Most couples will get pregnant after a successful vasectomy reversal. In fact, the reported pregnancy rate is approximately 65%. The natural pregnancy rate of couples trying to conceive who have not had a vasectomy reversal is only 80-85%. The remaining 15-20% of couples will have difficulty achieving a pregnancy with a male factor involved in half of cases and a female factor involved in the other half. It is important that any couple trying to conceive should have a female evaluation to optimize the success of pregnancy after a vasectomy reversal. A vasectomy reversal surgeon who is also a male infertility specialist can help the couple who is having difficulty achieving a pregnancy after a vasectomy reversal.
Anti-sperm antibodies (ASA) are a controversial cause of infertility in the vasectomy reversal patient. It is true that they exist and, in fact, 100% of men will have ASA after a vasectomy and vasectomy reversal. However, their exact significance is still debated in the literature since 65% of couples will achieve a pregnancy after the procedure despite the universal presence of ASA. The exact location of the binding of the ASA to the sperm has also been reported to determine the degree in infertility. Specialized esting can help determine the type of ASA present after the vasectomy reversal.
Varicoceles, or varicose veins around the testicles, are the most common cause of male infertility problems. They can be an isolated problem or contributing to other identifiable causes. Varicoceles are found in 40% of men presenting to an infertility clinic. These dilated veins are damaged and allow the testicles to become overheated, reflux metabolites and cause congestion. Varicoceles are also progressive lesions. If left untreated they can become problematic in future pregnancy attempts. Varicoceles are effectively treated with microsurgical varicocelectomy. Click on our link to learn more about varicoceles and their treatment.
Patients often wonder if there are any dietary modifications that can improve their sperm count and quality or, more importantly, if any dietary habits could be hindering normal sperm production. There is research to suggest that certain supplements such as vitamin E, fructose and acetyl-L-carnitine are beneficial to sperm when taken at recommended doses because of their anti-oxidant and nutritional properties. Other less studied ingredients include zinc, arginine, and vitamins C and B-12. These nutrients are the basis for many of the commercially available fertility blend supplements. However, it isn't necessary to over-pay for these commercial supplements when equivalent generic forms are available at virtually every health store.
Soy based milk and products are becoming increasingly popular, especially for lactose-intolerant individuals. They provide good nutrition and are considered healthy alternatives for milk products. However, all soy-based products contain weak estrogens (genistein and daidzein) which can negatively impact sperm quality. Recent human and animal studies have shown that when these substances are given at doses equivalent to human consumption they will cause the sperm to prematurely undergo capacitation and the acrosome reaction.(Fraser, Human Reproduction, 2006) This will essentially make sperm unable to fertilize an egg. Avoiding soy based products while trVying to conceive is recommended.
Hormones are an integral part of any infertility evaluation. Normal hormonal levels are important for normal sperm production. When abnormal, they can be an indication of other more significant problems. Correction of any hormonal abnormality is essential for a successful natural pregnancy.
Previous infection such as epididymitis, prostatitis or a sexually transmitted disease can be a contributing factor to male factor infertility. Patients can develop scarring and obstruction leading to very low sperm counts or sperm with low motility. This can be diagnosed and treated if identified. Additionally, unwanted inflammation in the reproductive tract can hinder normal sperm function and fertilization. Additional testing may be required to diagnose this problem. It can be the result of previous infection or increased sperm turnover secondary to another problem such as varicocele. Medical therapy exists for treating infection and inflammation. Other therapies may be indicated to treat the underlying problem leading to infection/inflammation.
Even when sperm production is normal, there can be a functional problem with getting the sperm where it needs to be at the time your wife is ovulating. This can be due to Retrograde Ejaculation or Anejaculation which can manifest itself as a normal or low semen volume. We commonly see this condition in patients with Diabetes Mellitus, Spinal Cord Injury, Neurologic Diseases, Previous Abdominal/Pelvic Surgery or Surgery for Testicular Cancer. This condition is easily treated with medication or a simple procedure.
Recurrent miscarriages can be the result of sperm chromosome abnormalities which prior to today went undiagnosed. We now know that most cases of miscarriage are due to abnormalities of a small set of chromosomes (13, 18, 21, X, Y). These chromosomal abnormalities of sperm can now be evaluated to give the couple a better understanding of the reason for the miscarriage and treatment options can be discussed to avoid future miscarriages.