800.223.2273 Ext. 49485
Andrology Lab appointments:
800.223.2273 Ext 48182 or 216.444.8182
With modern technology and methods, the number of treatment options for male infertility has expanded. Depending on the cause of infertility, treatment may include:
We also offer sperm banking for fertility preservation in men who will be undergoing cancer treatment.
When sperm production is too low to achieve pregnancy, medication to increase the number of sperm produced is an option. We offer the newest, most effective medications for this problem. For men with low hormone levels, hormone therapy may be required to correct the balance.
We also counsel our patients as needed regarding lifestyle practices that may improve their fertility.
Depending on the cause of infertility, a surgical procedure may be necessary to correct a defect or remove an obstruction. Our physicians are among the most experienced in the country in surgical procedures to restore fertility. The most common procedures performed here include vasectomy reversal and varicocele repair.
Vasectomy reversal - a vasovasostomy or vasoepididymostomy - are common procedures that we perform in an outpatient setting. In either procedure, the surgeon reconnects the vas deferens, the tube in the scrotum through which the sperm passes. Viewing the vas deferens through a high-power surgical microscope, the surgeon carefully sews the ends back together.
Blockages in the vas deferens are repaired with a similar technique. The vas deferens is surgically split, the blockage is removed, and the ends of the tube are reconnected. When the original vasectomy was performed many years previously, an additional blockage may have formed in the epididymis, the coiled tube that lies against the testicle where sperm cells mature. Blockage at the epididymis also can occur due to infection or injury. Whatever the cause, the surgeon will fix the problem by bypassing the blockage in the epididymis in a procedure called a vasoepididymostomy.
Decision Matrix for Varicocele Repair
Our research indicates that varicocele repair in men with abnormal semen parameters improves sperm quality and may improve fertility.
Varicoceles, clusters of dilated blood vessels in the scrotum, are a common cause of infertility in men. They develop during puberty in blood vessels that lack the valves that normally regulate blood flow. If a man has a varicocele, blood still flows through the veins in the testicles but it is slower than normal, which causes the veins to dilate.
For reasons not completely understood, varicoceles can interfere with fertility. However, in some men, the presence of a varicocele does not impact fertility at all.
Varicoceles usually are not apparent on physical examination. They often are discovered when abnormalities in a sperm analysis prompt the physician to look for them.
Our research shows that varicocele repair increases the odds for achieving pregnancy and improves sperm quality. In a large scientific study by the World Health Organization, researchers determined that varicocele repair resulted in a pregnancy rate 300% higher than the pregnancy rate in couples where men did not have the repair.
Our male infertility specialists are expert in the microsurgical techniques used for varicocele repair. The procedure involves tying off (ligating) the problem veins that form the varicocele while preserving other important structures such as the arteries of the testicle. The procedure usually is performed on an outpatient basis through a small incision to minimize postoperative pain and recovery. Depending on the size and location of the varicocele, nonsurgical treatment may be possible. One technique, transvenous embolization, involves blocking the enlarged veins by using steel coils that are placed through a catheter.
Effects of Free Radicals on IVF
Free radicals are a hazard at every step of assisted reproduction, causing damage that can lead to DNA damage, poor oocyte quality, abnormal fertilization and defective embryo development.
For some couples dealing with male infertility, in vitro fertilization (IVF) is the treatment of choice. Cleveland Clinic has one of the leading IVF programs in the country with excellent success rates. During the IVF process, the ovaries are stimulated with injected fertility medications to cause multiple eggs to mature. When the eggs are ready, they are collected in a minor procedure. Fertilization is accomplished by exposing the eggs to sperm in a culture dish, or by directly injecting a single sperm into each mature egg, a process called intracytoplasmic sperm injection (ICSI). After fertilization, embryo development is monitored over the next three to five days, and two to three embryos then are placed into the uterus by way of a small catheter inserted through the cervix.
Artificial techniques of reproduction have advanced to the point where a single sperm can be physically injected into an egg. This procedure, intracytoplasmic sperm injection (ICSI) has dramatically changed the treatment available for even the most severe male factor infertility. Because of this technique, 90% of all infertile men have the potential to conceive their own genetic child.
For more information about IVF at Cleveland Clinic, please call the Cleveland Clinic Department of Obstetrics and Gynecology at 216.444.2273 or toll-free outside the Cleveland area at 800.223.2273.
Approximately 1% of all infertile men are born with the congenital absence of the vas deferens, the "biologic equivalent" of a vasectomy. We now are able to help such men conceive using a non-surgical procedure to retrieve sperm from the epididymis and cryopreserve them for later use IVF ICSI.
Technologic advances now make it possible to extract sperm from the testes of men with non-obstructive azoospermia for use in ICSI. About 50% of men with this condition have sperm in the testicles.
The Cleveland Clinic Andrology Laboratory and Reproductive Tissue Bank has provided therapeutic sperm banking services since 1980 - longer than any other facility in Ohio. The laboratory staff is trained in the latest, most effective freezing, storage and recovery techniques, and works under the direction of a sperm cryopreservation specialist. The highest standards are used in accurately labeling and identifying specimens. The Cleveland Clinic laboratory is CLIA - certified and is also accredited by the American Society for Reproductive Medicine and the College of American Pathologists. Our sperm banking facilities are accredited by the American Association of Tissue Banks.