Topics
Vasectomy Reversal
Microsurgical Vasectomy Reversal (or microsurgical reconstruction of a blockage in the sperm transport system from a different cause) should always be performed when natural pregnancy achievement is possible.
The microsurgical skill set of the surgeon is as important as anything else in getting the best result for you. As microsurgery is a big part of my practice, I am happy to lend my expertise and experience in this area to help you optimize your chances to realize your dream of a beautiful baby.
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Microsurgical Epididymal Sperm Aspiration
Microsurgical Epididymal Sperm Aspiration (MESA) is performed when there is a blockage to sperm flow that cannot be corrected.
Having one of the world’s largest experiences in this procedure, I extract sperm from outside the testis, freeze it at one of the many IVF groups I work with, and they use it later as a source of sperm for a cycle of ICSI. The pregnancy rate is excellent. I authored the first papers on intentionally freezing the sperm, now a commonly used approach in the top IVF centers.
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Microsurgical Testis Sperm Extraction
Testis Sperm Extraction (TESE) is carried out in those unfortunate men who have a problem with sperm production to such a degree that there are no sperm seen in the semen. By microsurgically searching through the testis, I look for areas that may have tiny amounts of sperm within them. Those areas are harvested and either used right away in an ICSI cycle or frozen for later use.
As for MESA, we first described the intentional frozen-thawed approach, now used world-wide. A karyotype and Y chromosomal microdeletion assay almost always need to be obtained prior to TESE.
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Genetic Evaluation and Testing
Genetic evaluation and testing may be a critically important part of an individual’s work-up. As a recognized leader in the field of Male Reproductive Genetics, I cannot stress how crucial it is to know about the genetic basis of male infertility, to be able to describe to my patients what tests we might need and then to clearly explain any positive results so that we are all on the same page.
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Fertility in the Spinal Cord Injured Male
Spinal cord injury wreaks havoc on the male reproductive system. I was fortunate to be one of the first clinicians in the US to be actively involved in the treatment of infertility in the spinal cord injured male and authored some of the first papers detailing the application and results of penile vibratory stimulation and rectal probe electroejaculation.
My experience is second to none in New England and I love helping my SCI couples get pregnant. We start with the simplest techniques (oftentimes quite successful) and move to the most complex strategies only as we have to. Fatherhood in the SCI male is absolutely possible.
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Cancer and Infertility
Cancer is a devastating diagnosis but cure is so often achieved in this day and age that all of us need to pay great attention to preserving the fertility potential of every male patient, from infancy to adulthood.
Sperm or testis tissue banking before any chemo or radiotherapy are options and require the most compassionate interaction with the patient and/or his parents and I am happy to provide that in as timely a fashion as humanly possible. Testis tissue harvesting after chemotherapy or radiation therapy might be necessary for some men and I have a tremendous amount of experience in this area, having published one of the first papers on the topic.
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