Male Infertility

The only physicians in Austin and Round Rock with Specialty Fellowship training in Male Infertility, Vasectomy Reversals, and Reproductive Urology Approximately 20% of cases of infertility are due solely to male factor, and an additional 30-40% of cases involve both male and female factor.

A man’s fertility can be affected by the following factors:

Dr. Kavoussi is fellowship trained in the evaluation and medical and surgical treatment of male infertility, including microsurgical expertise in the field required for sperm harvest (microTESE) under certain circumstances.

Our goals in caring for infertile men include:

Dr. Kavoussi was involved in basic science research investigating new technologies on a cellular level to help improve the efficiency and success rates of sperm retrieval in an animal model to ultimately be applied to men without sperm in the semen to allow these couples to undergo IVF with the man’s sperm.

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A varicocele is an abnormal dilation of the veins from the testicle. Fifteen percent of men in the general population and forty percent of men presenting with infertility have a varicocele, and this is the most common correctable cause of male infertility. The varicocele can be repaired through an approximately 1/2 inch incision made in the groin. This is performed as a day surgery and the patient may return to full activity in one week. Seventy percent of men with infertility, abnormal sperm counts or abnormal sperm function, and a varicocele will have improvement in sperm counts/function after varicocele repair. Varicoceles can also damage the DNA inside of the head of the sperm cells with a process known as sperm DNA fragmentation. When men have high percentage of sperm cells with fragmented DNA, the fertilization and pregnancy rates are lower, and higher rates of miscarriage are associated with varicoceles. Varicocele repairs improve the health of the sperm cells and studies have shown higher pregnancy rates after varicoceles are repaired, even if sperm parameters do not improve and levels of reproductive assistance are required, as the healthier sperm cells do a better job fertilizing eggs and help sustain pregnancies. Dr. Kavoussi is fellowship trained in microscopic varicocele surgery and each perform multiple varicocele repairs on a weekly basis. ​Dr. Parviz Kavoussi was a co-author on a clinical guideline scientific paper on sperm DNA fragmentation and its importance in specific male fertility evaluations, including men with varicoceles.

Dr. Parviz Kavoussi provides care for a large number of men with varicoceles and with azoospermia (sperm count of zero) at Austin Fertility & Reproductive Medicine/Westlake IVF. Dr. Kavoussi has contributed a chapter on varicoceles and azoospermia to the Springer published textbook of Varicocele and Male Infertility. In these complex scenarios, it is always recommended that a man with a sperm count of zero without a blockage as the cause, who has a varicocele has that varicocele repaired as 20-40% of these men will have return of sperm to the semen several months after repair of the varicocele. In men who do not have return of sperm to the semen after varicocele repair, and have to go through the next step of microdissection testicular sperm extraction (microTESE), a meticulous microsurgical search for sperm in the testicle to be retrieved for use with IVF, the odds of retrieving sperm increase after the varicocele has been repaired. There will also be healthier sperm retrieved with better outcomes with IVF after the varicocele has been retrieved if microTESe is ultimately required.

To read more on Varicocele click on the following links:

Sperm Retrieval

It is known that 1% of all men will have no sperm in their semen and 10-15% of infertile men will have no sperm in their semen. In such cases or in cases when a man has a non-surgically correctable blockage not allowing the sperm to reach the semen, there are still options to retrieve sperm that can be used in combination with assisted reproductive techniques such as in vitro fertilization (IVF) to successfully achieve a pregnancy. There are multiple options for retrieving sperm including percutaneous epididymal sperm aspiration (PESA) where aspiration is performed from the epididymis (the structure connecting the testicle to the vas deferens), microsurgical epididymal sperm aspiration (MESA), testicular sperm aspiration (TESA) aspirating sperm directly from the testicle, testicular sperm extraction (TESE), and microdissection testicular sperm extraction (microTESE).

MicroTESE is a specialized procedure used for men without sperm in the semen who do not have a blockage​, but have a sperm production failure. Genetic testing is done prior to the procedure to give us an understanding of what the odds are of finding sperm at the time of sperm retrieval. A precise microsurgical technique is then used to look for possible pockets of sperm production throughout the testicle under the visualization of an operative microscope to find sperm that can be used in combination with IVF. The success rates of retrieving sperm using this procedure are highly dependent on the experience of the microsurgeon. Dr. Kavoussi is specialty fellowship trained in microsurgery to find such microscopic pockets of sperm production to allow these couples a chance to achieve a pregnancy with the man’s sperm ​with high percentage success rates. ​The team at Austin Fertility & Reproductive Medicine has a 71% of retrieving sperm in men undergoing microTESE which has been published in peer reviewed scientific articles, and is as high if not higher than any program that performs microTESE.

To read more on microTESE click on the following links:

Sperm DNA Fragmentation

Although the traditional semen parameters obtained on a semen analysis are the cornerstone to a man’s fertility evaluation, higher levels of sperm testing are useful in certain situations. Sperm DNA fragmentation is the test that has had enough scientific data to support its use in clinical practice thus far. It has been demonstrated that in men with elevated levels of sperm DNA fragmentation, there may be lower fertilization rates, lower pregnancy rates, and higher miscarriage rates for the couple. The current clinical recommendations are to offer sperm DNA fragmentation testing for couples with recurrent pregnancy losses, men with varicoceles, and in IVF failures with healthy eggs. Dr. Parviz Kavoussi was a co-author on the scientific manuscript used as the clinical guideline for testing and treating men for high DNA fragmentation.

The andrology laboratory at Westlake IVF offer sperm DNA fragmentation testing. To learn more about andrology laboratory services at Westlake IVF.

Dr. Parviz Kavoussi contributed the textbook chapter on surgical, radiographic, and endoscopic anatomy of the male reproductive system in the 11th and 12th editions of Campbell’s Walsh Urology textbook, which is considered the “bible of urology” used for training urology residents as well as the primary reference for practicing urologists. A mastery of this anatomy is paramount to optimize outcomes with the complex, meticulous surgical procedures performed to optimize male fertility outcomes.

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