Taking a Systemic Approach to Male Infertility Yields Great Rewards

Systemic diseases are often at the root of men’s fertility problems, and the ability to help them improve their overall health while also helping them achieve their reproductive goals is what Sarah Vij, MD, says she likes most about her job as the new Director of the Men’s Infertility Service.

“I get to see a lot of younger men, many of whom do not have a primary care physician, and I am able to use that as an opportunity to get them tied in to better overall healthcare,” she says. “Fertility specialists take care of the whole patient in a way that you don’t often see in other subspecialties and it is very gratifying to be able to help them improve their health at a younger age than they might otherwise present for care,” she says.

With the promotion of former men’s infertility Director Edmund Sabanegh, MD, to President of Cleveland Clinic’s main campus, Dr. Vij, has taken over his clinical duties. She officially started Aug. 1, following a Male Infertility and Andrology Fellowship with Dr. Sabanegh.

Full-spectrum services

What sets the department apart, she says, is that it offers the full spectrum of diagnostic and therapeutic services in one location, maximizing patient convenience. Cleveland Clinic also has a strong reproductive endocrinology group for the female half of an infertile couple, offering assistive reproductive techniques including intrauterine insemination and in vitro fertilization. The groups coordinate their efforts to achieve the best outcome for each couple.

Also, Cleveland Clinic’s Andrology Lab, run by Ashok Agarwal, PhD, is known for its extensive research and offers cutting-edge treatments, including specialized semen testing with DNA fragmentation, reactive oxygen species and oxidative reductive potential. Cryopreservation banking services are available for men who need to store semen for reasons such as undergoing chemotherapy or pursuing gender reassignment.

Active research pursuits

In addition to her clinical role, Dr. Vij is involved in men’s infertility research. One area her team is examining is the link between obstructive sleep apnea and male infertility. Does the apnea lead to a hypoxic state in the testicles, reducing sperm production? And can bariatric surgery and weight loss improve sperm counts?

“These are early studies but they are tied to a same idea, which is taking an overall view of health as a way to improve male fertility,” she says.

Our commitment to taking a systemic approach to managing urological symptoms led to a men’s health phenotype, ACTIONS, in conjunction with Daniel Shoskes, MD, Director of the Men’s Health Center, last year. It classifies men according to presence and severity of seven conditions: Anxiety/alarm falsification, Cardiovascular disease, low Testosterone, Insulin deficiency resistance, Obesity, Neurologic disease and Sleep apnea.

“It is a way of quantifying the burden of systemic disease that can impact urologic conditions,” Dr. Shoskes explains. “The ACTIONS phenotype is a useful tool in educating patients and informing treatment decisions in a way that can significantly improve overall quality of life for patients,” he says.