Fertility

Are you a man who does not wish to have children or extend your existing family further? If you answer with a yes, you may want to consider getting a vasectomy. At Urology Clinics Manchester our specialists team of urologists will guide you through the vasectomy process with care and ensure you understand how to prepare for a vasectomy.

What is a vasectomy?

A vasectomy is procedure a man will undergo when he does not want to impregnate a woman. In essence, it is an effective form of male birth control. It is also permanent. During the procedure, an experienced urologist will ensure that sperm won’t leave the penis when a patient has sexual intercourse.

How to prepare for a vasectomy

Your urologist (or a member of their team) will briefly review your history and medications, and will discuss the surgery again with you to confirm your consent. If you are scheduled to have your vasectomy under general anaesthetic, you must not eat, drink, nor smoke for 6-8 hours before the procedure. The anaesthetist will also discuss pain relief after the procedure with you. We usually provide you with a pair of compression stockings to wear. These help to prevent blood clots from developing and passing into your lungs. Your medical team will decide whether you need to continue these after you go home.

How to prepare for a vasectomy post operatively

You may feel sore for a few days. It is advised that you should rest for at least a day. Complete recovery is expected in less than a week.

• Apply ice packs intermittently to the scrotum the night of your vasectomy and as much as possible the following day. Do not apply for more than 20 minutes at a time.
• Remove all dressings–except one or two clean gauze pads–from inside the athletic supporter after 24 hours. Continue using the athletic supporter for one week.
• Cover the incisions with one or two clean gauze pads regularly for three days after surgery.  A small amount of blood on the gauze pads is normal. Tell your doctor if you have excessive bleeding or need to change the gauze pads more than two or three times daily.
• You may shower 24 hours after your vasectomy. Afterwards, keep the area of the incision clean and dry.
• Refrain from intercourse/ejaculation for one week.  Ejaculation may cause some discomfort in the groin and testicles until the tissues heal.
• You may return to work and resume normal, non-strenuous activity in about two days or 48 hours. Activities such as weight lifting and jogging should not be resumed for a minimum of one week.
• Note:  Absorbable stitches are used for closure of the wound and do not necessitate removal.
• You will likely have some postoperative discomfort; complications are rare but can occur.

To find out more please contact us.

Are you a man who feels tired, irritable, and not like yourself? If so, you could be suffering from low testosterone. The team of experts at Urology Clinics Manchester offers comprehensive urology services, including diagnosis and treatment for this.

Testosterone is a hormone produced in both the male and female body. In men, it’s produced in the testicles and affects several different physical features and functions. In men, it stimulates sex drive, sperm production, and the development of muscle and bone mass. It also triggers hair growth, the voice to deepen, and other male features.

Low testosterone does not always present symptoms, and some people only learn about it after a routine physical examination with blood work.

How can you tell if you have low testosterone? These are some of the most common signs and symptoms for you to recognise:

• Fatigue and decreased energy
• Reduced sex drive
• Difficulty achieving and maintaining an erection

These are some of the ways low testosterone can affect your body:

• Decreased bone density and increased fracture risk
• Depressed immune function and more frequent illness
• Loss of muscle tone and decreased skin elasticity

Males experience a gradual decrease in testosterone as they get older. The older you are, the more likely that you’ll have low testosterone. Fortunately, we are able to diagnosis and treat those who suffer from low testosterone.

It is important that we treat this issue so we can be ourselves again, having balanced levels mean a better quality of life for you. You will enjoy:

• An increased sex drive
• Boosted energy and stamina
• Improved muscle mass and muscle tone
• Enhanced mood
• Increased motivation and productivity
• A stronger immune system
• Improved memory and ability to concentrate
• Improved skin elasticity and tone

No matter what your age. If you are concerned about low testosterone. It’s time to talk with your urologist. To diagnose this issue, your doctor will often perform a physical evaluation and review your symptoms. Your doctor may also request testing to look for additional signs. Contact us today to see how we can help.

Having a vasectomy is a step that should be carefully considered because it’s a permanent form of birth control. Here you will find many of the questions many men have as they are considering having this procedure.

What happens during a vasectomy? A vasectomy is a simple surgical procedure done to prevent pregnancy. It involves cutting two tiny tubes called the vasa deferentia. (One tube is called a vas deferens or vas.) Typically, sperm cells travel through the vasa deferentia before they’re mixed with semen and ejaculated out of the body. By cutting these tubes, the sperm cells’ path is blocked. Instead of being ejaculated, the cells are absorbed by the man’s body.

How effective is a vasectomy? After it takes effect, this procedure is about 99.95% effective in preventing pregnancy. This success rate makes it one of the most effective form of birth control available.

Where can I have a vasectomy and how long does it take? This procedure will be done in a hospital. They take about a half hour, and men can go home the same day.

Does a vasectomy hurt? Men are given local anaesthesia, so there shouldn’t be any pain. There might be some minimal discomfort after the anaesthesia wears off. This can usually be managed with ice packs or paracetamol. Aspirin and ibuprofen are not recommended, as they raise the risk of bleeding or bruising.

Can there be complications after a vasectomy? All surgical procedures have some risk, but complications after this procedure are rare. Complications can include the following:

• Sperm granuloma. When a vas deferens is cut, stray sperm cells can leak out. The immune system responds, which can lead to inflammation and, eventually, a small mass called a sperm granuloma. The mass is benign (not cancerous). A sperm granuloma can cause some temporary discomfort, but it usually goes away on its own. Pain medications may help. If it is especially bothersome, it may need to be surgically removed.
• Infections.Some men develop an infection after their vasectomy. The infection is usually treated with antibiotics.
• Hematoma. A hematoma occurs when blood collects in the scrotum after surgery. It often goes away on its own, but men should call their doctor if their scrotum gets bigger or becomes painful.
• Post-vasectomy pain syndrome.About 1% to 2% of men have chronic pain after vasectomy due to fluid buildup in the scrotum. Pain medications and warm baths may help. In more severe cases, surgery—or a vasectomy reversal procedure—may be needed.

Does a vasectomy increase the risk for cancer or erectile dysfunction? No. Men who have vasectomies are not at higher risk for cancer or erectile dysfunction.

What is a vasectomy recovery journey like? Most men take it easy for a day or two after their procedure. There may be some pain and swelling, but these symptoms can be managed with pain medication and cold packs. Men who work desk jobs normally go back to work the next day. Heavy lifting is restricted for about a week, so men with more physically demanding jobs may need to adjust their routine. Men should avoid ejaculation, through partnered sex or masturbation, for about a week.

Is a vasectomy immediately effective? No. It takes time for sperm cells to “clear” each vas deferens after a vasectomy. For this reason, couples need to continue using another form of birth control for a few more months or about 20 ejaculations.

What happens to the sperm cells after a vasectomy? Instead of being ejaculated, sperm cells are absorbed by the body which is completely harmless.

Is sex different after a vasectomy? Sex drive and orgasms feel the same as they did before the procedure. Semen volume should also be about the same, as sperm makes up a small percentage. Partners don’t feel a difference either.

Some men find sex to be more exciting after a vasectomy because they can be more spontaneous as the anxiety of unwanted pregnancy is reduced.

Does a vasectomy help against STI’s? No. While this procedure is extremely effective in preventing pregnancy, they do not protect against sexually transmitted infections (STIs) like HIV, HPV, and gonorrhoea.

Can a vasectomy be reversed if I want children? Yes. Although this procedure is considered a permanent decision, and men should think carefully before having one. But there are times when a man decides he would like to father children after all. That’s when a vasectomy reversal may be considered.

For more information, contact us to book in for a consultation.

We all know that stress can have negative effects on your health but did you know that stress might have an effect on your fertility as well. Several studies have suggested a link between stress and male infertility.

Research has shown that stress may lead to a decline in testosterone, a hormone needed for sperm production. It also suggests that men under stress may have poorer semen quality. That means that sperm cells aren’t well-formed and could have trouble swimming and fertilising an egg cell.

While stress is difficult enough, the situation can become worse if you and your partner have been trying to conceive for a while.

Fertility treatment is complex. You and your partner are likely having emotional ups and downs, sometimes in a short period of time.

It’s easy for us other to say to try and “relax” as that is one of the key ways to increase your chances of conceiving.

Here are some stress management strategies that may work for you:

• Put a positive spin on it. If you can, reframe the way you view a problem. Is there a way to turn a negative into a positive? Can you break down a problem into small steps and handle them one at a time? Remind yourself that you are doing the best you can.
• Try perspective-building activities. Built into disciplines such as meditation, yoga, and tai chi, are exercises that help put the challenges of everyday life into perspective. These activities might help release you from the thought patterns that can lead to unproductive stress. Even just listening to music you enjoy may help transport you to a place where you can view challenges from a fresh perspective.
• Participate in activities you enjoy. When you’re involved in activities that bring you joy, it also helps put stress in perspective. Fun activities has the effect of pushing stress-inducing thoughts to the side. It’s important to find out what brings you peace and happiness and incorporate it in your routine.
• Take care of your relationship. You and your partner are a team. Providing the support to your partner that you would hope to receive from her helps you each shield one another from stress-inducing events.
• Take care of yourself. It’s easy to let self-care slide when you’re feeling stressed. Make sure you’re eating right, getting enough sleep, and exercising. Exercising regularly is a good way to manage anxiety and depression. It’s important to limit your use of alcohol or recreational drugs because they have a harmful impact on your physical and emotional health over time and can themselves become stress agents.
• Ask for help. Understand that you may not be able to do everything yourself and there’s no shame in asking for a hand.
• Reach out to others. Confiding in a trusted friend or relative may bring comfort, and that person might have insight for dealing with a stress-inducing problem that would otherwise been unobtainable. Support groups, where you can share insights with others experiencing similar challenges may also help.
• Seek help from a professional. Therapists can help us see our lives with a new perspective. If you find that your stress levels are escalating or tough to manage, seeing a therapist is a wise choice. An objective third party can make suggestions you might not have thought of.

We can’t guarantee that stress management will improve fertility, but taking good care of yourself during this difficult time will produce benefits for you and your partner. Together, you’ll be able to handle what comes next.

To find out how we can help you, contact us today.

Perhaps you are finished having children. Or you just know you don’t want children in the future and want to make sure no unplanned pregnancies happen. If this is the case, you might be looking for permanent methods of male birth control.

Could a vasectomy be the answer? For many couples the answer is “yes.” The vasectomy became a common male birth control procedure in the 1970’s and has provided men and families a safe, effective, minimally-invasive form of birth control with a fast recovery period. The procedure involves cutting two tubes called the vas deferens – the pathways that sperm travel through. The cut ends are then tied or sealed together with heat, blocking the path of sperm.

Vasectomies are usually considered a permanent method of male birth control. A vasectomy reversal is an option if a man changes his mind. Nowadays viable sperm can also be surgically retrieved for use with IVF (in vitro fertilization) procedures, even years after a vasectomy.

Are there alternatives to a vasectomy for male birth control? Yes there are.

Condoms – Male condoms can be an effective form of birth control as long as you use them the right way. Condoms can reduce the risk of sexually transmitted infections (STIs), too – again, when used correctly. Many men unknowingly use condoms incorrectly, often because they learned how to use a condom informally or casually when they were younger and perhaps sexually inexperienced.

Female contraception – Your female partner has temporary contraceptive options, too. Female condoms, hormonal contraceptives, birth control pills, intrauterine devices (IUDs), and diaphragms are all possibilities for temporary birth control. Her healthcare professional can help her choose which methods are best for her.

Withdrawal method – Some men wonder whether withdrawal (“pulling out” before ejaculation) is a viable contraceptive method. This approach is not considered reliable, as sperm cells can be present in pre-ejaculate (precum) and find their way into the vagina before the man withdraws his penis. The method also requires determination and perfect timing on the part of the man, which can be hard to control in the midst of intercourse. One more point to consider – withdrawal alone provides no protection against STIs.

To find out more, book in for a consultation with one of our vasectomy specialists.

If you and your partner are struggling to have a baby, you are not alone. If you have been actively trying to get pregnant for 12 months or more (and you are under the age of 35), or 6 months (and over the age of 35), there are various testing options – like genetic testing – that may be able to explain why you are having difficulties.

Infertility is most often defined as not being able to get pregnant after one year of frequent unprotected intercourse.

If either you or your partner have a family history of certain genetic conditions or health problems, it may be beneficial to consult with a healthcare specialist early in your reproductive journey. Some factors, either personal or in your family history, that may increase your risk for infertility include:

• A personal or family history of multiple miscarriages
• A history of irregular periods
• A history of absent, low, or irregular sperm
• A personal diagnosis of a genetic condition, such as Turner syndrome, Klinefelter syndrome or cystic fibrosis

Male infertility can be caused by low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Evaluation for males with infertility involve a thorough medical history, physical exam, semen analysis, blood work, and possibly ultrasound exams. These tests include:

Genetic testing: Genetic testing can be done to determine whether you carry a genetic change that could be impacting your fertility. The three main types of genetic testing available for men experiencing infertility are:

Genetic carrier screening (including the gene for cystic fibrosis): This test can identify individuals and couples at risk to have a child with a genetic condition by analysing their DNA to see if they are a carrier for a variety of genetic conditions. Carriers of genetic conditions typically do not have the condition themselves, but could pass it on to their children. Many carrier screening panels include the gene for cystic fibrosis (CF). Men who carry certain genetic changes in the gene for CF may have absent vas deferens, which would not allow for sperm to be transported.

Karyotype: A blood test to analyse the number and structure of one’s chromosomes. A karyotype can detect Klinefelter syndrome and chromosome rearrangements.

Y chromosome micro-deletion studies: A blood test to target if specific regions of the Y chromosome that impact sperm development are missing.

Semen analysis: A test that analyses the quantity and quality of sperm by measuring the amount of semen, the total number and concentration of sperm, and sperm movement and appearance. The semen sample is typically collected in an office setting as the analysis needs to occur within one hour of collection.

Hormone testing: A blood test to measure hormones follicle-stimulating hormone (FSH) and testosterone (T) that control sperm production. Either an excess amount or a decrease in these hormones can cause issues with sperm production.

To find out more about Genetic Screening call us today to book in for a consultation.

Sadly, many families deal with infertility, but thankfully due to recent medical breakthroughs there are ways that allows patients to successfully father children even when the outcome seems unlikely. One of these medical advances is Micro-TESE, a method of extracting sperm in men with non-obstructive azoospermia.

Micro-TESE is a more advanced procedure for men whose primary problem is failure to produce sperm cells.

The Micro-TESE procedure involves removing the testis from the scrotal sac in order to make an incision in the testis so that it can be opened like a book. It is then examined under an operating microscope to find the tubules that appears the fullest and most opaque which are the most likely ones to contain sperm.

The goal of Micro-TESE is to identify pockets of sperm and harvest the sperm within one procedure. The process of finding sperm can be lengthy, but the procedure is very thorough. Sperm obtained from Micro-TESE can be incubated into waiting eggs or frozen for future in vitro fertilization (IVF). During the procedure, your surgeon will search for seminiferous tubules that are most likely to contain sperm. Samples will be extracted and then searched for sperm by the lab technician.

Micro-TESE is an optimal way of obtaining sperm in men with a reproductive tract blockage (i.e, after a vasectomy, or in the congenital absence of the vas deferens). In this procedure your consultant will extract sperm from their storage site in the epididymis with the aid of a surgical microscope.This is a relatively painless and minimally invasive procedure performed under local anaesthetic.

Compared to traditional TESE treatment, Micro-TESE requires the removal of less testicular tissue and provides better overall results.The procedure requires only a small incision in the midline of the scrotum, which is one of the fastest healing areas of the body. For this reason, recovery is often quick. An ice pack and pain medication will likely be all that is needed for comfort in the first 24 hours. Your consultant might recommend that you avoid sex or strenuous exercise for about a week.

PESA is a procedure performed for men who are having sperm retrieved for IVF/ICSI who have obstructive azoospermia from either a prior vasectomy or infection.

Azoospermia is a condition where there are no sperm at all in a man’s ejaculated semen and there can be various reasons for this.

Sperm production and delivery involves a system of tubes within the male reproductive system. Sperm are initially produced in the testis in fine tubes called seminiferous tubules. In each testis these tubules are connected to a larger coiled tube called the epididymis in which sperm are held for a short while after production. The epididymis is in turn connected to the vas deferens which lead to the urethra. Sperm must move through this system in order to be deposited in the semen during ejaculation.

Azoospermia can be caused by an abnormality or blockage in the epididymis or the vas deferens. This is referred to as obstructive azoospermia. In these cases, sperm are being produced in the testes, they just can’t get out.

Sometimes however, sperm production in the seminiferous tubules does not occur at all or is happening at such a low level that sperm are not detectable in the ejaculate. This is referred to as non-obstructive azoospermia.

Using surgical procedures to try and extract sperm from the epididymis (PESA) or to dissect it out of tubules from the testis (TESA) can be an effective way of diagnosing what is causing the azoospermia.

More importantly though, these procedures can also be effective ways of isolating sperm for use in treatment to try to achieve a pregnancy. Even in non-obstructive azoospermia, as long as some sperm production is occurring, PESA/ TESA can still be an effective way of retrieving sperm for use in treatment.

PESA involves passing a fine needle through the skin into the epididymis to obtain sperm. TESA involves passing a fine needle through the skin directly into the testes and retrieving a small number of the seminiferous tubules themselves. The tubules are then dissected in the laboratory and the contents searched for the presence of sperm.

Both of these surgical procedures can be performed under either local anaesthetic or sedation. Your doctor will talk to you about which approach is suitable for you.

If you would like to speak to our team about PESA, please call us on 0161 327 1269 or email us at info@urologyclinics.co.uk.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition. 

TESE is a surgical sperm retrieval procedure used in fertility treatment for men who have no sperm in their ejaculate. TESE is used for men with both obstructive and non-obstructive azoospermia. These men have no sperm in their ejaculate because either there is a blockage in the route between the site of sperm production (the testes) and ejaculation or because there is a partial or complete failure in sperm production in the testes.

Why do some men have no sperm in their semen?

Often it’s due to genetics, but it can also occur as a result of a sexually transmitted infection or certain medical treatments. In some cases, no cause can be found in the same way that some female fertility problems have no known cause.

Sperm are retrieved from the testes and can be used to achieve fertilisation of eggs in the laboratory. However, because the numbers of sperm that retrieved is often very low, it is necessary to combine TESE with ICSI.

Your consultant may advise that TESE is carried out in advance of any fertility treatment to confirm that sperm production is occurring. If suitable numbers of sperm are identified on this occasion, it is sometimes possible to freeze the testicular extract and to thaw and use this sample for subsequent treatment.

More commonly however, once it has been confirmed that sperm production is occurring, the TESE procedure is repeated on the day of the egg retrieval and the fresh sample used for ICSI. Again, providing that there are suitable numbers of sperm present, the sample can sometimes be frozen for use in future treatment cycles.

TESE is a minor theatre procedure carried out on an outpatient basis under local anaesthetic.

If you would like to speak to our team about TESE, please call us on 0161 327 1269 or email us at info@urologyclinics.co.uk.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.