Andrology is the medical study that deals with problems relating to the male health pertaining to infertility, sexual dysfunction, and urological problems, particularly in men. The female counterpart to this is gynecology.
Andrologists specialise in treating conditions such as undescended testes, diseases of the genitalia and diseases affecting fertility and sexual function of men. Male infertility and sexual function are difficult issues that can hinder reproduction. For some, it can be devastating and the hardest challenge ever. However, male infertility should be considered as another disease that needs attention and treatment.
Diagnosis of Male Infertility and Sexual Health Diseases
The Andrologist investigates various aspects that are related to the male reproductive health. Any of the following could affect the low sperm count or abnormal sperm:
- Urological problems
- Varicocele – bulging of veins above the testicle
- Undescended testicle
- Infections in the testicle
- Medicines such as steroids
- Hormone problems
The following tests will be taken:
- Physical examination
- Sperm and Semen analysis
- Transrectal ultrasound
- Testicular biopsy
- Hormonal profile
Treatments for Male Infertility
Treatment of male infertility depends on the underlying cause. There are areas where drugs or surgery could cure the problem, the treatment is broken down into three types:
- Non-surgical therapy for Male Infertility
- Surgical Therapy for Male Infertility
- Treatment for Unknown Causes of Male Infertility
Let’s look at where treatments are supervised:
- Non-surgical therapy for Male Infertility: Without surgery, drugs can treat many male infertility problems. These include:
- Congenital Adrenal Hyperplasia (CAH)
- Genital Tract Infection
- Hypogonadotropic Hypogonadism
- Immunologic Infertility
- Reactive Oxygen Species (ROS)
- Retrograde Ejaculation
- Treatment for Unknown Causes of Male Infertility: When the causes of male infertility are difficult to find, an empiric therapy may be used to balance hormone levels. Assisted Reproductive Techniques (ART) may be used if infertility treatment is not successful or is not available. This includes:
- Intrauterine Insemination (IUI)
- Intracytoplasmic Sperm Injection (ICSI)
- Sperm Retrieval for ART
- In Vitro Fertilization (IVF)
- Testicular Sperm Extraction (TESE)
- Testicular Fine Needle Aspiration (TFNA)
- Percutaneous Epididymal Sperm Aspiration (PESA)
- Microsurgical Epididymal Sperm Aspiration (MESA)
- Surgical Therapy for Male Infertility: The following are surgically operated:
- Varicocele Treatments
- Azoospermia Treatments
- Microsurgical Vasovasostomy
- Transurethral Resection of the Ejaculatory Duct (TURED)
- Physical examination of the affected area and medical history.
- Abstaining from smoke, alcohol, recreational drugs, medicines and hot bath and whirlpools.
- Areas around the male reproductive systems are cleaned and sanitized for surgery.
- Through ejaculation, sperm may be collected. If this is not possible, a surgical procedure may be followed if the male patient does not have sperm count through a procedure known as percutaneous epididymal sperm aspiration (PESA), or testicular sperm aspiration (TESA). The sperm retrieved are frozen or used on the same day.
- Ultrasound, scans, tests, and analysis.
- For the female partner, stimulation of ovaries is done through hormonal injections to produce as many mature eggs.
Under local or general anesthesia, the doctor may perform open or laparoscopic surgery. Surgeries are mainly on out-patient procedures. Depending on the complexity of the procedure, the surgery could take at least an hour to five hours.
- Varicocele Treatments: It is performed to keep the blood flow normally in the scrotum. This could be performed through open and laparoscopic surgery. In the former, a small incision is made to see the small veins. In the latter, a catheter is inserted through a small cut a special camera is used to operate.
- Azoospermia Treatments: When there is no sperm count or blockage of sperm, ICSI is performed when a single sperm is injected into a mature egg or, through Artificial insemination, where a sperm is directly injected into a woman’s womb.
- Microsurgical Vasovasostomy: To reverse vasectomy, this surgical procedure allows the sperm to enter the semen before ejaculation by creating an opening between the separated ends of each vas deferens. From one side of the scrotum, an incision is made towards the abdomen, the same is done on the other side. The presence of sperm is identified and if found, the cut ends of the vasa deferentia will be connected. If no sperm is found, a complex procedure called a vasoepididymostomy or epididymovasostomy maybe performed to restore sperm flow.
- Transurethral Resection of the Ejaculatory Duct (TURED): Ejaculatory duct could face an obstruction. Through minimally invasive procedure, a small incision is made in the ejaculatory duct, and a cystoscope is penetrated inside the urethra.
Since some treatments are an out-patient procedure, there will only be a mild pain or aches. After resting in the hospital, the patient can be discharged on the same day. However, recovery and follow-up may vary depending on the surgery. After a varicocele treatment, a physical examination will be done. There will be semen test after every 3 months for at least a year until pregnancy occurs. If varicocele returns or remains infertile, an ART treatment may be considered.
Patients are advised to avoid using drugs like marijuana, cocaine and be free from tobacco. Two drinks of alcohol could affect the sperm production, so it is better to abstain from this. Men should avoid hot baths, and whirlpools as this could again reduce production of sperms.