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Male Infertility

Male Infertility

 The male reproductive system is designed to manufacture, store and transport sperm — the microscopic genetic cells that fertilize a woman's ovum. A number of hormones, the most important of which are testosterone and follicle-stimulating hormone (FSH), regulate this process. Like sperm, testosterone is also produced in the testicles. Sperm production begins when immature cells grow and develop within a network of delicate ducts — microscopic seminiferous tubules — inside the testicles. Because these new sperm cannot move initially on their own, they are dependent on adjacent organs to become functional. They mature while traveling through the epididymis, a coiled channel located behind each testicle. When climax, or orgasm, occurs, sperm are carried out of the body via semen, a fluid composed of secretions from various male reproductive glands, most notably the prostate and paired seminal vesicles.

Causes of Male Infertility

For starters, your infertility may be caused by a diminished output of sperm by your testicles. Abnormal sperm production can also be triggered by genetic factors and a number of lifestyle choices (e.g., smoking, alcohol, and certain medications), all of which can impair the normal production of sperm cells resulting in a decreased sperm count.  Long-term illnesses (e.g., kidney failure), childhood infections (e.g., mumps), and hormonal or chromosomal deficiencies (e.g., insufficient testosterone) can also account for abnormal sperm numbers.

Perhaps the most prevalent sperm production problem, however, is linked to structural abnormalities, most notably varicoceles. A worm-like bundle of enlarged or dilated varicose veins around the testicles; varicoceles are the most common identifiable cause of male infertility. They are found in about 15 percent of normal males and in approximately 40 percent of infertile men, most often on the left side or simultaneously on both sides. Evidence suggests that by creating an abnormal backflow of blood from the abdomen into the scrotum, triggering a rise in testicular temperature, varicoceles hinder sperm production and cause low sperm count.

Dr. Ramasamy is an expert in male infertility in Miami, Florida and has published about two different techniques of microsurgical varicocelectomy with and without testicular delivery.  

Ramasamy R, Schlegel PN. Microsurgical inguinal varicocelectomy with and without testicular delivery. Urology. 2006; 68(6):1323-6

Azoospermia (Zero Sperm Count)

Another issue that would lead to infertility would be a lack of sperm in the semen. Azoospermia, which accounts for 10 to 15 percent of all Male Infertility, refers to a complete absence of sperm in your ejaculate. Azoospermia can be due to a production defect that can be triggered by various hormonal or genetic defects often linked to testicular failure. Azoospermia can also be due to obstruction of the sperm transport. In a majority of men, physical exam of the testes and blood test (FSH) can help diagnose whether zero sperm count is to due to a production or a transport problem. In some men, a testis biopsy is necessary to confirm the diagnosis. 

In its "non-obstructive" form, azoospermia can be triggered by various hormonal or genetic defects often linked to testicular failure.  Dr. Ramasamy has a special expertise in treating men with nonobstructive azoospermia - men who do not have sperm in the ejaculate due to testicular failure. He published one of the largest studies comparing the conventional testis biopsy with microdissection testicular sperm extraction (micro-TESE). Micro-TESE uses an operating microscope to identify areas of spermatogenesis within the testis. 

Ramasamy R, Yagan N, Schlegel PN: Structural and Functional Changes to the testis following microscopic vs. conventional testicular sperm extraction. Urology 2005 65(6): 1190

He also published the successful microdissection TESE outcomes in the largest series of men with Klinefelter syndrome 

Ramasamy R, Ricci JA, Palermo GD, Gosden LV, Rosenwaks Z, Schlegel PN.: Successful fertility treatment of Klinefelter syndrome: Pre-operative management and predictive factors. J Urol. 2009; 182(3):1108-13.

For commonly asked questions, please see answers provided by Dr. Ramasamy or a video provided by the American Society of Reproductive Medicine 

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