we can help you become a father
Dr. Carrasquillo has advanced fellowship training in the diagnosis and treatment of all conditions affecting male fertility. Evaluation begins with a detailed medical history and physical examination. A semen analysis is critical to identifying abnormalities that may affect your fertility potential. Blood tests may be used to determine various hormone levels relevant to function of the male reproductive system. Additional male fertility testing beyond this may be required, including genetic testing or ultrasound depending on the results of the initial evaluation. Dr. Carrasquillo may also recommend certain lifestyle adjustments to maximize your fertility potential, such as weight loss, exercise, smoking cessation, and supplementation with antioxidant vitamins.
While a male fertility problem can be identified in up to 50% of infertile couples, it is important to consider the couple overall as the patient, and Dr. Carrasquillo is committed to open communication with you, your partner, and other fertility providers such as Gynecologists and Reproductive Endrocrinologists. It is encouraged that your partner accompany you to your infertility consultations with Dr. Carrasquillo, when possible.
Azoospermia, or the absence of sperm in semen, accounts for about 15% of male infertility and can be due to a variety of causes that generally fall into obstructive or non-obstructive categories. Physical examination and blood tests to evaluate hormone levels can help clarify why there is no sperm in the semen.
Causes of obstruction include a history of prior infections that cause scarring, prior vasectomy, prior hernia repair surgery than can injure the vas deferens (channels that sperm travel through), and genetic disease (for example, Cystic Fibrosis). Depending on the nature of the problem, Dr. Carrasquillo can offer surgical treatment to harvest sperm for IVF or reconstruct the reproductive tract allowing for natural pregnancy:
- vasectomy reversal
- microsurgical epididymal sperm aspiration (MESA)
- office testicular sperm aspiration (TESA)
- transurethral resection of ejaculatory ducts (TURED)
When non-obstructive causes of azoospermia are suspected, additional testing can determine if the problem may be genetic or non-genetic, and if medical therapy is an option to correct any hormone imbalances between the brain and the testicles where sperm are made. Additionally, microsurgical testis sperm extraction (micro-TESE) may be used to identify rare sites of potential sperm production in the testicle and allow Dr. Carrasquillo to safely extract these few sperm for use in IVF.
Varicoceles, dilated varicose veins within the scrotum, are one of the most common causes of male fertility problems. They are found in 15% of men and up to 40% of men in infertile couples. While only one testicle may have dilated veins present on examination, the consequences may affect sperm production from both testicles and low sperm count in semen. It is thought that this is due to increased temperature in the scrotum causing oxidative stress and DNA damage in sperm produced in both testicles. When the sperm count is normal, testing for sperm DNA damage can identify if the varicocele is causing a problem with sperm quality and function. Dr. Carrasquillo may recommend microsurgical varicocele repair and the use of antioxidants. The microsurgical approach carries the highest chances of success in eliminating the varicocele and improving fertility, and the lowest chances of complication such as bleeding, injury to the artery of the testicle, recurrence of the varicocele, and hydrocele (an enlargement of the scrotum caused by fluid around the testicle). Dr. Carrasquillo specializes in the microsurgical approach to varicocele repair.
The cryopreservation (freezing and banking) of healthy sperm can be critically important to certain groups of patients who desire to preserve their future fertility. These groups include, but are not limited to:
- Men undergoing orchiectomy (removal of one or both testicles) for testicular cancer
- Men undergoing certain types of chemotherapy or radiation for cancer treatment (these treatments are toxic to sperm production)
- Men who anticipate delaying fatherhood into their 50s or later (data suggest that children of older fathers are at higher risk of certain genetic disorders, schizophrenia and autism)
- Trans women undergoing gender confirmation surgery who desire biological children in the future
If any of the above apply to you or you are otherwise interested in learning more about fertility preservation, Dr. Carrasquillo can provide you with more information on how to proceed. In most cases ejaculated sperm is sufficient for cryopreservation, but individuals who have already undergone cancer treatments, do not have sufficient sperm count, or are not able to provide an ejaculated sample may require sperm retrieval procedures.