The Weaker Sex

One week from today will be Father’s Day. So in honor of that completely manufactured holiday I think that we should spend the next week focused on the weaker sex…men.

I honestly believe that if men had to be pregnant and go through labor & delivery that the human species would vanish in 1-2 generations. Men are chickens but hate to admit it in most cases. There are certain advantages to being a male gynecologist. If a patient tells me her periods are bad, she gets moody or she finds an exam uncomfortable I will always agree with her 100%. Since I don’t have the equipment, I cannot contradict any comments regarding said anatomy by my patients. If they tell me it hurts I believe them.

It is always tricky to deal with the emotions wrapped up in infertility treatments. In cases where there is severe male factor the woman may still have to be the one undergoing the majority of the procedures. This is not fair but it is the reality of the situation. The use of sperm donation is always an option but usually not the first choice of most couples.

So here is the first “Question of the Day” to start our week of exploring male factor infertility:

31. Can surgery improve sperm quality?


Surgical treatments for male factor infertility are very limited. Historically, varicocelectomy has been the surgical procedure most commonly used to improve sperm quality. In this procedure, dilated veins in the scrotum (varicocele) are cut or ligated. One theory is that these dilated veins may increase the scrotal-testicular temperature, thereby diminishing the sperm quality. By cutting the veins, the scrotal temperature is restored to normal and fecundity may be improved. Unfortunately, well-designed control studies have not shown any statistical increase in pregnancy rates following varicocelectomy. Furthermore, many fertile men have varicoceles. Today, this procedure is rarely, if ever, indicated. In most cases of male factor infertility, the best treatment involves intrauterine insemination or, more often, proceeding directly with in vitro fertilization (IVF) and possibly intracytoplasmic sperm injection (ICSI).