Male Infertility low testosterone. One of the first academic medical centers in the Both are fellowship-trained, male reproductive urologists prepared to deal nation to create a sperm bank continues to lead with the most complex infertility cases and the way in male infertility research and in complex to perform complex microsurgeries, such as vasectomy reversals and testicular-sperm clinical care. extraction. Partnering with URMC’s female infertility experts, the male infertility clinic An andrology lab and sperm bank were bank, today URMC’s Urology department is part of a designated in-vitro fertilization created more than 30 years ago at the now boasts two fellowship-trained male center of excellence in New York state. University of Rochester Medical Center infertility specialists—Jeanne H. O’Brien, (URMC). Grace M. Centola, Ph.D., M.D. and J. Scott Gabrielsen, M.D., Ph.D. Complex Care H.C.L.D., former associate professor of A nationally recognized male-infertility URMC’s male infertility clinicians see a Obstetrics and Gynecology at URMC, expert, O’Brien has received numerous growing number of patients with male- was instrumental in creating the bank, in awards and recognitions for both her factor infertility, such as decreased collaboration with Robert Davis, M.D., clinical and basic science research work. sperm counts, motility or morphology. and Abraham Cockett, M.D., from the Gabrielsen focuses on male reproductive The first steps in the care process are a Department of Urology. health, including male infertility, erectile baseline semen analysis, coupled with Building on the groundbreaking sperm dysfunction, male sexual dysfunction and an understanding of a patient’s health 4 UR Medicine | Department of Urology | urology.urmc.edu history. Hormonal and other testing may be from those help us to determine which in any of which could potentially disrupt obtained based on these results to try to type of testing to pursue. From there, the process. Meaning that in a group of identify the cause of infertility and how it we can recommend a solution, whether men with infertility, each man could have may be best treated. pharmacological or surgical.” a potentially different cause. Gabrielsen is Male fertility is complex and requires a Medications can be used to help boost using bioinformatics and machine learning Male Infertility number of genetic, hormonal, anatomical, sperm production and quality. Microscopic to identify specific causes for infertility environmental and other factors. As surgical treatments range from sperm in hopes that future treatments can be such, abnormalities in any of these areas retrieval for patients with cystic fibrosis and personalized to the individual. can result in infertility. Additionally, many vasectomy reversals on an outpatient basis, Discovering why some men do not lifestyle factors, medications, drugs and to microscopic testicular sperm extraction make sperm may also provide more global environmental exposures can impair a in an operating room. These treatments, insight into other causes of male infertility man’s fertility. “Given all the factors that can combined with advances in assisted and how fertility and general health are impact fertility, it’s a wonder people ever reproductive techniques, allow many men to linked. “Up to 87 percent of men who get pregnant at all,” O’Brien said. become fathers. undergo sperm extraction won’t ever father Infertility affects 10 to 15 percent The benefits of evaluating the male a child,” says Gabrielsen. “Understanding of couples. It is estimated that a male partner goes beyond just successful the underlying etiology is critical to factor contributes to 50 percent of cases. pregnancy. Both URMC male infertility helping these men become fathers and Nonetheless, it is often viewed as a specialists believe strongly that the time understanding the health of the father and “female disease,” and with only a few sperm has come for a men’s reproductive health child.” needed in order to do in-vitro fertilization, assessment to be part of a routine internal This is only part of the department’s most men do not undergo evaluation. medical exam. There is evidence that men innovative clinical and basic science Evaluation of the male partner is critical with infertility have higher rates of chronic research in male reproductive health. to improve the likelihood of successful disease, cancers and genetic abnormalities Gabrielsen also is exploring why pregnancy. “You can tell a lot from a compared to fertile men. While evaluation testosterone levels and fertility decrease physical exam and from patient history,” can help identify the cause and guide with age in men, specifically looking O’Brien added. “The information gleaned treatment, it is also an opportunity to at how body iron levels affect the male identify problems that could affect the reproductive axis. O’Brien is looking at how health of the man or his future children. vitamin D levels may affect testosterone levels. Both are collaborating to understand Innovative Research how blood sugar and body mass index Despite the advances in understanding affect testosterone and sperm levels, male infertility, much remains that is not and how metformin may improve these understood. To address this gap, URMC’s parameters. specialists are conducting a series of innovative research studies on male Preserving Testicular Tissue infertility. The institution that created one of the About 1 percent of the adult male nation’s first sperm banks now is working to population is sterile because they don’t expand fertility preservation options beyond make sperm. For many of these men, no conventional sperm banking. Gabrielsen sperm are found in the testicle and so there advocates for the development of a are no options for them to have their own protocol to store testicular tissues. children. Gabrielsen, who also has a Ph.D. in “By preserving tissue ahead of a Biochemistry, is looking to better understand hormonal or surgical transition, it may be why some men do not make sperm and possible to preserve fertility or to treat how we might help them move from “no infertility down the road,” Gabrielsen said. sperm to some sperm” — research that “Such a bank could have enormous future began during his andrology fellowship at benefits for children and for the transgender Baylor College of Medicine. population who undergo fertility-threatening Prior studies have had difficulty surgery, hormonal therapy or chemotherapy identifying new genetic abnormalities that before they enter puberty and have the contribute to infertility, in part because of opportunity to bank sperm.” the number of different potential causes. URMC’s infertility experts will continue For example, more than 3,000 genes are to provide innovative patient care and to necessary to make sperm, abnormalities achieve major advances in research. Left Scott Gabrielsen, M.D., Ph.D. Right Jeanne H. O’Brien, M.D. URology | Winter 2020 5.