Male Fertility Specialists in San Diego

Non-surgical/ Medication Therapy

• Spinal Cord Injury Treatments
• Electroejaculation therapy (EEJ)
• Hormone deficiency treatments
• Clomiphene citrate (Clomid, Serophene) for the infertile male
• For unexplained low sperm count
• For Genetic Defects

Surgical Therapy

• Varicocele ligation
• Sperm Retrieval Techniques (MESA, PESA, TESE)
• Vasectomy Reversal
• Transurethral Resection of Ejaculatory Duct

Assisted Reproductive Technologies (ART)

• ICSI and IVF
  

Non-surgical/ Medication Therapy
Spinal Cord Injury (SCI) Treatments
Many factors may predispose spinal cord injured men to infertility. Ejaculatory dysfunction, abnormalities of sperm production, chronic infections and blockage of sperm within the male reproductive tract are all potential factors. There is a number of different methods to obtain sperm, often combined with various forms of assisted reproductive techniques. For example, sperm can often be obtained through vibratory stimulation to the head and shaft of the penis if the level of injury is T-12 or above. Other therapies commonly used it the rectal probe. Electroejaculation (EEJ) or sperm harvesting along the ejaculatory path from the vas deferens, epididymis, and directly from the testis.

In combination with sperm cryopreservation, Dr. Bastuba works directly with female fertility specialists until a successful pregnancy is achieved for the couple. Spinal cord injuries could also cause male sexual dysfunction.

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Electroejaculation therapy (EEJ)
This is a very successful form of therapy for men who have normal sperm production but cannot ejaculate because of a short circuit in the nervous system. Initially used for men with spinal cord injuries, EEJ has also proven effective for loss of ejaculation in patients with other conditions such as diabetes, retroperitoneal lymph node dissection (RPLND), pelvic surgery, multiple sclerosis, or unexplained loss of orgasm. For patients with intact sensation, a pain free procedure of 30 minutes with local anesthesia at an outpatient surgery center. EEJ is non-invasive and patients routinely return back to desk type work that day.

Electroejaculation allows the retrieval of sperm in more than 90% of patients and up to 40% of couples will achieve pregnancy with IUI.. The very powerful sperm injection form of IVF, called ICSI, gives the remaining couples a 50% chance for pregnancy. Overall, the chances for pregnancy in the informed and motivated patient are similar to those of a healthy male.

Transurethral Resection of Ejaculatory Duct
Transurethral resection of the seminal vesicles (TURSV)
The procedure eliminates obstruction in the seminal tract or in a strategic area, improving the chances of the inflamed or chronically dilated zones to normalize.

Medication
Hormone deficiency treatments
If the man has a hormonal deficiency, it might be treatable with medications. These are rare cases.

Clomiphene citrate (Clomid, Serophene)
Some men with relatively mild sperm abnormalities have been treated with clomiphene citrate (tablets) in an attempt to improve the semen. Research showed that Clomid for the male sometimes can improve the sperm count or motility.

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Unexplained low sperm count
If there is a mild decrease in the sperm count or motility, we may prescribe Clomiphene citrate, a fertility pill commonly used to treat women who fail to ovulate. Clomiphene (also called Clomid or Serophene) mildly stimulates the pituitary to make hormones that stimulate sperm production. Sperm counts should be re-analyzed 3-6 months after initiation of the medication to evaluate the effectiveness of this treatment.

Genetic Defects
Men with low sperm counts or low motility often ask for treatment to correct the defect. Unfortunately, this is not often possible. Many cases of sperm abnormalities are genetic in origin. Since there is currently no way to correct such genetic defects, we end up working with the couple in other ways to increase their reproductive efficiency. Gene therapy holds promise for the future. If genetic testing is completed now, it may give specific direction for treatment when these gene therapies are available in the future.

Surgery
Varicocele ligation
If a varicocele is found, sometimes surgery to ligate (tie off) the abnormally dilated veins is recommended. If the varicocele is of significant size (Grade II or Grade III), about two thirds of men undergoing the surgery will see improvement in the sperm quality. Pregnancy rates following surgery are in the range of 40%, but most pregnancies occur 6-9 months following surgery depending on the female’s age. If the initial sperm count and motility are in the severe male factor category, it is unlikely that this surgery will improve sperm counts enough to enable the couple to conceive without assistance.

Sperm Retrieval Techniques (MESA, PESA, TESE)
Using today's minimally invasive techniques, sperm can be obtained from men with vasectomy; failed vasectomy reversal, absence of the vas deferens, or uncorrectable blockages anywhere along the seminal tract (obstructive azoospermia). In addition, we are able to retrieve and use sperm in case of non-obstructive Azoospermia or NOA.

Sperm retrieval procedures are typically done at an outpatient surgery and last about one hour. Local anesthetic, IV sedation or general anesthesia provide complete pain control during the procedure. Patients return back to desk type work in a day or two.

Watch Dr. Bastuba perfoming a microsurgical testicular sperm extraction - click here for our online video in broadband (click here for 56k version)

The procedures are either performed through the skin (percutaneous) or through a small opening in the skin about 1/2 inch in size (MESA or TESE). Percutaneous Epididymal Sperm Aspiration (PESA) uses a needle to penetrate the scrotal skin and draw a small amount of sperm from the epididymis while Percutaneous Testicular Biopsy (PTBX) removes small cores of testes tissue.

Applying microsurgical techniques in a process known as Microscopic Epididymal Sperm Aspiration (MESA), sperm can be gathered from the epididymis, a sperm rich tube at the back of the testis. Testicular Sperm Extraction (TESE) involves removing small samples of testis tissue for processing and eventual extraction of sperm.

Microscopic TESE (MicroTESE) is a very exacting search for sperm under high magnification in cases of extremely low sperm production.MESA and TESE procedures are the most popular because the goal is retrieval of sufficient sperm for freezing and use in future ICSI cycles.

MESA and TESE are often performed in advance of the ICSI cycle and frozen.

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Assisted Reproductive Technologies (ART)
In case of unknown fertility, assisted reproductive techniques are available that may be able to overcome the problem.

ICSI and IVF
Intracytoplasmic sperm injection (ICSI) has overcome virtually all forms of male factor infertility. In the past, infertile men utilized adoption or donor sperm to father children. Now the ICSI procedure has enabled most of these patients to conceive their own genetic offspring. The ICSI procedure, where a single sperm is injected into each ripe female egg, is combined with in vitro fertilization at an infertility clinic. Success rate from this treatment is quite high and the track record to date suggests that there are no significant increases in birth defects in children that result from this procedure. Read more in our IVF Overview.