Male Infertility Can Be a Complex Problem with Multi-faceted Solutions

By Andrew Wilson

The most common assumption when a couple can’t conceive a child is that the woman is the one with the fertility issues, but that’s not necessarily so.

“Typically, the solution to infertility is quite complex, as there are usually two people undergoing evaluation,” said Alex Katich, D.O., a urologist with Washington Health System (WHS). “About seven to nine percent of men experience fertility issues. Also, about 50 percent of all infertility issues in a heterosexual couple deal with the man.”

The causes of male infertility are as complex as the condition.

“There are lots of possible causes, and none are incredibly common,” he said.

Dr. Katich lists things like patient age – the older you get, less likely you are to be fertile - varicocele, which is swelling of the veins in the scrotum and around the testicle; an undescended testicle; recent febrile illness, which can impair spermatogenesis for 3 months, and previous genital infections as the issues he sees most commonly in the office. Less commonly, things like cystic fibrosis, a congenital absence of the vas deferens, Kartagener’s syndrome, and other conditions can also lead to infertility.

There are a number of possible treatments for males to improve the chance but some are quite complex.

“Sometimes surgery can improve chances of conception, but often people will require other interventions to assist with their ability to conceive,” said Dr. Katich. “Male infertility is extraordinarily complex. Sometimes solutions can be simpler than others, but the overall evaluation for true male infertility is oftentimes multifaceted.”

Dr. Katich says that some patients will require a referral to an andrologist, a urologist with fellowship training in male infertility.

“I try to do all I can to assist with conception, but sometimes specialists are needed for particular procedures such as testicular sperm extraction, repair of previous vasectomy, and others,” he said.

Some of those procedures are quite expensive. Dr. Katich offers some inexpensive health tips that could improve the chance of conception.

• Live as healthily as possible, including avoiding smoking, alcohol, and drugs

• Avoid prolonged heat exposure, such as that seen with hot tubs and saunas

• Regular exercise and appropriate stress management can assist with fertility

One of the often-repeated tips is for men to wear boxer shorts instead of briefs. Dr. Katich says while briefs may lessen sperm counts, “there is no consensus on its effects on conception.”

Five Questions and Answers About Vasectomies from WHS’ Alexander Katich, D.O.

1. What are the considerations before undergoing a vasectomy?

A: “Generally, we will ensure the partner is in agreement, if applicable. I explain that a vasectomy is meant to be a permanent form of birth control. It can be reversed but is not intended to be, and pregnancy after reversal is not guaranteed. Other than that, generally we want to make sure there have been no previous surgeries to the scrotum and no active pain. I also like to ask what a patient does for work so that we can plan for recovery.”

2. Is a vasectomy always 100%?

A: “No, nothing in medicine is 100% effective, but it is about 99.9% effective with a risk of about 1/1000 of the vasectomy failing, or having the ends of the vas deferens on one side heal back together, making the patient fertile when they want to be sterile.”

3. Can a vasectomy be reversed?

A: “Yes, but pregnancy after reversal is not guaranteed. The length of time between the vasectomy and the reversal is the greatest indicator of success.”

4. Are there side effects from a vasectomy?

A: “The most common side effect is a hematoma or a collection of blood in the scrotum. Though this still doesn’t happen often, it is usually small but can cause significant swelling or may even need urgent intervention. That is extremely rare. Infection can occur but is usually able to be managed with antibiotics. The vas deferens can heal in to the scrotal incision which is made, but again this is rare. Lastly, a post vasectomy pain syndrome has been described, though this is rare also.”

5. When can a man return to normal sex?

A: “A patient can have sex one week after vasectomy; HOWEVER, they need to use contraception. The patient will have to wait three months to have a semen analysis to show no sperm is present before unprotected intercourse can begin.”

6. What other things should a patient be aware of before getting a vasectomy?

A: Vasectomies are common but should always be performed by a board-certified urologist who performs the procedure often. They are most commonly done in the office with local anesthesia but can be done in an operating room with more general sedation used.”

Dr. Alex Katich, D.O., attended medical school at Chicago College of Osteopathic Medicine. He completed his residency in urological surgery at Charleston Area Medical Center in Charleston, WV. WHS Urology offers a comprehensive array of diagnostic and surgical treatments to residents of the tri-state area with a convenient location in Washington County. WHS Urology accepts most major insurance plans. They are located at 125 North Franklin Drive, Suite 3, Washington, PA. If you have any questions or concerns, please contact the office at (724) 229-2424.