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Q&A: Male infertility expert answers your questions

Is there hope for men with low sperm counts? Can vasectomies be reversed? Does marijuana use contribute to infertility?  Dr. Edmund Sabanegh answers your questions about male infertility.
/ Source: TODAY

While women are usually the focal point when it comes to the ability to conceive, studies show a roughly 50-50 split between men and women when there are problems. All told, 5 to 7 percent of males are diagnosed as infertile.

TODAY explored male infertility as part of its Rethinking Infertility series on Wednesday, and now Dr. Edmund S. Sabanegh, Director of the Center for Male Fertility for the Glickman Urological and Kidney Institute at Cleveland Clinic, answers your follow-up  questions:

Q: A couple of months ago we found out that my husband has Klinefelter's Syndrome (XXY) and has zero sperm count in the 2 sperm analyses he's had done. We've been told that there is a 50/50 chance of finding sperm for IVF if we do a testicular biopsy. Would you agree with those odds? If there are sperm to use for IVF, do you think they would lead to viable pregnancies and healthy babies?

A: Klinefelter’s syndrome is a genetic disorder in men caused by presence of an extra X chromosome (2 X chromosomes in each of the cells of the body instead of the usual one).  Men with this will have smaller testicles than normal and will have either no sperm or very low amounts of sperm in their ejaculations. 

The good news is that many of these patients will have sperm present in their testicles; it is just a matter of identifying the areas of sperm production and obtaining the sperm for In-vitro fertilization.  One of the newer developments that we are using in the field involves a microsurgical approach to harvest sperm.  In a minor surgery, we are able to inspect the interior of the testicle under very high magnification and identify small islands of sperm inside the testicle.  In fact, we can find sperm in up to 70 percent of these patients.   While the vast majority of offspring from these patients have been genetically normal, there have been some reports of occasional genetic problems so some have suggested closer genetic testing of fertilized eggs.

Q: Are some causes of male infertility hereditary? My son was conceived through in vitro fertilization using the ICSI procedure 14 years ago. The cause of my husband's infertility was not determined at the time, but I'm concerned that whatever caused it may have been passed on to my son. Are there genetic tests that can be done to determine if this is the case?

A: The question here involves the importance of heredity in male infertility. Up to 14 percent of men who have no sperm or very few sperm in their ejaculate will have a genetic reason for this.  Some of the reasons include deletions of areas of the Y chromosome which is the male chromosome.  Depending on the location of the chromosomal problem, there can be associated health issues for the man so it is important that these men receive screening and appropriate genetic counseling if a problem is found. 

Q: Does age in men affect sperm quality?

A: While men can remain fertile throughout their lives, sperm characteristics do decline as we age.  The primary question is – are our sperm healthy and capable of causing a normal child.  Sperm DNA does exhibit a higher chance of breaks and other problems as we get into our 40s and older, but in general the offspring of older men have only modest increased risk of genetic problems.  New research raises questions about higher risk of autism and schizophrenia in children of older men but this question is the subject of intensive ongoing research.-Anonymous

Q: My husband has been diagnosed with sertoli-cell only syndrome. Do we have any options for treatment? We both desperately want biological children of our own. -Anonymous

A: Sertoli cell only syndrome is a situation where the sperm production cells within the testicles are no longer present.  While we are not able to reestablish sperm in the testicles if they are truly all gone, we can often find small islands of residual sperm in these testicles using a new approach of microsurgical dissection of the testis.  This involves the use of very high magnification with an operating microscope to examine the interior of the testicle to find areas of viable sperm.  These sperm, once found, can be use for a type of in-vitro fertilization called Intracytoplasmic sperm injection (ICSI) where single sperm are injected directly into an egg to produce fertilization.-Anonymous

Q: Is it true that smoking marijuana causes low sperm count (infertility), and if so, how can it be corrected?  Will not smoking for a day help or is it something that has to be totally out of the system? - Louise Kendricks

A: Marijuana and a variety of other drugs including anabolic steroids can have very serious effects on sperm production as well as a man’s health in general.  Marijuana in particular affects the male hormone, testosterone, which is critical for the production of healthy sperm.  The sperm production line is about 74 days long so all use should be stopped for at least that long to see if sperm production recovers.  Anabolic steroids can have a much longer recovery time.Q:  I had a vasectomy 10 years ago is there any anything I can do have a child with my new wife?- Jose

A. Many men desire to have additional children after a vasectomy.  Reversal of a vasectomy can be performed, but involves delicate microsurgery to carefully bypass the vasectomy and allow the return of normal sperm flow.  This should be performed by a surgeon experienced in microsurgery and who has extensive experience in this area.

Q: What options exist for men who have varicose veins in the testicles that affect fertility?

A. Varicoceles are varicose veins in the scrotal sac which can lower fertility in some men.  While there are a number of theories for why they hurt our fertility, the main concept is that enlarged veins keep the testicles warmer and that this hurts sperm production.

To correct a varicocele, there are a variety of surgical approaches to tie off these veins.  One option is a microsurgical approach which involves a very small incision in the low groin area.  This allows us to identify delicate structures such as the artery to the testicle and only tie the veins which cause the problem.  Using this approach, complications are rare and a majority of patients will have some level of improvement in their semen characteristics.

Q: To what degree does a man's sperm count change from ejaculate to ejaculate? Can there be a wide range?- Stephanie, Hartford, Conn.

A. Men can show wide variability in their sperm count from ejaculate to ejaculate.  This can be from a variety of factors that include the length of time since their last ejaculation, stress, recent illness and other factors.  For this reason, we usually recommend a second semen analysis if the first specimen was abnormal.  Often, we will see an improvement in the second specimen.