Management of Male Infertility in Paris
Dr Adam Vardi - Urologist
Male infertility specialist in Paris and Neuilly
Dr Vardi - Urologist in Paris
Infertility is defined by the World Health Organization (WHO) as the absence of conception after 12 months of regular unprotected intercourse. It is estimated that one couple in seven faces difficulties conceiving, and in approximately 50 % of cases a male factor is involved, alone or in association with a female cause.
Dr Adam Vardi, urologist-andrologist, is involved in the investigation of male reproductive function. The aim is to identify treatable causes, to offer suitable assisted reproductive technology (ART) techniques, and to detect any underlying conditions.
Physiology of spermatogenesis and excretion
Urological Surgery in Paris & Neuilly
Sperm production, or spermatogenesis, is a continuous process that takes place in the seminiferous tubules of the testes over approximately 74 days. It is regulated by a complex hormonal balance involving the hypothalamus, pituitary gland, and testes (gonadotrophic axis). Once produced, spermatozoa mature in the epididymis before being conveyed via the vas deferens to the urethra during ejaculation.
Any alteration in production (secretory cause) or in transport of spermatozoa (obstructive cause) may lead to reduced fertility.
The main causes of male infertility
Dr. Adam Vardi - Urologist and Andrologist in Paris
The etiology of infertility is multifactorial. The andrological examination allows the causes to be classified into several distinct categories.
Varicocele: a frequent and curable cause
Varicocele is a varicose dilatation of the veins of the spermatic cord, most often on the left side. It causes stagnation of venous blood and an increase in scrotal temperature, which alters the quality of spermatozoa (decrease in number, motility, and increase in DNA fragmentation). It is the most common treatable cause of male infertility.
Obstructive (excretory) causes
Here, testicular production is normal, but spermatozoa cannot be expelled. This may be due to: – Sequelae of infections (epididymitis). – Bilateral agenesis of the vas deferens (often related to the cystic fibrosis gene). – Surgical history (vasectomy, pediatric inguinal hernia repair).
Secretory (non-obstructive) causes
The problem lies in the actual production of spermatozoa. This may be related to genetic abnormalities (Klinefelter syndrome, Y-chromosome microdeletions), a history of cryptorchidism (undescended testicle), or toxic exposures (tobacco, cannabis, endocrine disruptors, chemotherapy).
Management of male infertility in Paris
Urologist in Paris
Ejaculation disorders and environmental factors
Retrograde ejaculation (semen flowing back into the bladder) or severe erectile dysfunction prevent semen from being deposited in the female genital tract. In addition, lifestyle (obesity, heat exposure, oxidative stress) plays a not-insignificant role.
Diagnostic work-up by the urologist
Management begins with a thorough history-taking and clinical examination looking for varicocele or abnormalities of testicular volume.
The semen analysis: the pivotal examination
The semen analysis, performed after 2 to 5 days of abstinence, evaluates several parameters according to WHO standards:
- Motility: the ability of spermatozoa to progress.
- Morphology: the percentage of normally shaped spermatozoa (spermocytogram).
It is often supplemented by a semen culture (looking for infection) and, if necessary, by sperm DNA fragmentation tests to assess the quality of the genetic material.
Biological work-up and imaging
Hormonal testing (FSH, testosterone) is indicated in the event of severe abnormalities of the semen analysis. Scrotal Doppler ultrasound confirms varicocele and rules out a subclinical testicular tumor, which is more frequent in infertile men.
Therapeutic and surgical strategies
The strategy is adapted to the identified cause and to the couple’s parental project.
Surgical treatment of varicocele
In the event of clinical varicocele associated with abnormal semen parameters, embolization or surgical ligation (often under a microscope) may be offered. The aim is to improve semen parameters within the 6 months following the procedure, sometimes allowing natural conception.
Sperm retrieval surgery (testicular biopsy)
If you have azoospermia (a complete absence of sperm in the ejaculate), Dr. Vardi may refer you to a specialized clinic for a surgical procedure to retrieve sperm directly from the epididymis or testicle (TESE). The sperm collected in this way are frozen for later use in In Vitro Fertilization with Intracytoplasmic Sperm Injection (IVF-ICSI).
Medical treatments and lifestyle
Certain antioxidant or hormonal treatments may be prescribed to stimulate sperm production. Addressing environmental factors (quitting smoking, losing weight) is always encouraged, as it can significantly improve fertility potential.
Conclusion
Male infertility is not an isolated condition but rather a reflection of complex biological balances. Thanks to advances in microsurgery and assisted reproductive technology, most couples facing male-factor infertility can now hope to achieve a pregnancy. Dr. Vardi’s role is to approach this evaluation pragmatically, placing the couple at the center of the care process.