Secondary Infertility – One Hour Outpatient


NEW YORK, N.Y. (Ivanhoe Newswire) — It’s often called secondary infertility.  A couple has their first child- and then when they decide they want to have another baby, nothing happens.  If there is a medical reason for the delay, the culprit may be a fairly common condition in men.

Little Delilah Mundo is a curious, giggly, bundle of joy for dad, Daniel, mom, Jennifer and big brother, Zachary. But becoming a family of four wasn’t easy. After months of trying, Jennifer started seeing doctors.

Daniel Mundo told Ivanhoe, “There was nothing being red-flagged whenever she would just go for a doctor’s visit. She was fine; she was perfectly healthy.”

So, when Mundo made an unrelated appointment with urologist David Shin, MD, Chief at the Center for Sexual Health and Fertility, Department of Urology, Hackensack University Medical Center, for discomfort, fertility was still on his mind. Dr. Shin diagnosed Mundo with a varicocele. It’s a varicose vein that contributes to 40 percent of all male infertility.

“And what it does is create a heat effect as if the testicles are in a sauna, all day, every day. Now, being in a sauna 10-15 minutes, no big deal. 24 hours a day, seven days a week. Not so good,” Shin explained.

To correct it, Dr. Shin uses a minimally invasive microsurgical technique called varicocelectomy.

“And we use an operating microscope to look at about 25 times magnification, the veins, so that when we look at it, we tie off the veins that are problematic,” Dr. Shin continued.

Mundo went home the same day.  Dr. Shin says on average, most couples conceive about nine months after surgery.  For the Mundos, it was much faster.

“I would have to say it happened very late that same month or early the next month,” Mundo said.

Little Delilah was born ten months after Mundo’s procedure.

“This is the best thing I’ve ever done. I wouldn’t have it any other way,” he said.

Dr. Shin says when couples are having fertility issues, it is important for the man to make sure he sees a doctor. Up to 50 percent of the time, infertility issues stem from a complication on the man’s side. In addition to varicocele, infection, genetic defects or other medications could be contributing factors.

Contributors to this news report include: Cyndy McGrath, Producer; Kirk Manson, Videographer; Ken Ashe, Editor.

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REPORT:    MB #4707

BACKGROUND: Secondary infertility is what occurs when couples are having difficulty having a child after they have already conceived the first time. According to David Shin, MD, Hackensack University Medical Center, about 11% of the reproductive population suffers from secondary infertility. In about 40% of couples who have fertility issues, having a varicocele is the most common issue for males. There are other potential causes to secondary infertility. These include: impaired sperm production, function or delivery in men or endometriosis, fallopian tube damage, or ovulation disorders in women. Both the male or female need medical evaluations and a doctor will then determine if they should seek treatment at a fertility clinic.


DIAGNOSING: A varicocele involves dilated veins in a man’s scrotum. This creates a heat effect as if a men’s testicles are in a sauna and exposed to heat all day every day. This affects sperm production for the testes. This can cause men to have a low sperm count that will only decline as they get older. When men come in to be treated for secondary infertility, they must first receive a physical examination. The doctor will then confirm if they have a varicocele, this can be done by a scrotal ultrasound to confirm the presence of the veins. The next step would be a microsurgical varicocelectomy. It is important to note it may not just be a varicocele causing secondary infertility issues. It is also important that men be evaluated because this could also be caused by an infection of the testes or the medications they’re taking. Studies have shown that infertility may be the beginning stages of cancer in men whether it’s prostate, lymphoma or thyroid cancer.

(Source: David Shin, MD, Chief, Center for Sexual Health and Fertility, Hackensack University Medical Center)

MICROSURGICAL VARICOCELECTOMY: Varicoceles occur in about 15% of adult men and 20% of teen males. Once it has been determined that a male has a varicocele, they will undergo a microsurgical varicocelectomy. The specialist will make small incisions in the man’s lower abdomen, they will then insert a laparoscope into one of the incisions allowing them to see inside the abdomen. Using surgical tools, any enlarged veins that are blocking blood flow will be cut and sealed. This procedure improves the amount of sperm, the percentage of moving sperm and the percentage of shape sperm. In successful cases, pregnancy usually occurs nine months following the surgery.



David Shin, MD


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Doctor Q and A

Read the entire Doctor Q&A for David Shin, MD, Chief for the Center for Sexual Health and Fertility

Read the entire Q&A