Fertility As an expert in the field of the male reproductive system the andrologist is a specialist for men seeking help concerning fertility problems.

In the English language, the term 'fertility' was originally applied only to women, but it is increasingly applied to men as well, as common understanding of reproductive mechanisms increases and the importance of the male role is better known. The opposite of fertility is infertility.

Male fertility is influenced by serveral factors:
Hormones, Genital function, Sexual behaviour, Emotions, Nutrition and Environment.

It is the andrologist who identifies the correct diagnosis and helps the patients to become father by offering treatments for the infertile man.

Hormones:
Testosterone is the principal male hormone secreted by the testis. It is plays a key role for the male libido, energy, immune function, growth of muscle mass, bone density and stability.
Testosterone is responsible for the growth of penis and scrotum, development of a beard and male body hair, for sperm production in the testis and masculinisation of the brain.
In the testis, testosterone is produced by the Leydig cells. The male generative glands also contain Sertoli cells which require testosterone for spermatogenesis. Like most hormones, testosterone is supplied to target tissues in the blood. Most of it is supplied via a specific plasma protein, the sex hormone binding globulin (SHBG).
Low levels of serum testosterone are usually called 'Hypogonadism'. It is possible to treat a patient with testosterone, which is available as an injection or for transdermal application (gel).
The andrologist will analyse many factors influencing the secretion of testosterone:
Testical function (including the substance Inhibin B and Anti-Muellerian-Hormone), the hormonal 'axis' of the pituitary gland (LH, FSH, Prolactin), body composition (obesity can reduce the serum concentration of testosterone) and many other factors.
Analysing the male hormonal balance is difficult - the experienced andrologist will help the patient to become a 'healthy man'.

Genital function:
The correct function of the male genitals is mandatory for a fertile man.
Potency, a normal penis and regular erectile function are essential and are the subject of specialweb-pages of androdoc.com.
The testis are responsible for the production of testosterone and sperm cells.
The term sperm is derived from the Greek word spermos (Latin: sperma) meaning "seed".
Sperm cells are produced by a cell type called 'Sertoli-Cells'. The quality and quantity of the sperm cells are examined in a test called spermiogram.
Many factors influence the development of fertile sperm cells. The influence of the hormones is described above. Another factor is the testis temperature. The testis are located in the scrotum outside the abdomen - the temperature of the testis is lower than that of the body core.

Varicocele:
It has been shown that enlarged venes of the testis (called 'Varicocele'), normally located only on the left testis, can result in an increased testis temperature and reduced sperm quality.
A varicocele does often not cause any symptoms - only some patients may feel some testicular discomfort. The varicocele is normally identified by a physical examination and a Doppler-/Duplex sonography. If you have a smaller varicocele, your doctor may ask you to take a deep breath and hold it while you bend? down (Valsalva maneuver). This helps your doctor to detect abnormal enlargement of the veins.
 
A complication of a varicocele can be shrinkage of the testis (atrophy) and infertility.

The treatment of a varicocele is normally recommended to improve the male fertility (although varicocele treatment for infertile men is still discussed in science, it is recommended by most experienced andrologists.).
For Varicocelectomy, the surgical correction of a varicocele, Dr. Petsch recommends an inguinal approach using microsurgery instruments and a surgery microscope (or strong surgical loups). With microsurgical technique the enlarged venes of the testis can be ligated and the magnification of the microscope (or loups) helps to preserve artery and vas.
In experienced hands this method is a very safe and minimal invasive procedure.
An alternative to surgery is embolisation. Dr. Petsch recommends the 'antegrade embolisation technique (Tauber's procedure): With local anaesthesia of the scrotum and the use of fluoroscopy an enlarged vene is identified and punctured. By injecting a drug the varicocele scleroses. (This method is similar to the treatment of varicouse veins or piles/haemorrhoids.) The recovery period is shorter than with surgery and the risk of complications is minimised. However, overall effectiveness is not as high as the microsurgical method, which is still an option.
 
Laparascopic surgery is used by some centres for the treatment of varicoceles. The surgeon makes a small incision in the abdomen and passes an instrument and a camera into the abdomen. The procedure requires general anaesthetic and is not used generally since it bears more risks (bowel injury) while offering no obvious advantage.
 
As an experienced specialist and consultant for andrology and urology Dr. Petsch has helped many patients with fertility problems to become a father.
He has given lectures on several national and international conferences on andrologic topics.

You can view and download his presentation given at the Harvard Medical School Dubai 'Grand Round' here.

• Male infertility Dr. Petsch Havard