Hi, I'm Dr. Marc Sklar, The Fertility Expert and Welcome to FertilityTV, your YouTube channel
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Fertility issues are as much of a male issue as they are a female issue, but unfortunately
they're not discussed often enough and they're a big blow to most males' egos.
That's why I wanted to bring to you one of the most trusted male fertility experts I
know right here to you on Fertility TV, where we talk about sperm health and all things
related to men.
Check it out.
Dr. Martin Bastuba is a board certified urologist educated at the country's leading medical
institutions.
He is well known for his expertise and high success rates in vasectomy reversal procedures.
Patients from all around the world travel to San Diego to receive vasectomy reversal
surgery at his clinics.
He uses advanced microsurgical technologies to achieve high success rate in vasectomy
reversal procedures and also has a successful track record with redo vasectomy reversal
surgeries.
In addition, Dr. Bastuba is the medical director at the Fertility Center of California, a Cryobank
offering fertility services including sperm banking, donor sperm, artificial insemination,
sex selection, fertility preservation and andrology laboratory services.
I took the pleasure of writing out a series of questions to give all of you viewers the
benefit of Dr. Bastuba's knowledge and years of experience.
So the first one we're going to start off with a basic one because this is what I know
that many people watching always ask and they're trying to figure out the do's and don'ts when
it comes to fertility overall, but certainly male fertility because it's something that's
not spoken about very much.
When should a couple start to consider it and look down the male side of having a male
fertility workup done and what are the steps to get them going?
Well the short, not completely facetious answer is always, the male is always important.
That's my belief.
I would absolutely agree, yeah.
However, what has been the recommendation is for couples where the female is under age
35 if they have been trying for a year without success that then it's time to be looking
into fertility in general and always there should be a semen analysis at least on it.
That's what we have had as a recommendation.
Okay.
Is that recommendation changing or is there a newer version of that recommendation?
I mean, yeah, the 2.0 version.
I would say that really it's appropriate anytime.
A couple things that is appropriate is a more recent feeling about things.
For instance, couples are now generally waiting longer to get married, and this puts females
at an older age and so it's all about age on the female side.
The male side really doesn't have much impact.
Age is much less of an issue.
But for a couple, if the female is 33, she's finally made partner at the law firm, now
she wants to start her family.
It's very appropriate to be getting a semen analysis and not waiting a year, three months,
whatever, the couple feels.
And I can tell you that in certain situations guys, loving guys, they want to see him in
analysis before they get married.
They want to know where they're at so that they can be very upfront with their spouse
to be and be able to have knowledge on these issues.
To me, that's a caring man.
Oh, absolutely.
I couldn't agree more.
It's something that I find at least at our office that it gets pushed back.
The male workup tends to get pushed or delayed.
So I'd like to- Blasphemy.
... see that happen- Blasphemy.
... a lot sooner.
So on that note, is this something that primary care physician, a GP or OBGYN can take care
of and order for a couple?
Well, absolutely.
A semen analysis can be ordered by anyone.
In fact, we get a number of people who just walk in the door at our andrology lab and
they want semen analysis.
It's not a dangerous study in any way, so we do a semen analysis.
I give the order for that semen analysis.
So certainly a lot of primary care physicians do it.
I think very well-intending acupuncturist would oftentimes request a semen analysis
to see where we're starting from, but it's important to know also that a semen analysis,
while it is a useful study, it's certainly not the only study.
It's not the only part of a workup and that it is just one piece to a puzzle of trying
to figure out where we're at with male fertility.
DNA fragmentation testing is something that's come in and out of popularity right now.
It's much more in popularity because we can treat it much more effectively now through
the use of microfluidic chips and these types of new technologies.
That's great.
I've noticed I've got a lot of patients who come in and they have their semen analysis
done at let's say like a local lab in their area LabCorp or something like that.
Is that an okay place to have a semen analysis done or do you feel like those need to be
done in a different location?
Well, I think that a semen analysis is better than no semen analysis for the most part.
And I say that because some hospitals will actually say there is sperm and when we actually
do a more in depth semen analysis with high-speed centrifugation where we can find just a few
sperm to be present.
In about 5% of those, we'll find sperm where a couple or a man was told that you have no
spot.
And so that is unfortunate.
We always would like to see a semen analysis from a lab like ours, an andrology laboratory,
or an IVF laboratory of fertility laboratory where I know that they are doing, they're
competent people who can take a closer look at things and again spin the sperm down to
see if there's even a few sperm there.
Now with normal sperm counts, it's much less of an issue and so it's hard to fake a good
semen analysis.
By that I mean if somebody is having 90 million sperm as their concentration, then that's
going to be a pretty reasonable semen analysis and they have normal motility.
That's the amount of them that are swimming.
If these parameters are normal, it's probably, it's hard to blow it that bad that somebody
would make that up.
It's kind of at the low margins where it is more important that a semen analysis is done
at a really qualified laboratory.
Yeah.
I see a lot of those that come in from some of those other labs and I would agree that
that's better than nothing or at least a place to start, but ideally it should be done at
an andrology lab like Dr. Bastuba's here in San Diego or at your local fertility IVF clinic
as well.
Yeah.
No matter where you live, even if you're out in the middle of the country, there's usually
a reproductive laboratory somewhere where you could get to and get a more reasonable
result.
And I know I do a lot of telemedicine and we get patients from all over the place, but
they've gotten a real semen analysis.
I can usually tell by looking at it very quickly whether these people know what they're doing
when they're producing this semen analysis.
Great.
Can you treat patients who had a vasectomy and that's a cause for some of their fertility
issues?
Well, a vasectomy is a means of permanent contraception and so actually I've been in
San Diego nearly 30 years and I've done over 3,500 vasectomy reversals.
So one answer for...
And usually this is a man who's had children, thought he was done, had the vasectomy.
Now there's a change either in relationship or just a change of heart for that couple
and so a vasectomy reversal would be one option.
Another option is sperm retrieval.
Leave the vasectomy there.
A couple likes the control.
I can go and retrieve sperm.
Now when we retrieved that sperm, it's not useful for what guys might refer to as turkey
baster technique, also known as IUI or intrauterine insemination.
It's not useful for that, but it is quite for in vitro fertilization, also known as
IVF, or in guy talk test to baby.
For that, a sperm retrieval usually you can do three to six cycles of IVF with a single
spirometry.
That's fantastic.
It's quite useful for that.
And what is the success rate for a reversal?
In my hands, and again this is on thousands of patients, I keep close track of the patients'
successes.
It's anywhere from 94 to 98% that will get sperm back and they ejaculate following a
vasectomy reverse.
It's very important to know the difference between patency, the system is open and we
have sperm back, and pregnancy, the couple is getting pregnant.
And that again would be something where maybe acupuncture is useful, that we're getting
sperm back but the couple aren't getting pregnant yet.
We're trying to do things to augment that fertility.
So there are highly successful procedures at getting sperm back, but sometimes we need
a little bit of extra help to get the rest of the way for pregnancy.
Excellent.
Thank you so much.
Hopefully that was useful for all of you.
We're going.
to be posting a couple of other videos on male fertility.
I've got a whole list of questions that we're going to be answering, so check back to watch
some of those videos as well.
Thanks so much for watching.
Thank you everyone.
As you can see, there are many things to learn about male fertility.
Click right here to learn more about sperm health.
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