Bahrom Rustamovich Rustamov is an andrologist and urologist with 19 years of professional experience. His main areas of practice include male reproductive health, infertility, erectile dysfunction, varicocele, azoospermia, and the diagnosis and treatment of other complex andrological conditions. Microsurgery holds a special place in Dr. Bahrom Rustamovich’s clinical practice. He is a specialist who introduced microsurgical techniques such as Micro-TESE and vasoepididymostomy for the treatment of severe male infertility and azoospermia in Uzbekistan. His areas of practice also include microsurgical varicocele repair, surgical treatment of Peyronie’s disease, and penile implantation for erectile dysfunction.
Infertility Is Not Only a Woman’s Problem
Infertility is one of the major challenges in reproductive health today. According to the World Health Organization, approximately 1 in 6 people of reproductive age experience infertility during their lifetime. A scientific analysis published in 2025 on male infertility in Central Asia reported that the average proportion of infertile couples in Uzbekistan and Kazakhstan is around 15–17%, with a male factor identified in approximately 40–50% of cases. In the study itself, an isolated male factor was identified in 52.9% of 957 patients who sought medical care for infertility. Male infertility may be associated with a low sperm count or complete absence of sperm, abnormalities in sperm motility and morphology, obstruction of the reproductive tract, hormonal disorders, varicocele, and other factors. Nevertheless, when pregnancy does not occur for an extended period, the woman is often the first partner to undergo evaluation. In reality, reproductive health is the health of the couple. That is why we spoke with andrologist Bahrom Rustamovich about the causes of male infertility, its diagnosis and treatment, and modern microsurgical options.
What diseases and conditions most commonly cause male infertility?
One of the most common causes is varicocele, which is the enlargement of the veins around the testicle. This condition can increase local temperature and impair blood circulation, potentially having a negative effect on spermatogenesis. Another important group of causes includes hormonal disorders, complications of sexually transmitted infections, obstruction of the reproductive tract, as well as cryptorchidism and genetic conditions such as Klinefelter syndrome. In addition, smoking, alcohol consumption, obesity, and prolonged exposure to high temperatures can also negatively affect sperm quality. In many cases, the underlying cause can be identified and appropriate treatment can be provided.
Can a man have a reproductive problem even if he feels completely healthy?
Yes, this is quite common. Erectile function, sexual desire, and a general feeling of good health are not directly correlated with spermogram parameters. For example, varicocele or mild hormonal abnormalities may remain asymptomatic for years while still affecting sperm quality. Therefore, if a couple has regular sexual intercourse but pregnancy does not occur within one year, a man is advised to undergo evaluation, including a spermogram, regardless of how healthy he feels.
What does a male fertility evaluation begin with?
The evaluation begins with a detailed medical history and physical examination. The doctor asks about lifestyle, previous illnesses, surgical procedures, and medications. This is followed by an objective examination of the genital organs.The main test is a spermogram, which assesses sperm count, motility, and morphology. Hormonal tests and ultrasound examinations may also be ordered when necessary.
If the spermogram result is abnormal, does that mean the man is infertile?
No. One abnormal spermogram result does not by itself mean that a man is infertile. Sperm quality can be temporarily affected by illness, stress, heat exposure, or prolonged sexual abstinence. Therefore, if the result is questionable or abnormal, a repeat spermogram may be recommended after 2–3 weeks. A diagnosis is made based on multiple test results together with the overall clinical picture.
Can male infertility always be treated with medication?
No, not always. The treatment approach depends on the underlying cause. If the problem is caused by a hormonal disorder, medication may produce good results. However, varicocele or obstruction of the reproductive tract may require microsurgical treatment. In some severe cases, assisted reproductive technologies such as IVF/ICSI may be used. Therefore, treatment is always selected on an individual basis.
In which cases are microsurgical procedures used?
The choice of microsurgical technique depends on the specific condition. For example, in cases of significant varicocele, microsurgical varicocele repair may be performed. If the reproductive tract is obstructed, vasoepididymostomy — a procedure designed to restore the continuity of the reproductive tract — may be performed. When sperm production within the testicle is impaired, Micro-TESE can be used to locate and retrieve sperm.
What is Micro-TESE, and who is it recommended for?
Micro-TESE is a surgical technique used to retrieve sperm from testicular tissue with the assistance of an operating microscope. It is primarily used in cases of non-obstructive azoospermia, a condition in which sperm production within the testicles is significantly impaired. The use of an operating microscope allows the surgeon to identify areas of tissue where sperm production is more likely to be preserved, potentially increasing the chance of sperm retrieval. Retrieved sperm can subsequently be used for IVF/ICSI.
Does azoospermia mean that having a biological child is impossible?
No, it does not necessarily mean that. If azoospermia is caused by obstruction of the reproductive tract, the obstruction can often be surgically corrected. In cases of non-obstructive azoospermia, Micro-TESE may provide an opportunity to retrieve sperm directly from the testicular tissue. Retrieved sperm can then be used for IVF/ICSI. Therefore, with an accurate diagnosis and an appropriate treatment strategy, many men may still have the opportunity to become biological fathers.
Does varicocele affect male fertility?
Yes. Varicocele is one of the most common and potentially correctable causes of male infertility. Enlarged testicular veins can increase local temperature and negatively affect sperm production. Varicocele often causes no noticeable symptoms and may therefore be detected during a physical examination or ultrasound examination. Depending on its severity and the individual clinical situation, varicocele can be successfully treated surgically, and sperm parameters may improve significantly following treatment.
What is special about microsurgical treatment of varicocele?
The main advantage of the microsurgical technique is that an operating microscope allows the surgeon to precisely identify the enlarged veins and ligate them while preserving the surrounding arteries and the vas deferens. This can significantly reduce the risk of recurrence and complications compared with open or laparoscopic procedures. The recovery period is relatively short, and many patients can return to their usual activities within one or two days.
Does an andrologist only treat infertility?
No. An andrologist deals with a broad range of conditions related to male reproductive and sexual health.In addition to infertility, this includes erectile dysfunction, testosterone deficiency, premature ejaculation, penile curvature and injuries, Peyronie’s disease, and other conditions. An andrologist may also treat certain functional problems involving the testicles and prostate.In other words, andrology covers a broad spectrum of male health concerns.
Is surgery also used to treat erectile dysfunction?
Yes, but only in selected cases — primarily when medication and lifestyle changes have not produced satisfactory results. In some patients, shockwave therapy or injectable medications administered directly into the penis may also be considered. For severe organic erectile dysfunction, penile implant surgery is an effective treatment option.In general, surgery is considered a later-stage treatment option. Less invasive approaches are usually tried first.
What is your main principle when treating patients?
I consider an individualized approach to every patient and treatment directed at the specific underlying cause to be the fundamental principles of care. Treatment should be based on evidence-based medicine and, whenever possible, should begin with the least invasive options.It is also important to communicate with patients openly and respectfully, without embarrassment or stigma. This is not something to be ashamed of — it is a medical issue that requires professional care.The goal is not simply to relieve the symptoms, but to address the underlying cause of the problem whenever possible.
What advice would you give men who are experiencing difficulties when trying to conceive?
First of all, I recommend not delaying a consultation with a specialist. Early identification of the problem can make treatment easier. A spermogram is a simple and accessible first step, and there is no reason to feel embarrassed about undergoing the test. Lifestyle changes can also be beneficial, including quitting smoking, limiting alcohol consumption, and avoiding excessive exposure to high temperatures.Most importantly, both partners should undergo evaluation together. A comprehensive assessment of both partners can help identify the cause of the problem more quickly and determine the appropriate next steps.
Book an Andrology Consultation
If you are experiencing difficulties when trying to conceive or have questions related to male reproductive or sexual health, you can schedule a consultation with AKFA Medline andrologist Bahrom Rustamovich Rustamov.
The specialist will assess your condition, recommend the necessary diagnostic tests, and develop an individualized treatment plan based on the results.
