Why O “Y” Has My Sperm Gone: Male Infertility

Did you know that a man’s sperm production is tied to his ability to have male offspring? When sperm counts decrease, so do the Y chromosomes and it is the Y chromosome that is responsible for siring a son.

In the past it was always thought that having an X chromosome on the sperm made girls and Y made boys and it was just a mere 50-50 coin flip. Now a recent study from Stanford University has demonstrated that men having a low sperm count, or less than five million sperm per cubic centimeter, had fewer Y chromosome and thus less likely to have male offspring.

The next study is going to look at whether treatments that are used to increase sperm counts may affect the ratio of X to Y chromosomes.

Will keep you posted on this piece of important information!

Take Two And Call Me In The Morning-Sex Not Aspirin

In the past, this blog focuses on wellness, exercise, and mental health.  In this issue I will devote to the benefits of having intimacy with your partner.  Who would ever imagine that an activity that is so much fun could be so beneficial to your health.

Sexual intimacy is a form of exercise.  Each time that you engage in the sex act you burn approximately 100 calories.  Of course, if you have sex like Lady Chatterly’s Lover, then it’s a lot more.  Now 100 calories a pop doesn’t sound like much, but if you engage in sex 2-3 times a week, that’s 5000-7500 calories a year.  That’s equivalent to the energy required to jog from New Orleans to Mobile, Alabama.

In addition to the aerobic work out of huffing and puffing and increasing your heart rate, sexual activity provides resistance training.  This is the contraction of the muscles of the back, pelvis, and extremities against passive resistance.

Another advantage of regular sex is that it can actually lower your total cholesterol level, and increase the high-density lipoproteins (HDL) or the good cholesterol.  So if you indulge yourself in an extra steak with butter, indulge yourself in extra sex and you’ll be calorically even.

Sex also jump-starts your hormones.  Men can have a surge of testosterone during sex.  Testosterone is the hormone produced in the testicles that is responsible for libido or sex drive, muscle mass, and strength of bones.  Regular sex increases the level of estrogen in women which results in increase in the blood supply to the vagina keeping the vaginal tissues young, supple and moist.  There is even evidence that sex prior to or at the time of the menstrual period may relieve the symptoms of premenstrual syndrome (PMS).  There are other studies that suggests that oxytocin, a hormone secreted by the pituitary gland during sexual intimacy, contributes to long-term bonding between partners.

Sexual intimacy also results in the release of endorphins which is the ultimate painkiller or analgesic.  Endorphins are many times more potent that morphine, the most powerful man-made analgesic in use for the relief of pain.  So the next time you have a headache, don’t turn down sex but turn on and your relief is just a few minutes in the sack away.  There’s even a scientific explanation for the relief of headache pain with sex.  During sex there is an increase in the blood supply to the muscles and the genital organs.  As a result there is a decrease in the blood supply to the brain thus taking the pressure off of the tension in the brain.

For men, sexual intimacy is protective for the prostate.  Prostate infections and prostate enlargement, which begins after the age of 50 in most men, result in compression of the urethra, the tube in the penis that allows transmission of urine from the bladder to the outside of the body.  As a result men complain of difficulty with urination.   For dozens of years,  older men have gone to the doctor to have their prostate gland massaged to express the retained secretions that produce many of the symptoms of prostate disease.  For most men this is uncomfortable and expensive if you don’t have Medicare or insurance to pay for the doctor’s visit.  One inexpensive and fun way to relieve these symptoms produced by an enlarged prostate gland is to engage in sexual intimacy either through intercourse or even masturbation.   Both will produce prostate pleasing results.  So if you want to be good to your prostate gland, be good to your significant other….in bed.

Sex is good for stress.  Never let the sun set on an argument.  Having sex is an effective method of reducing the tensions that exist between partners.  You can’t be arguing when you are having good sex.

So for those of you who are not interested in going to the YMCA or a health club, you can have the benefits of a health club not in your own back yard but in your bedroom.   There are naysayers that say this is fooey. Take Two and Call Me In the Morning-Not Aspirin, But Sex. For those of you who need more motivation, give me a call and I’ll write you a prescription!

Low Sperm Count? The Culprit Might Be Your Laptop Computer

Whoever invented the ‘laptop’ probably didn’t worry too much about male reproductive health.  Turns out, unsurprisingly, that sitting with a computer on your lap will crank up the temperature of your genitals, which could affect sperm quality.

It is well known that the scrotum and its contents are about one degree cooler than the core body temperature of 98.⁰F.  If the testicles are exposed to increased heat such as frequent hot tubs and certain occupations such as bakers and welders, it may decrease the sperm count and result in infertility. Under normal circumstances, the testicles’ position outside of the body makes sure they stay a few degrees cooler than the inside of the body, which is necessary for sperm production.

The researchers at State University of New York at Stony Brook hooked thermometers to the scrotums of 29 young men who were balancing a laptop on their knees. They found that even with a lap pad under the computer, the men’s scrotums overheated quickly. To hold a laptop on your knees, however, you need to sit still with your legs closed. After one hour in this position, the researchers found that men’s testicle temperature had risen by up to 2.5⁰.

Nearly one in six couples in the US have trouble conceiving a baby, and about half the time the man is at the root of the problem.  This number may be much higher for men using laptop computers for long periods of time.

Bottom Line: Your laptop may be hazardous to your sperm production.  The extra heat generated to the testicles is enough to impact sperm counts. The solution may be as simple as putting your laptop on a desk or spreading your legs to allow the added heat to escape.

 

Male Infertility-It’s Not Always the Woman’s Fault

Nothing is more devastating to a couple than the inability to conceive and have a child.  Infertility is currently a problem for one out of five couples presently trying to have children.  In one-third of the couples the problem is due to a problem in the man; one-third is due to a female cause; and one third is due to both the man and the woman.  Therefore in nearly 2\3 of the couples, there is a male factor associated with the failure to conceive or for the woman to become pregnant.

Any couple embarking on an infertility work-up does so with some fear and reluctance.  It often helps to know what is ahead, to be informed and aware of how it will feel and what the doctor is hoping to find.

The nature of the infertility work-up necessitates that it become a priority in your daily life.  Suddenly, there are specific days that you must have intercourse.  In certain tests you even have to report to the doctor’s office a specific number of hours after intercourse.  As a result, spontaneous lovemaking becomes difficult.  Vacations and business trips become low priority.  Schedules have to be made to fit the demands of the testing cycle. Many women find it hard to take time off from work, especially if they don’t want it known that they are undergoing an infertility evaluation.  It is a stressful time.  Both husband and wife are being tested and scored.  There is a feeling of “pass or fail” and a real sense of despair if a test comes back showing questionable or negative results.  Women often feel frightened and violated by the infertility tests.  Men often feel helpless.  For the husband, testing is over if the semen analysis is normal.  In contrast, he may see his wife having to go through various tests which can be painful and frightening.  This understandably can upset both members of the couple.  Added to this worry and uncertainty is the lingering fear of what the doctor will find.  What if they indeed find an answer, but a discouraging one?  Suffice it to say that deciding to start an infertility workup is a big decision. (This paragraph could be deleted if you are pressed for space)

The following is an overview of the tests involved.  You may want to use it to understand what may be required medically or as a tool to double-check that you have had all the tests.

Initial Appointment

Some infertility specialists like to see the couple together for the first appointment.  This provides a opportunity for the couple to establish good communication with the doctor.  It also is an opportunity to evaluate what, if anything, has been done and what will be needed in the future.  The doctor will be able to explain tests to the couple and will give them a time frame in which he or she hopes to complete the evaluation.(Could be deleted)

The doctor will take a very careful medical history from the male. The doctor will want to know about the medical history of the immediate family.  Attention will be paid to details concerning previous surgery, infections, chronic illnesses, and hospitalizations.  Background information on smoking, alcohol intakes and medications and exposure to environmental or occupational toxins will be requested.  Of course, a reproductive history from both partners will be needed.  Details about the types of birth control practiced will be obtained.  In addition, any history of previous pregnancies should be discussed. Information about frequency and nature sexual intercourse and previous venereal disease is crucial in the evaluation.

Physical Examination

A physical examination of the male is usually done on the first visit.  The physical exam will include an examination of the genital organs, with the doctor noting size, position and condition of the penis and testes.  A rectal exam is done to determine the size and consistency of the prostate gland and seminal vesicles.  The doctor will also note the development of secondary sex characteristics such as hair and fat distribution.

The Medical Evaluation of the Male

Semen Analysis – This is the first and most informative test done on the male.  An analysis can be done any time because a man is not cyclic as women are.  Abstinence from intercourse for 48 hours before the analysis is suggested.  Abstinence for a longer period than two days is not necessary.  For the semen analysis, the doctor will ask the man to masturbate a specimen into a sterile container.  This can be done at home and kept at body temperature and delivered to the lab for evaluation.   Then the laboratory will examine the specimen under a  microscope looking for the number of sperm present, how fast the sperm are swimming (motility) and the shape of  the sperm (morphology).

A fertile semen specimen should have at least 20 million sperm, with at least 50% of the sperm motile and 50-60% with good morphology.  Normal volume is 2-5 cc.

Several additional tests may be done on the male if the semen analysis is not normal.

Evaluation for a varicocele is done by palpating the scrotum while the man is bearing down or coughing.  The link between the presence of a varicocele and infertility is not clearly understood.  The most common theory is that the presence of a varicocele causes poor circulation which ultimately inhibits normal sperm production.

In the event of a subfertile semen analysis, a small biopsy of both testicles may be done.  This procedure is done in a hospital under local or general anesthesia.  The testicular tissue is examined in the laboratory.  This test can tell the doctor if there is an absolute infertile state with no sperm-producing tissue present, or blockage in the vas deferens indicated by the presence of normal testicular tissue yet little or no sperm in the ejaculate.

Finally, if a blockage in the vas deferens is suspected during a testicular biopsy, a vasography can be done to pinpoint the area of  the blockage.  This is an x-ray study in which dye is injected into the vas deferens and a series of x-rays are taken.

Once an infertility work-up is underway it is  important that the couple get the results of each test as they are done.  Couples should ask  their doctors for explanations if need be.  It is your body and you have a right to know what is being discovered.  Sometimes it is wise to make a consultation appointment with your doctor if you feel confused or upset about the tests end results.  This is especially important if the work-up has been going on for a long time or if there is a male factor  problem as well as a female one, which is being treated by another doctor.  It is easy to feel helpless and powerless during an infertility work-up.  Good communication with your doctor can help alleviate some of these feelings.

If men have a normal semen analysis, then the focus shifts to the female partner.  For men who have decreased sperm counts or abnormal motility, there are medications that can be given to enhance the number of sperm and methods to put the sperm in contact with the egg.

Bottom Line: Infertility is problem that impacts the lives of many young couples hoping to conceive a child.  The man is cause of the problem in 50% of infertile couples.  Help is available and much can be done to help a couple make their dreams come true.

Male Infertility-Tips To Putting a Little Vim and Vigor Into Your Sperm Count

Patients with infertility can have some control of their reproductive function by living healthy lifestyles. Often some negative lifestyles may be contributing to their infertility. Therefore, if patients live healthy lifestyles, it is possible that there will be some improvement in their reproductive function. There may not be conclusive evidence for all these lifestyle recommendations, but rarely will following these guidelines hurt, and often they may help:

1. Avoid excessive heat (avoid waterbeds, saunas, hot tubs, etc.).
2. Limit coffee to 1 or 2 cups per day.
3. Do not smoke.
4. Do not use marijuana, cocaine, or other recreational drugs. Marijuana stays in the testes for over 2 weeks; so even using it once every two weeks will have a negative effect.
5. Exercise regularly and moderately.
6. Drink no more than 2 ounces of alcohol twice per week. Alcohol is a male reproductive tract toxin, which associates with a decrease in the percentages of normal sperm. Female should abstain from alcohol if pregnant.
7. Have good nutritional habits, especially a diet rich in fresh fruits and leafy vegetables (organically grown foods).
8. Be aware of sexual problems and do not hesitate to ask for medical help.
9. Infertile men should educate themselves about health and reproduction.
10. Seek emotional and/or psychological support; consider meditation to reduce stress.

Key Vitamins and Nutritional Supplements: Taking certain vitamins (C, E, B12, etc.) may help improve your fertility. The mechanism of action is believed to be as follows: The breakdown of oxygen as it passes through the cells in our body results in substances known as free radicals. Infertile men have a higher concentration of free radicals in their semen as compared to fertile men. Free radicals attack and destroy the membrane that surrounds sperm. Anti-oxidants fight against these bad effects. Therefore, Vitamins are natural anti-oxidants!

I suggest you also take:

Vitamin C (500 mg/day). It helps to protect sperm against free radical damage. It also guards sperm from oxidative damage. Many studies show that supplement Vitamin C also improves the quality of sperm in smokers and reduces sperm agglutination (a condition when sperm stick together, then fertility is reduced.).

Vitamin E (400 IUS/day). Vitamin E has an important function as an antioxidant. Therefore, Vitamin E supplements can decrease and mop up enough free radicals to prevent the damage to sperm cells.

Selenium (200 mcgs/day). A double-blind study shown that selenium supplement can significantly increase sperm motility.

Multivitamins containing zinc (20 mg). Zinc plays an important role for the male reproductive system. A lack of zinc can effect the normal sperm production. For men with low testosterone, zinc supplements may raise testosterone levels and increase sperm production.

Bottom Line:  All of these recommendations may not have scientific merit but they certainly won’t hurt you or cause any deterioration of your sperm count.

Varicocele-A Cause of Male Infertility

Varicocele is a mass of enlarged and dilated veins that develops in the spermatic cord within the scrotal sac. A varicocele can develop in one testicle or both, but in about 85% of cases it develops in the left testicle.

Incidence and Prevalence

Approximately 40% of infertile men have a varicocele and among men with secondary infertility -those who have fathered a child but are no longer able to do so-prevalence may be as high as 80%.

Signs and Symptoms

Most men who have a varicocele have no symptoms. Asymptomatic (i.e., symptom-free) cases are often diagnosed during a routine physical examination. Signs and symptoms include the following:

• Ache in the testicle
• Feeling of heaviness in the testicle(s)
• Infertility-can suppress sperm counts and sperm movement
• Shrinkage (atrophy) of the testicle(s)
• Visible veins under the scrotal skin-the veins collapse when the man lies down
• Recurrent or constant discomfort or pain in the genital region should be reported to a urologist to determine the cause.

Treatment

If the patient with varicocele is asymptomatic and infertility is not an issue, no treatment is warranted. If the discomfort is mild, the condition usually can be managed by wearing an athletic supporter or snug-fitting underwear during strenuous activity or exercise.

Surgery

If the varicocele causes pain or atrophy (rare) or if the condition is causing infertility (most common), surgery may be recommended. Most varicoceles can be corrected through a surgical procedure called varicocelectomy (i.e., surgically “tying off” the affected spermatic veins).

Surgical ligation

This treatment usually requires general or regional anesthesia. In this procedure, a 2- to 3-inch incision is made in the groin or lower abdomen, the affected veins are located visually, and the surgeon cuts the veins and ties them off above the varicocele to reroute the blood through unaffected veins. Surgery can be performed on an in- or outpatient basis. The patient typically can resume light activity within a week and strenuous activity in about 6 weeks.

About 50% of men who undergo varicocelectomy to correct infertility father children within the first year. It takes about 90 days for a sufficient quantity of new sperm to be produced to permit fertilization. Semen analysis usually is done at 3- and 6-month intervals after the operation.

Bottom Line: Varicoceles are very common and can be a cause of male infertility.  Help is available and most men can have improvement in their sperm counts after surgical correction

Tick Tock or When Your Biologic Clock Slows Down

When the phrase “biologic clock” is mentioned, most think this is in reference to women who experience a loss of hormone production at the time of menopause.  But men also have a clock that starts to slow down around age 35.  It is at this time that men experience decreasing hormone production, decrease in fertility potential, as well as an increase risk of genetic problems in children born to men who are older.

The theory that men go through a change in life, similar to what women experience, could be taking hold. We know for certain that the cause of the slowing of the biologic clock in women is due to a decrease in the production of estrogen.  If less estrogen in women leads to the end of menstruation, moodiness, hot flashes, loss of sexual interest and osteoporosis, couldn’t male versions of these symptoms be caused by less testosterone?

How common is male hormone deficiency?  Currently in the U.S., at least 6 to 10 million men suffer from the effects of extremely low testosterone levels in their bloodstream.  Sadly, only 1 out of 6 of these men will ever receive treatment to resolve this problem.

Infertility and aging

It has been noted that more men, and women, are deferring parenting until they are older, finished their education, and are more financially stable.  As a result the number of children born to fathers older than 35 years has increased considerably in the past few decades.  This creates a problem as there is a decrease in fertility in men with increasing age.  Since it takes longer to achieve a pregnancy in older men, they should be counseled and may consider starting their family sooner before their clock completely winds down.

Since there is evidence of the existence of a male “biological clock,” the likelihood of taking more than a year to conceive doubles when the man is over 35. The implication is that a man’s age should be another factor that is taken into account when looking at the chances of conception in couples who are having difficulty conceiving.

In addition, as men age, the genetic quality of their sperm declines significantly. According to the Centers for Disease Control and Prevention, the number of babies born to parents older than age 35 more than doubled from 1970 to 1999, from 6 percent to 13 percent. This trend has led to the rise in the rates of infertility in the past decade, and to increased miscarriage rates and the possibility of a baby born with Down Syndrome (in addition to other genetic abnormalities).

When testosterone levels drop

In women, menopause generally marks the end of youth, hence the idea of a “mid-life crisis.” Some women get hot flashes, are moody, irritable and/or depressed. Male menopause, or andropause, is not as clearly defined for men as it is for women.  There probably is a syndrome of testosterone deficiency in aging men, and that testosterone deficiency is manifested by a diminished sexual drive, difficulty in getting or maintaining an erection, lack of energy, even irritability and grumpiness.  There are even changes in a man’s height, caused by bone loss and osteoporosis.

If a man is experiencing any of the symptoms of testosterone deficiency, they need to see their physician and undergo an evaluation which includes a blood test to measure the testosterone level.  Not all male mid-life crises are a result of testosterone deficiency.  First, the doctor must be sure that the symptoms are not due to depression.  Many of the issues in testosterone levels could be confused with the effects of depression. If you’ve got symptoms that may be suspicious, the first thing is to have a thorough physical and laboratory work and make sure you rule out other medical conditions such as diabetes, which also affect testosterone levels. Treat those conditions first, before you consider looking at testosterone.

There is also a useful questionnaire, ADAM-Androgen Deficiency in the Aging Male, that is helpful for men to identify testosterone deficiency.

The ADAM questionnaire asks you to check for the following symptoms:

1. Decrease in sex drive

1. Lack of energy

1. Decrease in strength and/or endurance

1. Lost height

1. Decreased “enjoyment of life”

1. Sad and/or grumpy feelings

1. Erections less strong

1. Deterioration in sports ability

1. Falling asleep after dinner

1. Decreased work performance

Men experiencing Loss of morning erections depression, tiredness, memory loss, decreased muscle mass and increased weight, more fragile bones, or a diminished sex drive might be candidates for testosterone replacement therapy.  Treatment of testosterone deficiency is easily accomplished with injections of testosterone, patches placed on the skin that transmit the medication from the skin to the blood stream, or topical gels applied to the upper arm or lower abdomen can quickly restore a man’s libido and sex drive.

So if you are over 35 and are feeling less than your best, you should talk with your doctor about your symptoms. A complete medical examination that includes laboratory tests can help show whether testosterone supplements might help you feel better. If treatment is suggested, then I encourage men to try it for a period of a few months while keeping track of the changes. If low testosterone is the cause of their symptoms, men will not have to wait long to see the effects of treatment.   Bottom line…men, you may not be able to turn back the clock of time but you certainly can reset your biologic clock with hormone replacement therapy.

Dr. Neil Baum is a urologist at Touro Infirmary.  For more information, contact Dr. Neil Baum at (504) 891-8454 or go to his Website, http://www.neilbaum.com