Reproductive Urology FAQ

Progyny covers treatment for sperm related or male-factor infertility. While treatment will vary, you may need to see a reproductive urologist who specializes in reproductive health for individuals or individuals who produce sperm. The Progyny benefit provides treatment coverage for these services and access to a curated network of reproductive urologists. There are many reasons why you should reach out to these providers to understand your family building options. For example, if you are in a heterosexual relationship and are having trouble conceiving, if you or your partner has experienced pregnancy loss, you have a known or suspected infertility diagnosis, or history of cancer treatments. You do not need to meet these criteria to book an initial consultation.

Progyny members, you can always reach out to your dedicated Progyny Patient Care Advocate (PCA) for more information.

Infertility is common and issues relating to sperm make up just under half of all infertility cases. Oftentimes infertility may be due to low sperm count, low sperm motility (too few moving), or poor sperm morphology (abnormally shaped sperm). There are three main causes of sperm related infertility: anatomic conditions (related to the structure or function of the penis), hormonal abnormalities, and genetic causes.

Anatomic conditions:

• A varicocele is effectively a varicose vein of the testicle. Varicoceles are very common and they don’t always cause semen analysis problems or fertility issues, but in some situations it can cause problems with sperm production.
• Sometimes anatomical blockages can be found and can be corrected by surgery. They can often be bypassed through a procedure where sperm is taken from the testicles and used during the IVF process.

Hormonal factors:

• Many individuals also have hormonal abnormalities that can impact a semen analysis. A reproductive urologist can help identify the cause and determine how to solve the hormonal issue to improve the semen analysis.

Genetic conditions:

• While rare, individuals may also have a genetic issue that impacts sperm production.

Like an initial consultation you may have had at your fertility clinic, the initial consultation is often your first appointment with a reproductive urologist. You will discuss your family building goals and have an in-depth physical evaluation. It is important to be prepared to go through your medical history, surgical history, family history and provide information on any medications or supplements you may be taking. Be sure to bring any records of previous semen analyses and or recent medical evaluations with other physicians, internists, or endocrinologists.

Check in with your reproductive urologist and their office to understand if there is anything else you can do to prepare for your appointment.

It is important to remember that sperm starts in the testicle, and it takes about three months until they move into the ejaculate. As you are considering your fertility and family building goals, it’s important to focus on a healthy diet, limiting alcohol, avoiding tobacco, and minimizing marijuana use.

During an initial evaluation, the reproductive urologist will go through a lot of questions to learn more about you, your partner, and your health. They will also likely order laboratory tests and blood work to check hormone levels.

Those tests may include:

• Doppler ultrasound of the scrotum which is an evaluation of the testicles and the surrounding structure.
• Genetic testing that includes bloodwork and helps to identify genetic abnormalities.
• Sperm DNA fragmentation testing which provides an estimate of DNA damage in a sperm sample.

There are many possible treatments for infertility depending on your unique situation. Each treatment will differ in terms of invasiveness and any required follow up. It is important to discuss your options with your doctor.

• Medication: Medications may be prescribed that can correct hormonal issues and assist with sperm production.
• IUI: Once sperm has been collected, it can be inserted directly into a partner’s uterus through a catheter during ovulation.
• Surgery: Surgery may be performed to correct issues like blockages that could lead to better quality sperm.
• ICSI: Intracytoplasmic sperm injection (ICSI) is a laboratory technique that is performed in most IVF cases in the United States. Once the eggs are ready for insemination, a micropipette or tiny needle is used to inject a single, normal appearing, living sperm directly into the center of an egg to promote fertilization. ICSI is most often used in cases of male-factor infertility such as low sperm count; poor sperm morphology (shape) or motility (movement); or if the sperm have trouble attaching to the egg.
• TESE/MESA: When there is no sperm in the ejaculate, a minor surgical procedure called a testicular sperm extraction or testicular sperm aspiration can be performed. This procedure removes sperm directly from the testes and makes it available during an IVF cycle.
• Donor sperm: In cases where sperm count cannot be improved, your doctor may recommend a sperm donor in order to conceive.

If issues are addressed up front, you may not necessarily need treatment in the future. If you require surgical intervention, for example surgical sperm retrieval, your sperm can be frozen and preserved for future use. Talk to your doctor to discuss your options.