Spermogram
It is the initial test to evaluate semen volume, concentration, motility and other characteristics of sperm. Your results will vary; a change may need confirmation and should be interpreted along with the history and physical examination.
Male reproductive health
Infertility Male
Male infertility deserves its own investigation
When pregnancy does not occur, the man needs to be fully evaluated. An altered spermogram may be the first sign of a hormonal, anatomical, genetic condition or a broader health problem. Even an apparently normal result does not in itself end the investigation.
My job is to understand the couple's history, identify factors that may affect male fertility and discuss what can be treated. The assessment of the man takes place in parallel to the assessment of the woman, because fertility concerns both.
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Restorative reproductive medicine
Investigate the causes to take care of reproductive function.
Restorative reproductive medicine seeks to recognize and treat conditions that impair reproductive function. Instead of just starting from the final result of a test, it asks why that change occurred and whether it is possible to improve the patient's health and fertility. This may involve changing habits, treating illnesses, medication or surgery, depending on the diagnosis.
In my work, this look is especially focused on men. I work together with gynecologists who work with NaProTECHNOLOGY® and with professionals linked to FertilityCare Brasil, so that male and female aspects are investigated in a coordinated way. The Creighton Model FertilityCare™ System tracks biomarkers of the female cycle; NaProTECHNOLOGY® uses this information in gynecological evaluation and treatment. My responsibility in this team is the investigation and andrological treatment of men.
I also carry out research in restorative reproductive medicine, with a particular interest in male fertility and ways to improve its investigation and treatment.
Office · Itaim
02 / 03The office
An environment reserved for consultation.
Consultations take place at Itaim, in São Paulo, in a space reserved for calm conversations, examinations and discussions at each stage of the investigation and treatment.
Office 153
Rua Bandeira Paulista, 726, cj. 153Itaim · CEP 04532-002
Individualized assessment
What is the first consultation like?
I start by listening to the couple's reproductive history: how long they have been trying to get pregnant, whether there have been pregnancies, pregnancy losses, previous treatments and what tests have already been carried out. We talked about frequency of intercourse, sexual and ejaculatory function, in addition to the partner's gynecological evaluation.
The investigation includes the man's general health. I ask about illnesses, surgeries, undescended testicles in childhood, infections, recent fevers, medications, use of testosterone or anabolic steroids, tobacco, alcohol, sleep, weight, and exposures at work or in the environment. This information helps to interpret exams and find problems that deserve attention, even outside of urology. When necessary, I refer the patient to another specialist.
Physical examination is part of the diagnosis
I evaluate sexual development, the penis, the volume and consistency of the testicles, the epididymis and the vas deferens. I also examine the presence or absence of palpable varicocele, dilation of the spermatic cord veins which, in some men, is related to altered sperm production.
The physical examination helps to distinguish situations that are very different from each other, such as production difficulties, suspected obstruction or hormonal changes. Therefore, I do not replace this step with a list of exams.
Targeted investigation
What tests may be needed?
Blood tests
Depending on the findings, I investigate the hormonal axis with tests such as FSH, LH, testosterone and prolactin, as well as other tests related to metabolic and general health. Infectious screening is requested according to history, symptoms and clinical context; it is not an identical panel for everyone.
Testicular ultrasound with Doppler and other images
These are useful resources in selected situations, such as a physical examination that is difficult to interpret, suspected testicular abnormalities or investigation of a possible obstruction. Doppler does not replace the clinical evaluation of varicocele, and imaging tests are not mandatory at every first consultation.
Fragmentation of sperm DNA
It can add information in specific circumstances, such as recurrent pregnancy losses or some infertility situations that have not yet been clarified. It is not a routine exam for all men.
Genetic testing
In cases of azoospermia or very reduced sperm production, I can recommend karyotyping and research for microdeletions of the Y chromosome. In situations that suggest the absence of the vas deferens or certain obstructions, other tests, such as analysis of the CFTR gene, may be necessary. The indication depends on the set of findings and includes advice on the meaning of the results.
Possible factors
What can cause male infertility?
Varicocele
It may be associated with changes in sperm production, but its presence does not mean that everyone needs surgery.
Hormonal changes
Sperm production depends on coordinated functioning between the brain and testicles. Some axis changes can be treated with medications chosen for the identified cause.
Obstructions
Sperm can be produced, but not reach the ejaculate. Previous vasectomy is an example; There are also other causes that require specific investigation.
Use of testosterone and anabolic steroids
These substances can suppress hormonal signals that stimulate the testicles and greatly reduce sperm production, sometimes even causing azoospermia.
Other factors
Genetic conditions, infections, systemic diseases, previous treatments and changes in sexual function can also participate in the condition. In some patients, even after careful evaluation, a single cause cannot be identified.
Treatment
The cause guides the conduct.
If I find a treatable hormonal change, I consider the appropriate treatment to stimulate or restore reproductive axis function. This is especially relevant for men who want to have children and have hormonal suppression after using testosterone or anabolic steroids. In these cases, I evaluate the interruption of exposure, hormonal and seminal exams and the possibility of drug treatment and follow-up. Recovery may take time and is not guaranteed. Testosterone alone, including in implants, can harm sperm production and is not a treatment for those seeking fertility.
When there is a clinical varicocele associated with infertility and seminal changes, microsurgical correction can be discussed depending on the couple's context. In cases of obstruction, microsurgical reversal of a vasectomy or other reconstruction of the ducts may allow sperm to return to the ejaculate. No surgery is indicated just because a test was altered: I consider diagnosis, potential benefit, duration of infertility and the partner's reproductive status.
In other situations, treatment may involve associated diseases, habits, medications or monitoring over time. The plan is explained with its limits and revised according to the clinical and laboratory response.
Principles of care
Why don't I perform assisted reproduction?
My practice is dedicated to the investigation and treatment of men, with a preference for paths that seek to restore their health and reproductive function. This choice is also linked to my personalistic understanding of medicine and my ethical principles about human reproduction. I do not perform artificial insemination, in vitro fertilization or ICSI.
This does not mean promising that all couples will achieve a spontaneous pregnancy, nor does it mean omitting the existence of other possibilities. I explain the diagnosis, prognosis and limits of treatment clearly, respecting the couple's decisions.
Care for the man and the couple
Investigating fertility is also taking care of men's health.
Infertility may be a sign of a condition that deserves attention in its own right. Investigating men means taking care of their current and future health, in addition to understanding their reproductive possibilities. If you are trying to get pregnant or have received an altered spermogram, the evaluation can help define the next step.