Webinar: Infertility - not just a female condition

My husband and I really want biological children, but he has sertoli-cell only syndrome. Are there any treatments?

From Dr. Trost: I'm not sure if there is a definitive answer to this question. I did a quick literature search to see if anything had ever been published on this, and I was not able to find anything specific. It would seem to make empiric sense to me that the optimal position for the female would be laying on her back as this would increase the amount of time that sperm are present in the correct location near the cervix. It is interesting, however, that sperm are able to travel to the location of the egg within a few minutes of ejaculation. This would argue that the actual position maybe less important than one would think.

From Dr. Trost: That is correct. There are some estimates that in up to 66% of patients with Klinefelter Syndrome we are able to retrieve sperm. In these cases I usually recommend that the patient be started on a medicine, such as clomiphene citrate, for several months and then consider undergoing a microscopic testicular sperm extraction. This gives you the optimal chance to find sperm. As long as you can find sperm you should be able to achieve a viable pregnancy. This assumes of course that the female partner is able to achieve a pregnancy (younger and BMI < 30 = better success). Typically in cases like this IVF is not possible and ICSI (intracytoplasmic sperm injection) is preferred. That is because typically we only find a small number of sperm and IVF requires a much larger number.

From Dr. Trost: Some forms of male infertility have clearly been linked to genetic causes. One test that can identify some known causes is looking for Y-chromosome micro deletions. This test is often not covered by insurance and can range from a few hundred dollars to several thousand dollars. I would say, however, that the far majority of causes of male infertility have not been associated with specific genes. Genetics in general is very challenging because there are so many potential genes which may contribute to infertility, and very few of these have actually been fully identified.

Does smoking marijuana cause low sperm count? Is it something that I’d have to quit completely or could I just give it up for a while?

What should I do to raise my sperm count?

I had a vasectomy but have remarried, and we now want children together. Would you recommend vasectomy reversal or IVF using extracted sperm? Or is there another option that would increase our odds of getting pregnant?

Men with Sertoli only syndrome may still have pockets of normal sperm production. In approximately 33-50% of cases we are able to find some sperm in men with Sertoli only syndrome (sufficient for IVF or ICSI). Typically in cases like this though I almost universally recommend going on a medicine such as Clomid for at least three months followed by a microscopic testicular sperm extraction. Because this has to be done under anesthesia and can take several hours the costs of the procedure typically range from $3,000-$12,000.

Yes, Marijuana results in reduced sperm counts and often can cause hormonal abnormalities as well. Usually, stopping Marijuana for a few months will improve sperm quality. I do not believe there are any studies which have demonstrated permanent impairments in sperm production with Marijuana use.

This would depend on many factors. We typically would need to perform an initial evaluation including a physical examination as well as obtain testing such as a semen analysis and blood work. We would also evaluate various lifestyle factors that you're experiencing including various substances, obesity, as well as work exposures and habits. From this we can usually give you several recommendations which can improve your sperm count. Also depending on the results of your testing you may require additional tests and may or may not benefit from surgeries or medications.