C O N R A D | PEARSON CLINIC INFERTILITY

Microsurgical Sperm IVF IUI THE CONRAD PEARSON CLINIC Harvesting (MESA) UROLOGY CENTER OF THE SOUTH Another complex situation in male is severe or azospermia. In these cases, sperm production is so limited John R. Adams, Jr., M.D., FACS Perry J. Larimer, M.D., FACS that sperm have to be microscopically Ravi D. Chauhan, M.D., FACS H. Benjamin Maddux, Jr., M.D., FACS harvested for use with in vitro fertilization Lynn W. Conrad, M.D., FACS H. Michael McSwain, M.D., FACS procedures.  is procedure is performed Embryos are inserted into the During Paul R. Eber, M.D. Richard M. Pearson, M.D., FACS in an outpatient surgery center under uterus. intrauterine Howard B. Hasen, Jr., M.D.  omas B. Shelton, M.D., FACS insemination, general anesthesia. Using microsurgical sperm are H. David Hickey, Jr., M.D., FACS Carla Dirmann, FNP techniques, sperm can be harvested inserted into Sperm are the uterus. Robert S. Hollabaugh, Jr., M.D., FACS from the testis or and cryo- combined with extracted eggs. preserved for future in vitro fertilization procedures. In vitro fertilization has several versions, but each involves getting Our dedication to the specialty includes If getting pregnant has proven more Infertility By Robert S. Hollabaugh, Jr. MD the eggs out of the female, fertilizing them equipping our own surgery center with di cult than you had expected, make with sperm, and replacing the fertilized state-of-the-art operating microscopes sure to get full evaluation to make sure Conceiving a baby is often taken for testing is relatively uncomplicated – the man not have any ejaculation for 48 eggs back into the female uterus. For a and microsurgical instruments which that you have all of today’s information granted. While seemingly simple, usually being related to analysis. In hours prior to specimen collection.  e variety of reasons in vitro fertilization are integral to the success rates of these at your disposal. Whether you have a requires an intricate series of the female, there are lots of gynecologic, specimen should be collected in a sterile may not be a realistic option for everyone. procedures. Make sure to see a urologist minor fertility problem, want to reverse events to take place in the right order at anatomic and hormonal considerations cup from the doctor’s o ce; and Emotional,  nancial, religious, and ethical who is experienced with these procedures a , or just need to clarify a the right time in the male and female. that have to be evaluated. In the male, a other collection devices do not allow for considerations must be reconciled in the so that you can get the most accurate very complicated situation, the Conrad- When one knows the complexity of properly performed semen analysis is the accurate interpretation. Once collected, hearts and minds of each couple, and it is information about today’s high-tech Pearson Clinic can help you with state- these processes, it is easy to conclude that  rst step in the evaluation of the male the specimen needs to be delivered to a very personal decision-making process. fertility options. of-the-art evaluation and management of conception is nothing short of a miracle. and provides the basis for any subsequent the lab site as soon as possible; preferably Accurate education about the options is your fertility needs. Even the most fertile couples have only a testing. within 30 minutes but absolutely within very important as the technology available one in four chance of pregnancy during 2 hours. If delayed, the sperm will in today’s world of assisted reproduction a given month. For those who cannot Semen Analysis start to die and we will never know if extends well beyond the “test-tube baby” get pregnant easily, science and medicine  e semen analysis includes several they came out dead or just died due to of past decades. Even in extremely FERTILITY: FACT OR FICTION can o er additional considerations. characteristics, but the most important the environment. Most labs allow for di cult cases where sperm are virtually Sperm counts  uctuate widely, even among normal, fertile individuals. Couples experiencing fertility problems are semen volume, sperm quantity or collection at home; however, some labs non-existent, if a few viable sperm can be Seemingly minor illnesses can cause major temporary decreases in sperm need accurate information on each of the concentration, sperm motility, and sperm prefer on-site collection. Make sure to isolated microsurgically then pregnancy production. A bad cold, the  u, or even an elective surgery can depress sperm various options available in today’s highly- morphology. When these parameters clarify where the labs is located that you rates using the most sophisticated form counts for several months. sophisticated world of reproductive plan to use, and that the lab is open when SPERM AND EGG of in vitro fertilization (intracytoplasmic medicine. you plan to collect the specimen. If the  e life cycle of a sperm is about 70 days. Any interventions done hoping sperm injection or ICSI) can exceed specimen is not a good specimen, we may to improve sperm counts need 3-4 months before an accurate assessment of In the general population, infertility is 50 percent. Just 15 years ago, this type need to get a second specimen at a later their success or failure can be judged. usually perceived as a female issue. It of therapy had not been even dreamed date. is important to realize, however, that of, let alone performed; now it is a Taking testosterone (shots, gels, or patches) will suppress sperm production. problems with fertility can originate in the commonplace part of fertility counseling Do not, however, rely on testosterone use as a form of birth control. Causes of Infertility male or female, and possibly, both. When at the Conrad-Pearson Clinic. Our clinic If the semen analysis is normal, the Recreational Street drugs, heavy alcohol use, and smoking do likely interfere couples are unsuccessful at pregnancy over specializes in as well as male system is generally cleared. When with male fertility. a period of 12 months with unprotected microscopic sperm harvesting procedures. the semen is abnormal, the speci c intercourse, fertility evaluation is de ciencies will direct the subsequent warranted. Fertility evaluation should testing. Areas of abnormality in quantity, involve both male and female factor Wolf River O ce and Surgery Center Methodist North O ce morphology, and motility may hint at evaluation. Surprisingly, in 30 percent 1325 Wolf Park Drive, Suite 102 3950 New Covington Pike, Suite 340 phone: 901.252.3400 are compared to established normal the root cause. It is essential to obtain a Germantown, TN 38138 Memphis, TN 38128 of infertile couples, a male factor is the ranges, the likelihood of pregnancy thorough medical history with particular fax:901.763.4305 sole cause, and in another 20 percent, Southaven O ce West Memphis O ce can be assessed. For a semen analysis emphasis on conditions that can a ect Please visit our website at both the male and female have problems. 125 Guthrie Drive 228 West Tyler, Suite 202 www.conradpearson.com to be accurate, it must be a fresh and health, as certain medical and Southaven, MS 38671 West Memphis, AR 72301 Compared to the female evaluation, male representative sample.  is requires that environmental factors can greatly a ect C O N R A D | PEARSON CLINIC INFERTILITY C O N R A D | PEARSON CLINIC INFERTILITY

General Considerations infertility. Approximately 20 percent of SPERM TRANSIT FEMALE CYCLE couples have this type of unexplained When trying to get pregnant, several infertility. In the case of the male, he simple measures may help. First of all, your Day of may just be “subfertile” with a sperm mother would tell you to “stop wearing Cycle 1 7 14 21 28 count that is inadequate to produce Gland tight underwear.” While it seems silly, a pregnancy in the usual manner. there actually is some scienti c backing 99° Sperm Consequently, empirical therapy with to this. Any added heat to the testicle Basal Body Temperature male fertility medication (Clomid) can may adversely e ect sperm production. 98° be used with the hope of improving the  e hang outside the body where to a point that pregnancy they are slightly cooler than the body core Cervical 97° Mucus can occur. For complex infertility temperature. Pressing them against the situations such as prior vasectomy or body can raise their temperature.  e Luteinizing Hormone (LH) severely low sperm counts (oligospermia same concept is involved with taking hot Seminal Vesicle or ) a variety of highly baths and using hottubs regularly.  e sophisticated options exist. constant excess heat raises the testicle temperature. Exercising and sweating Menstruation Egg Matures Ovulation Egg Moves into Uterus in Ovary Vasectomy Reversal Epididymis will not raise the testicle temperature as your body meticulously regulates internal () Timing of sex can enhance chances for While vasectomy is usually performed Testicle core temperature. Anatomy pregnancy as well. Fertility kits generally as a permanent method of birth control, Beyond patient medical history and Steroids adversely e ect sperm can help determine the point of ovulation. the high instances of divorce and Scrotum physical exam, a general understanding production. Steroids come in the form  ey help to identify the timing of the LH remarriage  nd many couples wanting a of sperm physiology can help focus in on of medications used to treat a variety of surge which brings on ovulation. Usually, vasectomy reversal. Fortunately, modern the evaluation. Sperm are produced in medical conditions including asthma, lung in a 28 day menstrual cycle (day 1 of the microsurgical technique allows reversal of sperm production. Speci c questioning deferens during previous inguinal hernia the testicle.  e stimulation for sperm problems, lupus, and arthritis. Steroids cycle is the  rst day of menstruation), vasectomy with a high degree of success. related to scrotal surgery, testicle injury, repair can severely impair the sperm production comes from pituitary gland are also occasionally used by atheletes to ovulation occurs on the 14th day. Actual For vasectomy reversal, it is important to genital , radiation exposure, transport process and thereby compromise messengers. Once the sperm is produced, increase muscle mass. Regardless of the timing of cycles may vary, and ovulation  nd experienced surgeons who have been toxic chemical exposure, hot tub or infertility. Certain chemical (pesticides, it is delivered outside the body thru a intent, steroid use will suppress sperm kits used over several months time can trained in the most advanced techniques sauna exposure, bathing habits, steroid for example) or radiation exposure (x-ray) plumbing system called the vas deferens. production. Testosterone is also a steroid, help specify the exact interval between of microsurgery. While a variety of exposure, and drug use are critical is toxic to the sperm producing cells. When sperm counts are abnormal, the and use of testosterone will depress sperm ovulations. Once ovulation is predicted, parameters can help predict success elements. Abnormal patterns of urination Some activities of routine living can problem is usually related to either production. couples should have sex every 48 hours rates of vas reversal, if the procedure is may suggest “blockages” that can also adversely a ect fertility, such as regular production of sperm or delivery of sperm. around the date of ovulation. For example, performed within eight years of the man’s block delivery of sperm. Injury to the vas sauna or hot tub use. A detailed history Other considerations involve If a production problem is suspected, if ovulation occurs on day 14, couple vasectomy, there’s a high likelihood that can identify many such issues, and point understanding anatomy. As a basic evaluation focuses on the testicle and the should plan sex on day 11, day 13, day his sperm production over time will return VARICOCELE in a direction for correction. Physical concept, the sperm must end up inside pituitary gland. If a delivery problem 15, and day 17. More frequent sex, while to fertile levels. While there is no absolute examination is particularly helpful as the vagina in order to get pregnant.  e is suspected, evaluation focuses on the entertaining, is no more helpful. Also, time limit, success of vas reversal clearly Normal vein Enlarged the most common factor a ecting male female position during sex may contribute plumbing system. While it sounds vein men should not have any extra ejaculation declines beyond 12 years after vasectomy. (varicocele) fertility is a varicocele, which is commonly to di culties. Most experts recommend simple, only an experienced urologist during that timeframe so as to allow for identi ed on examination. A varicocele is that the female be on the bottom with a specializing in male fertility can sort out best quality semen during intercourse. a dilated collection of veins that envelope pillow under her buttocks to elevate the the  ne details of these systems to arrive VASECTOMY REVERSAL the testicle, typically on the left. Often pelvis.  is best insures that the sperm Many couples get frustrated during the at a correct diagnosis. Much of the testing the varicocele causes no problems will remain in the vaginal vault rather than months trying to get pregnant. Men often and counselling used just 10 years ago is except swelling of the scrotal sac or mild leak out.  e female should remain on her experience temporary erection di culties. now completely out of date. testicle ache. It can silently a ect sperm back for a few minutes to allow the sperm  is is usually psychological, due to the production though. In some cases, the to reach the cervix before getting up. fact that sex has become a scheduled chore Complex scrotum has the appearance of a “bag of Certainly, wait a few minutes before using rather than a spontaneous, recreational  e Conrad-Pearson Clinic has specialists any vaginal hygiene products after sex. activity. Better performance will in male fertility that work hand in hand Testicle worms” as the veins are easily seen; whereas Testicle in other cases the varicocele is very subtle undoubtedly return. with female fertility experts in the area and can only be recognized by ultrasound. to provide state-of-the-art fertility Separated Reconnected Vas Deferens Vas Deferens Scrotum A varicocele can be surgically corrected in evaluation. In some cases, evaluation may hopes of improving sperm quality. yield no particular diagnosis to explain the