Male Fertility Specialists in San Diego

If you have concerns that your inability to attain or sustain an erection are affecting your ability to father a child or are negatively impacting your sex life, we suggest you speak with your physician. It may be a little awkward at first, but the piece of mind and quality of life you experience as a result will likely be worth your trouble. If you have more questions, please contact us via our secure online contact form.

Here are some commonly asked questions, which may assist you:
Q. Do you see out of area patients?
Q. Where can I stay in San Diego?
Q.I sometimes have difficulty attaining or sustaining an erection, does this mean I am infertile?
Q. What are the differences between male infertility, impotence, erectile dysfunction, and premature ejaculation?
Q. Is it possible to reverse a vasectomy?
Q. With ICSI only a handful of sperm are needed, why should I have a vasectomy reversal?
Q. Does using a hot tub affect my fertility?
Q. Does it matter what kind of underwear I wear?
Q. Does masturbation affect fertility?
Q. Should I be concerned about fertility if I have a veneral disease?
Q. How often should I have intercourse?
Q. What is the effect on fertility of working outside in the heat?
Q. Why is it that my semen analysis is different here than in my first doctor's office?
Q. Why do I frequently have pain during my first urination after ejaculation?
Q. Why do I have "clumps" in my ejaculate? Is this normal?
Q. Does it matter what position we use during intercourse?
Q: Should I wear briefs or boxers to improve my sperm count?
Q. How long should I abstain from sex before I give a semen analysis?
Q. Are there any diet changes I can do to improve my semen quality?
Q. How long does it take for my sperm count to improve after treatment?
Q: How come the quality of my semen analysis is so different between laboratories?
Q: Does exercise affect sperm quality?
Q: When is the best time to have sex when we know the ovulation date?
Q: If my sperm count is normal then does that mean I am okay?
Q: At what sperm count am I no longer able to father a child?
Q: I'm taking Viagra, does this mean I am more fertile?

Q. Do you see out of area patients?
A. As one of the preeminent male fertility specialists in Southern California, the majority of our patients come from California, Arizona, Nevada and Mexico. However, we see patients from all over the USA and from other countries as well, and have our own travel concierge for our patients to help with travel arrangements.

Q. Where can I stay in San Diego?
A. There are many fine lodgings available, take a look at our travel information or contact our travel concierge.

Q.I sometimes have difficulty attaining or sustaining an erection, does this mean I am infertile?
A. The answer to this somewhat common question is "not necessarily". Guys, its quite natural to not always be able to "perform" flawlessly. For many men, especially as you get older, your ability to attain and sustain erections declines. Also, a need for increased periods of time between sessions is also common as men age. However, for conception to occur, it is necessary for the male partner to sustain vaginal intercourse to the point of ejaculation. If ejaculation during intercourse is not possible, it is unlikely that conception will result. The important thing to remember is that a decline in your ability to perform like you did in your early 20's does not indicate or correlate to your fertility. Likewise, your ability to attain and sustain erections does not reflect your fertility. Many men with fertility problems experience no outward signs that they have a problem and enjoy a very active sex life.

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Q. What are the differences between male infertility, impotence, erectile dysfunction, and premature ejaculation?
A. Infertility is defined as the inability to establish a pregnancy after trying to conceivefor 1 year. Impotence or erectile dysfunction is the inability of a man to achieve or maintain an erection. Premature ejaculation is more difficult to define but is generally described as recurrent ejaculation with minimal stimulation before the person wishes. These conditions may be related in some patients or may occur independent of each other. Men experiencing fertility problems may be potent and men with erectile dysfunction may be fertile.

Q. Is it possible to reverse a vasectomy?
A. Vasectomy reversal is not only possible but is highly successful when performed by an experienced infertility microsurgeon. Unfortunately other doctors without these special skills will perform the surgery themselves rather then reffering the patient to an infertility specialist. Once again it is incumbent upon the patient to make sure that his doctor performs the procedue regularly and successfully. A good idea is to ask to speak with some of his patients that have already undergone the procedure. Studies have shown that the outcome of surgery is so dependent on the surgical technique and the surgeon that performs it that it is well worth making the extra effort in going to a specialized center. Although failed vasectomy reversals can be repaired, the first attempt at reversal is the easiest and best opportunity for success.

Q. With ICSI only a handful of sperm are needed, why should I have a vasectomy reversal?

A. Both vasectomy reversal and ICSI/sperm aspiration are good alternatives to father a child after vasectomy. They each have advantages and drawbacks. In most situations vasectomy reversal offers the greatest chance for pregnancy. It requires one procedure be performed only on the man and couples can then try to get pregnant every month the old fashioned way using "IBF" or what we call "in-bed fertilization". ICSI on the other hand requires that both partners undergo a procedure and the woman is stimulated with fertility drugs to treat a "male problem". The costs of establishing a pregnancy are three times greater with ICSI than with vasectomy reversal. It is even less expensive to have a vasectomy reversal and a repeat vasectomy (if desired) then to have ICSI. The advantage of ICSI is the possibility for some couples to establish a pregnancy quicker than with vasectomy reversal. We recommend ICSI/sperm harvesting in those situations where vasectomy reversal would be difficult or impossible, the female partner is of advanced reproductive age, or when there is also a female factor contributing to the infertility. Each couples' cicustances are unique and need to be addressed on an individual basis. Our goal is to assist couples in having a child of their own, regardless of the path they choose.

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Q. Does using a hot tub affect my fertility?
A. Excess heat applied to the testicles of animals does indeed cause a decrease in sperm production. A study in California showed that men who used hot tubs experienced q drop in sperm production. However, when the heat is avoided for several months, sperm production should return to normal. The production of sperm is a process requiring approximately three months. Consequently, when any condition or factor injurious to production of sperm is removed, a change in sperm quantity or quality should not be expected for a minimum of three months.

Q. Does it matter what kind of underwear I wear?
A. The old wives' tale that tight underwear causes decreased fertility has, perhaps, some basis in the truth. The truth is that excess heat applied to the testicles can decrease sperm production. This has been shown in men using hot tubs. However, the type of increased heat produced by tight clothing and/or underclothing has not been shown to elevate scrotal temperature. Hence, tight underwear has not been shown scientifically to cause any increase in testicular heat and is not thought to have any effect on sperm production. Nevertheless, if you would like to try a change in clothing to see what happens, there is really no reason not to try it.

Q. Does masturbation affect fertility?
A. Masturbation is not different from normal intercourse in that an orgasm causes ejaculation whether it is the result of masturbation or sexual relations. When fertility is a concern, masturbation should not be practiced around the time of the wife's fertile period. Theoretically, this can decrease the sperm reserve in an individual with a low or low-normal count and thus reduce semen quality at the time that the highest quality is needed - when the wife is ovulating. However, masturbation will not have a long-term injurious effect on the testes.

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Q. Should I be concerned about fertility if I have a veneral disease?

A. In the male, most sexual transmitted diseases cause irritating symptoms at the time the disease is active. Following the acute stage of the disease, long-term problems with fertility is not common. However, untreated veneral disease can cause infection of some of the accessory sexual structures, such as the epididymis (the gland that collects the sperm) or the vas deferens (the tube that transmits the sperm). If these become infected by gonorrhea or chlamydia (common sexually transmitted organisms) the result can be scarring which affects fertility by blocking the transport system. Sperm production should not be affected unless the disease process spreads to the testes.

Q. How often should I have intercourse?
A. The frequency of intercourse generally should be that which the couple considers most enjoyable. However, during the time of the moth when ovulation takes place, the most advantageous frequency of intercourse is every other day (i.e., every 48 hours). The reason for this interval is that sperm should survive for 48 hours within the woman's reproductive tract and the egg should be subject to impregnate for 12 to 24 hours. Intercourse every other day keeps sperm along the course of the fallopian tube ready for contact with the egg as it makes its descent from the ovary towards the uterus.

Q. What is the effect on fertility of working outside in the heat?
A. Heat is bad for sperm production according to data gathered by applying heat directly to the testicles. However, environmental heat, such as that experienced by workers in the sunshine should not affect sperm production.

Q. Why is it that my semen analysis is different here than in my first doctor's office?
A. Semen quality changes day to day, week to week and month to month. There are also certain minor variations in laboratory techniques that will result in differences in evaluation of the semen quality from one office to another. However, the differences should not be sufficient enough to make an abnormal semen normal or visa versa. Usually, when the sperm production has once been adversely and seriously affected, one's sperm count stays in the low range, no matter where it is tested. A change of two or three million is not a significant variation. However, in order to establish a good base line for future therapy, at least three semen analyses should be collected. They should all be collected with a minimum amount of variation, i.e., always after a 48-hour abstinence, and delivered to a doctor's office within two hours of collection.

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Q. Why do I frequently have pain during my first urination after ejaculation?
A. It is not unusual for the male to experience some burning (dysuria) during urination following ejaculation. This is the result of friction developed along the urethra (the lining of the penis) during the act of sexual intercourse or masturbation. Urine moving along the urethra creates a burning sensation. It should not be considered a sign of any active disease or indicative of injury to the penis but rather a natural event. However, if burning persists in the absence of ejaculation or sexual contact, some tpye of infection may be present.

Q. Why do I have "clumps" in my ejaculate? Is this normal?
A. The visible ejaculate is a combination of material from the testes, prostate, and seminal Vesicles. The latter two are known as the sex accessory glands in the male. At the time of ejaculation, the seminal fluid is a gel. It will normally liquefy within 5 to 30 minutes. During the process of liquidation, the ejaculate may appear lumpy. This is not abnormal and should not be considered a pathological situation.

Q. Does it matter what position we use during intercourse?
A. Positions during intercourse should not adversely affect fertility and subsequent pregnancy. The loss of some semen from the vagina is experienced by most women following intercourse and does not indicate that enough semen is leaking out to prevent pregnancy. However it is a good idea, if fertility has been a problem, to minimize semen loss and maximize contact of the cervix with the seminal pool within the vagina. This is achieved most conveniently if the woman lies on her side with her knees brought up towards her chest following sexual relations. This forces the cervix down into the vaginal pool of semen which has been created. It is also helpful for the female to minimize trips to the bathroom following intercourse by voiding prior to sexual activity. The sensation of having to void following intercourse usually is caused by irritation of the urethra, is normal in nature, and should pass if the female merely waits.

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Q: Should I wear briefs or boxers to improve my sperm count?
A. This question is a very common question without a strong affirmative answer. Heat does reduce sperm production. Some people's sperm production is more susceptible to heat than others. In general, the increase heat associated with tight underwear is less than the heat seen with varicoceles, hot baths, febrile episodes, or high scrotal testes. I recommend boxers because every little bit helps but I do not expect great improvement in sperm count based on underwear type alone.

Q. How long should I abstain from sex before I give a semen analysis?
A. The quality of the semen analysis is highly dependant on the method of collection. The ideal number of days to wait after sex to give a semen analysis is three to five days. Giving a semen analysis in less than three days after an ejaculation produce a small volume low count semen sample. Giving a semen sample after greater than five days from ejaculation can cause the sperm to have decrease motility.

Q. Are there any diet changes I can do to improve my semen quality?
A. My recommendations are based on well designed studies. Vitamins C, E, Zinc, and Selenium improve the quality of the seminal fluid which bathes the sperm. Drinks or activities to be avoided include excessive alcohol intake, large amounts of coffee or any recreational drugs. DHEA pills and anabolic powder supplements can also decrease sperm quality.

Q. How long does it take for my sperm count to improve after treatment?
A.: Sperm require around three months to fully mature. Once you remove the offending condition then three months are needed for a new cycle of sperm to be released. Some men see improvements in their semen analysis sooner if the offending condition is minor. Some men take longer to improve if the size and firmness of their testicles are poor.

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Q: How come the quality of my semen analysis is so different between laboratories?
A. The quality of a semen analysis is very highly dependent on the processing technique. Method of collection, time of specimen drop off, temperature of the specimen in the laboratory, pippeting technique, and counting system all can introduce error into the results. Daily controls by the lab is very important to standardize the process of semen analysis. It is hard to compare semen analysis between two laboratories unless both labs follow the recommended processing technique.

Q: Does exercise affect sperm quality?
A: Moderate exercise is good and is helpful to reduce stress. Endurance training or high intensity exercise may decrease the quality of the semen analysis. A semen analysis prior to changing your exercise routine can be helpful to answer this question.

Q: When is the best time to have sex when we know the ovulation date?
A: The best time to have sex is on the day of ovulation and 24 hours afterwards. Healthy sperm can survive around 48 hours in the female reproductive tract. By having sexual intercourse back to back you increase your chances of having higher sperm counts at the fertilization site.

Q: If my sperm count is normal then does that mean I am okay?
A: A normal semen analysis is a pretty good indication of normal male fertility. The one aspect of semen quality which is poorly measured on semen analysis is sperm function. The morphology of the sperm approximately measures the quality of the sperm function. The morphology evaluation is the hardest test to perform correctly in the semen analysis. A normal count, motility and morphology is a good indication of normal male fertility.

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Q: At what sperm count am I no longer able to father a child?
Answer: The lower limit of normal sperm count is 20 million sperm per milliliter of semen. Many men with lower sperm counts have initiated pregnancies. The standard for low sperm count was derived from looking at the fertility history of thousands of men and whether they initiated a pregnancy. There was a modest break in fertility potential when the sperm count decreased below 20 million sperm per milliliter. Your semen quality has to be high enough to overcome whatever deficiencies in fertility your wife may have. Fertility potential is judged based on the deficiencies that exist within the couple.

I'm taking Viagra, does this mean I am more fertile?
Absolutely not. If you are suffering from male factor infertility, there is no clinical evidence that Viagra will affect or reverse your condition. While Viagra can enhance your ability to attain and sustain an erection, this is not an indicator that you are or are not infertile. If you and your partner have been trying to achieve pregnancy for a year or more, or you have reason to believe you may be infertile, consult your family practice physician or urologist.

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