Causes of male infertility

Two reports from physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center shed new light on male infertility.

A first report shows that a common cause of male infertility -- varicoceles, or varicose veins in the scrotum -- also results in a depletion of testosterone. In a second related finding, researchers demonstrate that once a common, simple surgery is used to treat varicoceles and thereby restore fertility, testosterone levels are also improved.

Dr. Marc Goldstein, Professor of Urology and Reproductive Medicine at Weill Cornell Medical College and attending urologist at NewYork-Presbyterian/Weill Cornell, has presented his novel research at the 2007 annual meeting of the American Society for Reproductive Medicine (ASRM) in Washington, D.C.

"People often forget or often don't realize that the testes have two purposes," says Dr. Goldstein, who was also awarded the prestigious Howard and Georgeanna Jones Life Time Achievement Award by the American Fertility Association. "One is the production of the sex cells (sperm), and the other is to produce testosterone."

In his research, Dr. Goldstein hypothesized, and later found that, the presence of varicoceles causes significantly lower testosterone levels. He also observed that following varicocele removal, testosterone levels are greatly improved -- up to 100 percent -- in more than two-thirds of the men studied.

With impaired testosterone production, males may experience andropause, analogous to menopause (lowered estrogen levels) in women. A man may have a lowered sex drive, the inability to have erections, lowered muscle strength and energy level, and even depression. Also, affected men are more prone to osteopenia and osteoporosis, causing weakened bones.

Testosterone production is lowered when varicoceles become enlarged and twist around the testis of men. The condition can be hereditary and is found in 15 percent of all males; it also leads to a lowered sperm count and quality.

Thirty-five percent of all cases of primary infertility (first pregnancy attempt) and 80-percent of secondary infertility (attempts at pregnancy following a successful impregnation) are due to varicoceles.

Dr. Goldstein, a pioneer in urology surgery, helped to invent the microsurgery procedure now considered the standard in the treatment and removal of varicoceles.

Varicoceles begin forming at puberty and most doctors do not screen patients during routine check-ups.