00a0 Baseline pregnancy rate in non-azoospermic couples is 1-3% per month. 23% will conceive within the first 2 years, 10% more will conceive in the following 2 years.<\/p>\n<p>[box style=&#8221;1&#8243;]<\/p>\n<p>If you have concerns about infertility, <a href=\"http:\/\/www.dralexurology.com\/appointments\/\">make an appointment with Dr. Shteynshlyuger<\/a> for a thorough and complete evaluation. \u00a0We welcome men to bring their significant others to the appointment.<\/p>\n<p>[\/box]<\/p>\n<p><b style=\"font-size: 1em; line-height: 1.5;\">Male infertility can be classified as<\/b><\/p>\n<ul>\n<li>Reversible \u2013 varicocele, infections, obstruction<\/li>\n<li>non-reversible that can be managed by ART (Assisted Reproductive technologies),<\/li>\n<li>non-reversible that cannot be managed by ART (azoospermia).\u00a0 Donor insemination and adoption are viable options.<\/li>\n<li>Due to underlying medical problems \u2013 recent febrile illness impairs spermatogenesis for 1-3 months; testicular cancer, pituitary problems, neurological diseases, renal failure.\u00a0 60% of patients with testicular cancer\/lymphoma have oligospermia.<\/li>\n<li>genetic\/chromosomal abnormalities that affect the patient and\/or offspring<\/li>\n<\/ul>\n<p><b>Factors that affect male fertility:<\/b><\/p>\n<ul>\n<li>Genes that control male fertility, including androgen receptor genes, are located on the X chromosome.\u00a0 Relevant family history includes history of infertility in maternal uncles.<\/li>\n<li>Lubricants \u2013 many are spermicidal; others (KY, surgi-lube, saliva) affect sperm motility.\u00a0 Peanut oil, vegetable oil, egg white do not affect motility.\u00a0 Avoid lubricants if possible<\/li>\n<li>Cryptorchidism (undescended testis) \u2013\u00a0 slight decrease in fertility if unilateral, 90% fertile; significant decrease in fertility if bilateral, 65% are fertile;\u00a0 timing of orchiopexy does not matter as long as it occurs prior to puberty. \u00a0Many men are not aware or only vaguely aware that they had orchiopexy as children. \u00a0It may be worthwhile to inquire parents or older family members about this.<\/li>\n<li><span style=\"font-size: 1em; line-height: 1.5;\">Testicular trauma\/Torsion \u2013 can lead to testicular atrophy;\u00a0 predisposition to antisperm antibody formation<\/span><\/li>\n<li><span style=\"font-size: 1em; line-height: 1.5;\">Delayed\/absent puberty \u2013 androgen receptor defects; endocrine disorders<\/span><\/li>\n<li><span style=\"font-size: 1em; line-height: 1.5;\">Gynecomastia \u2013 hyperprolactinemia or estrogen abnormality<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>Surgery can affect man&#8217;s ability to reproduce:<\/b><\/p>\n<ul>\n<li>Bladder neck surgery \u2013 retrograde ejaculation<\/li>\n<li>Scrotal surgery \u2013 vas deferens\/epididymal injury<\/li>\n<li>Inguinal surgery \u2013 vas deferens injury<\/li>\n<li>Retroperitoneal LN dissection \u2013 can injure sympathetic nerves, leads to failure of emission or retrograde ejaculation.<\/li>\n<li>Sympathectomy: ejaculation \/ emission problems<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>Infections:<\/b><\/p>\n<ul>\n<li>Prostatitis\/UTI\/STDs \u2013 no evidence for infertility causation<\/li>\n<li>Mumps \u2013 10-30% of patients age 11+ present with mumps orchitis;\u00a0 mumps rarely affects testis in prepubertal boys.<\/li>\n<li>Epididymitis \u2013 azoospermia with bilateral epididymal obstruction.<\/li>\n<\/ul>\n<p><b>Low Volume Ejaculate:<\/b><\/p>\n<ul>\n<li>\u00a0#1 cause \u2013 poor collection; repeat with care<\/li>\n<li>absent vas deferens and\/or seminal vesicles<\/li>\n<li>obstruction of the ejaculatory ducts,<\/li>\n<li>retrograde ejaculation<\/li>\n<li>hypogonadism (low testosterone)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>Social\/Behavioral:<\/b><\/p>\n<ul>\n<li>use of hot tobs\/spas decreases sperm motility by 10%<\/li>\n<li>Smoking seems to decrease sperm density<\/li>\n<li>Obesity \u2013 leads to hyperestrogenemia.<\/li>\n<li>Marijuana use<\/li>\n<\/ul>\n<p><b>Ejaculatory dysfunction or ED<\/b>:<\/p>\n<ul>\n<li>Diabetes<\/li>\n<li>Multiple Sclerosis<\/li>\n<li>Renal Failure \/ Dialysis<\/li>\n<li>Other Neurological and Systemic diseases.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>Medical Treatment:<\/b><\/p>\n<ul>\n<li><b>Medications<\/b>:\u00a0 nitrofurantoin, calcium channel blockers, cocaine, pot, caffeine, anabolic steroids.<\/li>\n<li><b>Chemo\/radiation<\/b>: may take 4-5 years for spermatogenesis to resume if germ cells are NOT permanently damaged.\u00a0 Can predict azoospermia based on medication\/doses.<\/li>\n<li><\/li>\n<\/ul>\n<p><b>Congenital Diseases:<\/b><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><b>Immotile Cilia Syndrome (Kartagener\u2019s)<\/b> \u2013 immotile sperm, situs invertus, frequent URI<\/li>\n<li><b>Cystic Fibrosis<\/b> \u2013 almost all patients with clinical disease have CBAVD (Congenital Bilateral absence of vas deferens).\u00a0 Most patients with CBAVD have CF.<\/li>\n<li><b>Young\u2019s Syndrome<\/b> \u2013 azoospermia and frequent URI.<\/li>\n<li><b>Kallman\u2019s Syndrome<\/b> \u2013 anosmia, hypogonadotropic hypogonadism.<\/li>\n<\/ul>\n<p>Testicular temperature is 1-2.5F below body temperature. No evidence that underwear affects spermatogenesis.\u00a0 Frequent use of saunas, hot tubs decreases sperm motility by 10%.<\/p>\n<p><b>Female Factor Infertility<\/b><\/p>\n<ul>\n<li>present in 75% of infertile couples (40% female only, 30% male + female)<\/li>\n<li><\/li>\n<li>30% are due to ovulatory dysfunction<\/li>\n<li>regular menses 21-35 days suggest normal ovulatory function<\/li>\n<li>evaluation involves: urinary or plasma FH levels, transvaginal US to evaluate follicles, midluteal phase serum progesterone (from corpus luteum) is used to confirm the diagnosis;\u00a0 endometrial biopsy several days before onset of menses<\/li>\n<li>most common treatment involves induction agents such as clomiphene citrate or gonadotropins<\/li>\n<\/ul>\n<p>25% are due to fallopian tube abnormalities<\/p>\n<ul>\n<li>Common causes include PID, adhesions<\/li>\n<li>Hysterosalpingogram (repeated twice) is diagnostic<\/li>\n<li>Treatment involves laparoscopy, surgical repair or IVF<\/li>\n<\/ul>\n<p>5% are due to endometriosis \u2013 treatment involves laparoscopy<\/p>\n<p>4% are due to\u00a0hyperprolactinemia<\/p>\n<p>4% are due to cervical mucus abnormalities.<\/p>\n<p>If you have been unable to conceive or have been diagnosed with abnormal semen analysis or infertility\u00a0and are\u00a0<strong>looking for a thorough male infertility evaluation or a second or third opinion<\/strong>\u00a0<strong>make an appointment with Dr. Alex Shteynshlyuger.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Male Infertility Evaluation and Treatment Males infertility or subfertility is a contributing factor in 50% of couples seeking evaluation and treatment for infertility. \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 20% of infertility cases are caused by the male factor \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 30-40% involve both male and female factors \u00a0 \u00a0 \u00a0 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-11","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Male Infertility - Expert Urological Evaluation in New York City - Sexual Health: ED and Libido &amp; 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