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Infertility


General Information

During your visit, we will make a thorough review of your medical history, physical examination and laboratory tests, including blood, urine and semen analysis and ultrasound. If you have had any laboratory or X-Rays done before, please bring the report of the results with you.


Evaluation and Treatment

There are many significant advances in the assessment and treatment of male subfertility. We now believe that the subfertile couple is a dilemma. This is partly due to our increased knowledge of factors associated with male subfertility, as well as recent advances in testing and diagnostic equipment. In addition, the availability of sophisticated reproductive technology has allowed us to offer even to men without sperm in the ejaculate, the possibility of fathering a biological child.

The male factor is the primary or contributing cause of 40 to 60% of couples presenting for fertility evaluation. Therefore, both male and female partners should be evaluated at the same time. It is no longer enough to say that man is "normal" just because the semen parameters, they are "within normal range." Many factors, other than semen quality are also important.
The following selected examples of our patient population shows some treatable diseases in male fertility:

A 30-year-old man is presented without sperm in their ejaculate, is diagnosed with the absence of the vas deferens. Surgical exploration and recovery of fluid from the epididymis was used for micro-insemination oocytes on his wife, using the in vitro fertilization technique. The couple now has a healthy one- year old child. The sophistication of assisted reproductive technologies has made this possible.

A pediatrician trying to conceive her second child was presented for evaluation. A decrease in the number of motile sperm appears normal effectively and was found in his evaluation. His wife had had a normal evaluation. Surgery is performed great varicocele (abnormally enlarged veins that drain the testes) this resulted in a doubling of the number of spermatozoa and four and a half times the increase in the number of progressively motile sperm and morphologically normal (44 million preoperatively to 206 million after the operation). A pregnancy occurred 7 months after surgery. Over 80% of men with secondary subfertility were found to have varicoceles to impair fertility of the couple. The best first step is diagnosis. We recognize that your time is valuable. We have all the advanced diagnostic tests available in our environment.


Varicocele

Definition

Varicoceles are enlarged veins that drain the testicles. They are usually larger on the left side. A varicocele causes the accumulation of blood in the scrotum and an increase in testicular temperature. This increase in temperature has a negative effect on sperm production and function. Surgical repair of varicocele, varicocele ligation, ends with further deterioration of sperm production, and often improves the quality of sperm fertility levels.

Preoperative Preparation


Avoid aspirin and aspirin products for one week before surgery


Reverse Vasectomy
There are two procedures that can be made to "invest" the blockage caused by a previous vasectomy. These are a vasovasostomy and vasoepididymostomy. A surgical microscope used has been documented to provide the best success rate. A microsurgical vasovasostomy is the reconnection of the two cut ends of the vas deferens. The vas deferens is the conduit for sperm to go from the testicle to the urethra. This is the preferred procedure and offers the best chance to return sperm to the ejaculate and pregnancy later on. Vasoepididymostomy microcirúrgica (VE) is the final connection of the vas deferens to the epididymis. This is a more extensive procedure and is performed when there is a congenital obstruction of the vas deferens, or sperm does not flow from the open end of the vas deferens at the time of reconstructive surgery.

Normally operates as an outpatient procedure in the Ambulatory Surgery Center

Fasting is required for this event and is defined as nothing to eat or drink except water for at least 8 hours. We will meet an hour prior to surgery to review and answer any questions.

The surgery will take between two to four hours, depending on the type of surgery needed to restore your fertility. The procedure is done under a general or spinal anesthesia, which are extremely safe and effective.

You will stay in the recovery room for at least an hour, until you feel alert to travel

Post-operative care

A small amount of bright red blood may appear in the patch. Do not be alarmed if you feel that the amount is excessive, call our office

The moment you leave the ambulatory surgery center, prescriptions for pain and antibiotics are given. Be careful when walking or climbing stairs while taking any medication.

Do not drive for 48 hours after surgery or while taking pain medicine

You may shower 48 hours after the surgery. Keep the dressing dry until then

Swelling and black or blue are normal and may take several weeks to disappear

You will have to wear an athletic supporter (jock) at all times, even when sleeping, during 3 weeks after surgery. It can only be removed while showering

Neither work nor sports are allowed for 3 weeks after surgery

Avoid sexual intercourse for 4 weeks after surgery


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