Steroids such as prednisone will reduce sperm antibody levels and thereby increase sperm movement and function in nearly one half of cases of antibody problems. Nearly all cases of hypogonadism will respond to replacement hormone therapy, but this is an uncommon cause of male infertility. Surgical therapy Surgical therapy may include varicocele repair, sperm duct microsurgery, microsurgical vasectomy reversal, transurethral resection of the obstructed ejaculatory duct, or sperm harvesting procedures such as epididymis or vas deferens sperm retrieval and electroejaculation. Most of these are safely and effectively performed as outpatient procedures under local anesthesia with intravenous sedation. This is based on an extensive review of the medical literature on varicocele correction as well as a critical analysis of our own results.
Varicoceles are the most common and treatable diagnosis in our experience.
It takes a knowledgeable clinician and quality laboratory testing to determine when it is appropriate to correct a varicocele, and at what point after correction there has been sufficient improvement to justify continued efforts at natural conception, or when the level of improvement has only been sufficient to allow conception through medically-assisted methods. This type of practice specific data is critical to the credibility of any clinician treating male infertility so that he can properly advise couples on comparing treatment options. In the current era of infertility treatment for male factors, sperm duct microsurgery has been increasing in its frequency. Experience and the technical expertise of the microsurgeon are critical to success. Dr. Buch personally inspects the sperm samples in the operating room at the time of the procedure in order to determine the correct level to reconnect the obstructed sperm ducts and at which level to harvest sperm for use in assisted reproductive techniques.