Video consultation
Right for a specific question, reviewing results, or a second opinion. 30 minutes.
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Consultations
Every plan starts with a conversation with Prof Raheem himself.
In-clinic consultation
Best for a full assessment, because it includes an examination and an ultrasound scan of the testes, which is usually charged separately. 45 minutes, at Avenues, London NW1.
Follow-up consultation
Online or in person.
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Tests
Only the tests your situation needs. Each one answers a specific question.
Semen analysis
The starting point. Measures how many sperm there are, how well they move and their shape.
Sperm DNA fragmentation
Checks damage inside the sperm that a normal semen test can't see. Useful after miscarriage, failed IVF or unexplained infertility.
Semen culture
Looks for a hidden infection in the prostate or seminal vesicles that can harm sperm.
Semen microbiome
A newer test that uses DNA sequencing to profile the bacteria in semen. It can pick up imbalances that a standard culture misses, which may affect sperm quality.
Hormone profile
A blood test of the hormones that control sperm production: FSH, LH, testosterone, oestradiol and prolactin.
Genetic tests
For very low or zero counts, to find genetic causes that matter for treatment and could pass to a child.
Scrotal ultrasound
Performed routinely by Prof Raheem in subfertile men to rule out problems in the testes.
Transrectal ultrasound
Used when a blockage near the prostate is suspected, often when the semen volume is low.
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Conditions we treat
Each condition has its own page explaining the causes, tests, treatment and what to expect.
SPERM PROBLEMS
No sperm in the semen (azoospermia)
Sperm can often still be found, by treating a blockage or with microsurgical sperm retrieval.
Low sperm count
Often has a cause that can be treated, so you aren't sent straight to IVF.
Poor motility and morphology
Sperm that don't swim well or have an unusual shape, and what can improve them.
Sperm DNA fragmentation and recurrent miscarriage
Damage a normal semen test can't see, which can often be reduced.
Not conceiving despite a normal semen test
What a standard semen test can miss, and how to find it.
CAUSES WE FIND AND TREAT
Hormone problems
Including hypogonadism (low testosterone), low FSH and LH, and high prolactin (hyperprolactinaemia). These can often be corrected with medication to restart or improve sperm production.
Chronic infections
Long-standing infection or inflammation of the prostate, seminal vesicles or epididymis can harm sperm without obvious symptoms. It is found with semen culture and ultrasound, and treated with targeted antibiotics.
Medicines and lifestyle
Some prescribed medicines, smoking, cannabis, excess weight and heat exposure can all lower sperm quality. Often the simplest things to put right.
General health conditions
Diabetes, thyroid problems, excess weight, and liver or kidney disease can all lower sperm quality. Improving them often helps fertility too.
Sexual and ejaculation problems
Retrograde ejaculation, no ejaculation, erectile difficulties, premature or delayed ejaculation, and pressure related to timed sex are common issues, often linked to diabetes, prostate surgery, or certain medications. These conditions are often treatable with medication or other approaches, including sperm collection from urine when needed, and are worth discussing during your consultation.
Blockages after surgery or infection
For example, the vas damaged during childhood hernia repair, or the epididymis scarred by infection. Often fixable with microsurgical reconstruction.
Vasal aplasia (CBAVD)
Born without the vas deferens, with sperm retrieval and genetic planning for IVF.
Genetic causes
Including Y-chromosome microdeletions (AZF), chromosome translocations, 47,XYY, 46,XX male syndrome, cystic fibrosis gene (CFTR) changes, and inherited hormone conditions such as Kallmann syndrome. Most can't be cured, but finding them guides sperm retrieval and IVF, and allows genetic counselling to plan for your child. Kallmann syndrome itself can be treated with hormone injections.
Past testicular problems
Undescended testes, torsion, injury or mumps affecting the testes. Fertility can often still be improved, or sperm found with microsurgery.
Antisperm antibodies
The immune system can make antibodies against sperm after vasectomy reversal, injury or infection. They are managed with targeted treatment or ICSI.
Testicular cancer and other scan findings.
Testicular microlithiasis, cysts and, rarely, testicular tumours, which are more common in men with fertility problems. A specialist scan protects your general health as well as your fertility and the in-clinic consultation with Prof Raheem includes a scrotal ultrasound.
SPECIAL SITUATIONS
Fertility after 40
The male biological clock is real. Finding out where you stand, and what can be improved.
Fertility preservation before cancer treatment
Sperm freezing or surgical retrieval, arranged quickly.
FAMILY PLANNING AND VASECTOMY
Vasectomy, including Prof Raheem's nerve-sparing modification
Using Prof Raheem's own modification of the standard technique, which leaves the nerves around the tube intact.
CHRONIC SCROTAL PAIN
Chronic scrotal pain
Finding the cause, including microsurgical denervation of the spermatic cord where it will help.
S P E C I A L I S T S E R V I C E S
Two services couples ask about
Fresh sperm retrieval on the day of egg collection
For men with no sperm in the semen, sperm can be retrieved on the same day as your partner's egg collection and used fresh, without being frozen and thawed. This matters most when very few sperm are found.
Testicular sperm for high sperm DNA damage
For men with a good sperm count but high DNA fragmentation, sperm taken directly from the testis usually carries two to three times less DNA damage than ejaculated sperm. It is used fresh for ICSI on the day of egg collection.
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Treatments
From the simplest option upwards. Surgery is only offered when it is the right answer.
Medical treatment
Lifestyle and nutrition advice and antioxidant supplements, tailored to your results rather than a generic list.
Hormone treatment
hCG and FSH injections, and tablets such as clomiphene and enclomiphene to stimulate the testes, or cabergoline for high prolactin.
Treating infection
Targeted antibiotics, chosen from semen culture and microbiome results.
Varicocele repair
A large varicocele works like a blocked drainpipe, reducing blood flow to the testis. It can be repaired microsurgically or by embolisation, both as a day case.
Surgical sperm retrieval
For men with no sperm in the semen. Microdissection testicular sperm extraction (micro-TESE) under general anaesthetic for men with a production problem (non-obstructive azoospermia, NOA), or testicular sperm aspiration (TESA), percutaneous epididymal sperm aspiration (PESA) or microsurgical epididymal sperm aspiration (MESA) for men with a blockage. Onco-TESE for men with cancer. Fresh sperm retrieval on the day of egg collection is also available.
Microsurgical reconstruction
Bypassing a blockage so sperm can reach the semen again: vasectomy reversal, epididymovasostomy, or resection of a blocked ejaculatory duct (TURED).
Help with ejaculation problems
Medicines for retrograde ejaculation, penile vibratory stimulation, electroejaculation, and sperm collection from the urine.
Sperm freezing
Protecting your fertility before any treatment that could affect it, whether surgery, chemotherapy or other medication.
Working with your IVF clinic
Preparing sperm for IUI or ICSI, using testicular sperm when DNA damage is high, fresh sperm retrieval on the day of egg collection, and testicular sperm for men with high DNA damage.
Support with sexual problems
Treatment for erectile or ejaculation difficulties, and help with the pressure of timed sex.
Vasectomy with a nerve-sparing modification
Using Prof Raheem's own modification of the standard technique, which leaves the nerves around the tube intact.
Microsurgical denervation of the spermatic cord
For chronic scrotal pain, dividing the pain-carrying nerves while keeping the artery, vas and lymph vessels.