Meet the Woman Behind Men’s Fertility at Cleveland Clinic

Each fall during Cleveland Clinic’s annual MENtion It® campaign, Sarah Vij, MD, urges men around the world to be active in their own health. The Director of the Center for Male Fertility at Cleveland Clinic encourages men to make healthy lifestyle choices at every age.

After all, healthy living affects more than fertility.

What drove Dr. Vij to become an advocate for men’s health? Learn more about her and the program she leads in this Q&A.

What sparked your interest in medicine?

I come from a family of physicians, so in some way it’s always been on my radar. Even in high school, I was exposed to patient care, and those interactions taught me that medicine was the career for me. It combines meaningful human interaction and science. That marriage suits my interests and my strengths.

Why urology and male fertility?

I was drawn to urology as a medical student because it encompassed endoscopic, robotic and open surgery as well as microsurgery. I enjoyed all of it.

I also liked how a lot of urology is about quality of life. Urologists do see patients with cancer, but many cases are very treatable and more about survivorship. The same is true of the benign conditions we treat. A man who leaks urine won’t die of it, but may become depressed, feel miserable and be afraid to leave his house because of it. Urologists have a meaningful impact on patients’ quality of life

As for the fertility field, my first exposure was as an intern, during a microsurgery course. We did microsurgical vascular reconstruction on a rat. I thought it was fun and liked the fine detail. Later, as a resident, I spent time in an infertility clinic. For the most part, the patients were young, healthy guys who just wanted to start a family — such an innate biological desire. When you can help patients achieve that, it’s very meaningful.

What are some of the biggest advances to come in treating male infertility?

The patient population that is the biggest challenge for us are the azoospermic patients (men who have no sperm in their ejaculate). Our field is working on some novel ways to try to improve the ability to obtain sperm from their testicles, whether mapping with imaging (to determine the small sites of sperm production) or testing sperm to determine if it has the potential to cause a healthy embryo. Usually the sperm from these men, if we do find it, is impaired. These are the patients that fertility specialists can help the most. There’s hope for them.

Another hot topic in our field is sperm-quality testing — specifically for use with in vitro fertilization and intrauterine insemination. Currently we have very few ways of looking at individual sperm to determine its health. Fertility specialists are working to develop tests that can identify the best sperm to help improve pregnancy rates.

Home sperm-testing kits are becoming more prevalent. What do you see as their role in treating male infertility?

Home testing, even with more advanced smartphone-based methods, is an adjunct to the services offered by fertility specialists. Most of us who do this for a living are excited about the potential.

There aren’t high-quality andrology laboratories everywhere in the world. At-home semen analysis gives preliminary information to men, wherever they are. And it can be useful for men who are self-conscious about giving a semen sample in an office setting, or who won’t do it for cultural or religious reasons.

These home kits don’t replace a thorough evaluation by a physician or semen analysis in an andrology lab, however. I wouldn’t make any treatment decisions for a couple based solely on the results of a home sperm test. Men still require a formal assessment if there’s trouble getting pregnant.

How do you build meaningful relationships with patients?

As an infertility specialist, I am working with patients to achieve the goal of parenthood — a goal that people go through life thinking they can absolutely achieve if they want to. It’s a challenge to realize that this goal may be harder than anticipated.

A large part of my job is instilling hope, coaching them through, and being a partner in the shared goal. Being invited into such a personal moment in my patients’ lives is rewarding, and a bond is formed.