Yale Urology Pivots to Optimize Male Reproductive Evaluation and Treatment During COVID-19
Professor of Clinical Urology
Yale Urology
330 Orchard Street, Suite 164
New Haven, CT 06511
203-785-2815
Stanton.Honig@yale.edu
The COVID-19 pandemic has changed the world significantly. Patients are now being seen via telehealth on a regular basis. This is a great advantage for the male infertility patient as we can begin the initial evaluation and speak to patients, take a detailed history from the patient and his partner, and start to determine if there are treatable and reversible causes of their male infertility via a video consultation.
On an initial telehealth visit, we review personal history and the semen analysis data, including all parameters that are important to fertility such as semen volume, sperm concentration, sperm motility, and sperm morphology (evaluation of the anatomy of the sperm: head, midpiece and tail). All of these parameters are important. In addition, on the initial telehealth visit, we will order appropriate blood tests to check for a hormone imbalance or an underlying genetic problem.
The physical exam continues to be a very important part of the male infertility evaluation. There may be an underlying medical problem that may be the cause of male infertility. This could include a varicocele or large veins that surround the testis. In certain patients, the testes may be heated up by these veins and this may be cause of the lower sperm quality. There may be evidence of a treatable blockage of the epididymis, or patient may be missing their vas deferens (the tubes that carry the sperm), which can be identified on physical examination. In rare cases, patients may present with an underlying testis tumor; 99% of these are treatable when identified early.
We continue to see new patients for male factor infertility as telehealth visits as well as in-person visits. For patients that have not had semen testing or are not comfortable coming to the office, there are new sperm home tests and “mail-in” tests that can be done from the privacy of your own home. These are generally used more as “screening tests” than detailed tests as they do not give all the information that a standard semen analysis can provide.
As the COVID-19 pandemic heightens again, we are not allowing visitors to accompany our patients in the clinic. We recognize that infertility is a concern of couples and we will ALWAYS include the partner in a phone or virtual interaction at the time of the in-office visit with our male patient.
We receive many questions about COVID-19 and its presence in semen. A frequent question is whether it can be transmitted via semen - in other words, can COVID-19 be transmitted sexually? At the present time, this is unclear, but most studies point to the fact that the COVID-19 virus has not been identified in semen. One initial study did show a small number of patients with the COVID-19 virus identified in semen, but it is still unclear at the present time. Also, can COVID-19 affect sperm quality? We do not know for sure. So far, there is mixed data regarding the effects on the quality of sperm in patients who have active COVID-19 or are recovering from COVID-19. It is unclear if this is specific to COVID-19, or the same as one would see with any virus or extreme illness such as the flu.
At Yale Urology, we strive to provide the best comprehensive care for male factor infertility in the infertile couple. There are many treatable reversible causes of male factor infertility that could be identified on a full history, physical exam, and evaluation of semen. We have pivoted in this challenging time to provide the best possible care for our patients.