Specialist Care for Bladder and Prostate Problems

Male fertility and Andrology

The Urologists at Birmingham Bladder Clinic deal with various aspects of male sexual health including erection problems and impotence (erectile dysfunction), male fertility, premature ejaculation as well as testicular pain and lumps. The Clinic offers microsurgery for varicoceles, vasectomy and reversal of vasectomy as well as adult circumcision.

Mr Almallah is the lead male fertility specialist at University Hospital Birmingham NHS Foundation Trust (Queen Elizabeth Hospital) with specialist experience in azoospermia vasography and microsurgical sperm retrieval. He performs reversal of vasectomy using microsurgical techniques (using high magnifying surgical microscope).

Mr Almallah is a specialist in Andrology. (Andrology is the medical term used to describe issues unique to male health as gynaecologists specialise in areas unique to women’s health).

Mr Almallah accepts referrals from the majority of the West Midlands’ leading Fertility Clinics- including  BMI the Priory Fertility Centre, Birmingham Women’s NHS Hospital Assisted Conception Unit and Midlands Fertility Services (MFS), Aldridge.

With one in seven couples in the UK having difficulties being able to conceive, over a quarter of these cases are due to male factor fertility issues, such as low sperm count or no sperm being produced by the male partner (1), the Birmingham Bladder Clinic has the specialist expertise in male fertility issues to help to give you the answers and treatment plan that is right for you and your partner.

Male fertility and azoospermia

Azoospermia (i.e. – no sperm) is the medical condition which affects about one in a hundred men where there are no measurable levels of sperm in the semen. This condition is associated with very low levels of fertility.

There are different forms of azoospermia resulting in no sperm being present in the ejaculate:
• No sperm is being produced by the testis.
• Occlusion- whilst sperm is being produced, there is a blockage stopping the sperm being released
• Retrograde ejaculation- where sperm passes into the bladder at ejaculation rather than out or a problem with ejaculation.

What are the other causes of male infertility?

Other factors impacting on male fertility can include:
– Hormonal imbalances- very low levels of FSH, LH or testosterone hormones
– Chromosome abnormalities
– A special type of carrier status for Cystic Fibrosis
– Spinal injury preventing ejaculation
– Recreational drugs and non-prescription drugs can cause serious damage to sperm production
– Problems with, or absence of the vas deferens (part of the spermatic cords and connect the epididymis to the ejaculatory ducts which enable the sperm to move.
– Previous vasectomy
– Variococele- this is a medical term describes the enlarged testicular veins. Some men who have variococeles can experience fertility problems.

Treating male infertility to achieve a pregnancy

Most men who are due to undergo semen analysis fear the diagnosis of azoospermia. However, such diagnosis does not mean that the man produces no sperm, or can never be made to produce any sperm therefore will never have his own biological child.
Even then if there are no sperm in the ejaculate, sperm can often be harvested and used to achieve fertilization.

Depending on the cause, treatment is either by treating obstruction, hormone treatment, or by retrieving sperm.
Obtaining sperm directly from the testis (as opposed to from the ejaculate) is used for men without sperms. Microsurgical sperm retrieval is performed via a surgical microscope under local or general anaesthetic.

The sperms collected can then be used during various forms of fertility treatment like ICSI (intracytoplasmic sperm injection). This form treatment is an option for men who have a very low sperm count. During the ICSI procedure a single sperm is injected into the egg to fertilise it and create an embryo.

Other methods of sperm retrieval include:
PESA (percuataeous sperm aspiration)- During the PESA procedure a fine needle is inserted into the epidermis via the scrotum skin where sperms can be retrieved. Sperms that are retrieved from the epididymis via this technique are still immature and the ICSI procedure is needed to fertilise an egg.

TESE (testicular sperm extraction)- This procedure involves removing a small piece of tissue from the testicle and removing sperm cells found in the tissue which can then be used in the ICSI procedure.

The development of both the ICSI (Intracytoplasmic sperm injection) and TESE (testicular sperm extraction) techniques have reduced the reliance on donor sperm to achieve pregnancy.

As a specialist in the area of male fertility, Mr Almallah and his team at the Birmingham Bladder Clinic will be able to guide you through the options that are available to you, with the overall aim of achieving a pregnancy.

Mr Almallah recently completed a clinical audit on a group of infertile men with testicular failure and azoospermia. Mr Almallah successfully retrieved sperms in 77% of the infertile men that had been referred to him from other fertility centres in the West Midlands. For more information about this clinical audit please click here.

Couples seeking advice about the treatment options available for male fertility issues have the opportunity to meet with Mr Almallah at one of the free open evenings held at BMI The Priory Hospital in Edgbaston. To find out more details please click here

Couples will have the opportunity to discuss other aspects of male fertility.

As seen on TV

A Testimonial from one of the patients that Mr Almallah

Channel 4 programme Embarrassing Bodies. Sperm Extraction from Mark as part of his Fertility Treatment by Mr Zaki Almallah Consultant Urologist and Specialist in Male Fertilityhas treated

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