Archive for the ‘infertility’ Category

The Semen Analysis: There’s Even an App for That!

March 23, 2017

The first examination for male infertility is a history followed by a physical exam.  Next comes the semen analysis, where a single drop of seminal fluid is examined under the microscope.  The semen is examined for the number of sperm, the motility of the sperm, and the shape of the sperm.  This test is performed after 48 hours of abstinence and the cost is $75-$150 depending on the sophistication of the lab performing the test.

Soon it is possible to have an accurate sperm count in the privacy of your home and will be as easy as a home pregnancy test.

Researchers have developed a device costing less than $5 to make that attaches to your cellphone and provides a quick and easy semen analysis. The results in early testing are just as accurate as the elaborate computer-assisted semen analysis machines costing tens of thousands of dollars in measuring sperm concentration, sperm motility, total sperm count and total motile cells.

The device uses an optical attachment for magnification and a disposable microchip for handling the semen sample. With two lenses that require no manual focusing and an inexpensive battery, it slides onto the smartphone’s camera. Total cost for manufacturing the equipment: $4.45, including $3.59 for the optical attachment and 86 cents for the microfluidic chip that contains the semen sample.

The software is designed with a simple interface that guides the user through the test with onscreen prompts. After the sample is inserted, the app can photograph it, even create a video of the sperm motility and report the results in less than five seconds. The test results are stored on the phone so that semen quality can be monitored over time.  The results can be shared with the medical professional who is evaluating the man\couple for infertility.

Another application of the app is for men who have had a vasectomy and need to be certain that there is absolutely no sperm in the ejaculate following the procedure.  With this app, a man can perform his own semen analysis at home and email the result to the urologist to confirm permanent sterility

The Food and Drug Administration hopefully will approve the device within the next two years.

Bottom Line: Technology is making medical care easier and can be accomplished without being face to face with the doctor or even having to go to the doctor’s office.  This is the way modern medicine is going to be practiced.  Welcome to the new age of medical care.

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Smoking Is Also Hazardous to Your Urologic Health.

November 26, 2016

It is given that smoking is deleterious to your lungs and heart causing lung cancer, chronic obstructive pulmonary disease and heart disease, just to name a few of the common medical conditions causes by smoking.  There are also urologic conditions that are affected by smoking.

Bladder cancer is 4th most common cancer in men with nearly 80,000 new cases each year in the united States.  Smoking causes harmful chemicals and drugs to collect in the urine.  These toxic chemical affect the lining of the bladder and increase your risk of bladder cancer.

Nearly 30 million American men have erectile dysfunction or impotence  This is usually due to a reduction of poor blood flow to the penis.  Smoking can harm blood vessels, when decrease the blood flow to the penis.  As a result, men will have difficulty obtaining and keeping an erection adequate for sexual intimacy.

Kidney cancer is in the top ten most common cancers in both men and women with nearly 60,000 new cases every year.  Smoking puts noxious chemicals from the lungs into the blood stream where it is filtered into the kidneys and can cause kidney cancer.

Kidney stones affect 1 million Americans and smoking is a known cause of having kidney stones and also for having recurrent kidney stones.

Painful bladder syndrome affects 12% of women.  The condition is irritated by smoking and produces more symptoms of pain and discomfort in the pelvis.

Overactive bladder (OAB) affects more than 30 million American men and women.  Smoking irritates the bladder and increase the frequency of urination.  Smoking also is associated with coughing that can increase urinary leakage.

Infertility caused by male factors affects 50% of all problems related to difficulty with achieving a pregnancy.  Smoking can harm the genetic make-up in eggs and sperm.  The infertility rate for smokers in nearly twice that for those men who do not smoke cigarettes.

Bottom Line:  Most people are looking for reasons to stop smoking.  There are so many medical conditions that are caused by or are made worse by smoking.  Talk to your doctor about some of the effective ways to achieve smoking cessation.

Turing On Your Laptop May Turn Off Your Sperm Count

September 28, 2016

Go onto any college campus or into any Starbucks and you see nearly every person pecking away on their computers.  Some men will balance their laptop computers on their laps.  As a result the heat from the laptop raise a man’s scrotal temperature a very small amount.  This small elevation of temperature, if done often enough, may decrease a man’s sperm count.

Elevated scrotal temperatures have been linked to poor sperm counts according to a study at New York University.  Other situations that can raise scrotal temperatures including hot baths, saunas, and the wearing of tight jockey shorts.

The study which was reported in the Journal of Human Reproduction measured the scrotal temperature every three minutes between men holding computers on their laps which were turned on and men holding computers which were left in the off position. Those men holding a working lap top computer had a 5 degrees Fahrenheit increase in scrotal temperature.  Also noted was that men with their thighs held close together had the greatest increase in scrotal temperature. The researchers concluded that “Working on laptop computers in a laptop position causes significant scrotal temperature elevation as a result of heat exposure and posture-related effects.”

The main question is the increase in temperature enough to impair male fertility? The researchers didn’t conclude the connection between laptop use and sperm counts. However, the authors noted that another study showed that sperm concentration dropped by 40% when median daytime scrotal temperature rose by 1 to 2 degrees Fahrenheit.

Bottom Line:  I know for sure that more heat to the scrotal area is going to be deleterious for sperm production.  Therefore, I suggest that young men or men in the fertility age group may want to limit their use of laptop computers on their laps.

Sperm Counts Really Do Count-Improving Sperm Quality

March 24, 2015

Infertility affects 24% of couples wishing to have a baby. Nearly 1\3 are due to female causes, 1\3 to male causes, and 1\3 are due to both the man and the female partner. Therefore, men are involved in 2\3 of the problems that are responsible for failure to achieve a pregnancy. The first test for any man is the semen analysis. This test is obtained after two days of abstinence or no ejaculation and submitted for a sperm count, sperm movement or motility, and the shape of the sperm.

The world’s largest study on the effects of lifestyle on the quality of sperm has been published this week, with some surprising findings.
Researchers at the universities of Manchester and Sheffield found that smoking cannabis can have a severe effect on male fertility, yet other lifestyle choices such as drinking alcohol and wearing tight briefs were not considered to cause problems, despite earlier reports suggesting otherwise.

Sperm quality has been in decline for decades, and scientists seem unable to make up their minds as to the exact causes, citing everything from smoking to an increased exposure to estrogen.
The latest evidence is good news for jockstrap-wearers and bad news for dope smokers, but how else can you improve your sperm count? Here are five recommendations from leading experts:

1. Eat red food
Last month a report published by Ohio’s Cleveland Clinic, following analysis of 12 studies conducted by different groups around the world, found that consumption of lycopene improved the quality, mobility and volume of sperm dramatically, increasing sperm count by up to 70 per cent. Lycopene is an essential nutrient found commonly in red fruit and vegetables such as tomatoes, strawberries, cherries and peppers.

2. Lay off the laptop
A 2011 study published in the journal Fertility and Sterility suggested there could be a link between using a laptop with a Wi-Fi connection and a reduction in sperm quality. Sperm samples from 29 men were stored normally and under a laptop connected to WiFi. The sperm stored under the laptop became more sluggish and showed signs of DNA damage.

3. Get off your bike
Cycling has myriad health benefits, but not when it comes to your sperm. A 2009 Spanish study found that a prolonged spell on your bike can severely affect the shape and quality of your sperm. After monitoring 15 Spanish triathletes with an average age of 33 the study found that those men that cycled 300 kilometers a week (about 160 miles) – had dered a fertility problem.

4. Keep your cool
The optimum temperature for sperm production is 34.5 degrees celsius, which is slightly below body temperature. A three-year University of California study in 2007 found that five out of 11 men who stopped taking hot baths (including saunas) experienced a sperm count rise of almost 500 per cent.

5. Drink coffee – Go For Joe-but not too much
In 2003, researchers from Sao Paolo University in Brazil studied 750 men and concluded that drinking coffee can improve the swimming speed, or motility, of human sperm, although whether this means pregnancy rates are higher among coffee drinkers is unclear.

Bottom Line: Men are part and parcel of the baby making equation. If you have any questions, see your urologist and start with a sperm count.

Low T-Is Clomid a Solution For Men Who Wish To Have Children?

February 19, 2015

I am now seeing many younger men with low testosterone levels who have symptoms of lethargy, decreased libido, and problems with their erections. Upon further testing, many of these men are found to have low testosterone levels or low T. This blog will discuss the use of Clomid for the management of younger men with low T levels.

Whether you are a 30, 50, 80 or even 110 year old man, having low testosterone levels (hypogonadism) is neither fun nor healthy. The symptoms of low testosterone in men range from lack of energy, depressed mood, loss of vitality, muscle loss, muscles aches, low libido, erectile dysfunction, and weight gain.
Low testosterone in men may be caused by problems in the testes (or gonads). This is called primary hypogonadism and can be brought on by the mumps, testicular trauma, or testicular cancer, etc., and is often treated with testosterone replacement therapy.

Traditionally, if low testosterone is diagnosed, testosterone replacement therapy is prescribed, and it most commonly comes in the form of a cream, gel, pellet, patch, and by injection. And although these types of therapy are effective, some methods are better than others, and there are side-effects with all of them. For example, testicular shrinkage, gynecomastia (breast enlargement), low sperm count/sterility, and polycythemia (overproduction of red blood cells) are common side-effects of testosterone replacement therapy.
However, specifically due to the risk of sterility and low sperm count, such testosterone treatments aren’t a good option for men who want to have children. In these young men, clomiphene citrate (or Clomid) and/or human chorionic gonadotropin (HCG) have been used for decades to increase testosterone production, increase sperm production, and increase fertility. Both these therapies effectively help stimulate the testes to produce testosterone and thereby increase testosterone levels.

Clomid works by stimulating the pituitary gland to make more LH and there is an increased production of testosterone by the testes. HCG works by mimicking LH, which also increases the release of LH to produce more testosterone in the testes. I caution you that using testosterone in a young man wishing to have more children does the opposite of what clomiphene and HCG do and can shut off the release of LH and thus affect the testicles production of testosterone and affect sperm production.

With traditional testosterone replacement therapy, the brain (hypothalamus and pituitary) gets the message that there is plenty of testosterone being made in the testes, so much so that it doesn’t need to make anymore. Subsequently, the pituitary stops producing LH, and the natural production of testosterone (and sperm) in the testes ceases, which is why traditional testosterone replacement results in testicular shrinkage and low sperm count. Clomiphene citrate and/or HCG do not turn off the testosterone manufacturing plant but rather turn it back on or reboot it. While some hypogonadal men require continuous use of clomiphene, for others it can be used for a 3-6 month time period and then discontinued. And, the checks and balances system is not interrupted, so there aren’t the testosterone replacement side-effects which may occur with tstosterone injections, gels, or pellets.
The 5 Main Reasons Clomiphene Citrate (Clomid) May be a Good Alternative to Testosterone Replacement Therapy in Men with Low Testosterone Due to Secondary Hypogonadism:
1. Clomiphene citrate stimulates the body’s own production of testosterone
2. Clomiphene citrate doesn’t interfere with the body’s checks and balances of testosterone
3. Clomiphene citrate comes as a pill easily administered by mouth
4. Clomiphene citrate is generic and very cheap
5. Clomiphene citrate has little side-effects and low risk of developing these side-effects

Bottom Line: Clomid is a treatment option in young men with low T who wish to continue to have children.

Low T (Testosterone) May Mean No Baby

February 19, 2015

I am often seeing men with symptoms of low testosterone levels who are still planning to have children. These men need to know that the standard treatment of hormone replacement may not apply to those men who are still interested in having children. This blog will discuss the management of men with low T and who wish to continue to have children.

Testosterone replacement therapy (TRT) can bring your testosterone levels back to normal and restore your sex drive.
But if you want to have children, there’s one downside to TRT you should know about. It gives you back your sex life, but it might also reduce your ability to father children as long as you’re on it.
Testosterone replacement therapy has a profound impact on a man’s reproductive potential.

Approximately 90% of men can drop their sperm counts to zero while on testosterone. By increasing testosterone, you’re not going to increase fertility.

Testosterone, the hormone produced in the testicles, plays an important role in making sperm. Your brain makes special hormones, called gonadotropin-releasing hormones (GnRH). These hormones signal the testes to make more testosterone, vital for a healthy sperm count. When you’re getting testosterone replacement therapy, testosterone is added into the bloodstream by patches, gels, or other treatment methods such as pellets placed under the skin. Your brain interprets this rise in testosterone levels as a sign that you now have enough testosterone. So it stops sending signals to the testes to make more testosterone. But when your testes don’t make more testosterone, your sperm production goes down.
Therefore, a low sperm count makes it harder to conceive a child. My advice is that if you have any kind of reproductive goal, you should not be using TRT.

If you have low testosterone, one way to improve sperm count is with gonadotropin injections. This stimulates the production of sperm. It may be considered as a way to increase a man’s fertility when your partner are having trouble conceiving a child.
It’s standard practice to check a man’s sperm count when a couple has difficulty getting pregnant. If your sperm count is low, the next step is to measure your testosterone. If it’s below normal, we can then inject the signal to produce more testosterone by giving a gonadotropin.

You should also make sure to follow a lifestyle of regular exercise and a healthy diet if you want to father a child. Overweight and obese men tend to have lower testosterone levels because excess belly fat converts testosterone to estrogen, another hormone that can impact sperm production. Shedding those extra pounds will likely have a positive effect on your fertility. Losing weight can definitely increase testosterone.

Bottom Line: If you have symptoms of low testosterone levels or if you have an abnormal sperm count, hormone replacement with testosterone is not the treatment of choice. You should consider gonadotropin injections as a solution.

Male Infertility-Some Low Cost Practical Solutions

December 27, 2014

Infertility is a common problem affecting many American couples. One-third are due to the woman who may have a gynecologic problem, one-third due to male factor, and one-third due to a combination of both the man and the woman. This blog will discuss the treatment and solutions for male factor infertility.

Keeping Mobile Phone in Pocket
A finding by some researchers at the University of Exeter in England showed that keeping mobile phone in the front pocket which is near the scrotum could affect sperm quality. They found out that exposure to cell phone radiation lowers sperm motility or movement by 8% and viability of the sperm by 9%. This finding is still a controversial one but it would be safer to keep away mobile phones from the pocket as much as possible. Therefore, my recommendation is to keep your mobile phone out of your trouser pocket. I also suggest that you do not text holding your phone at waist level.

Heavy Drinking
It is said that alcohol affects the body’s ability to absorb zinc which is a nutrient vital for healthy sperm. It’s still unclear what quantity of alcohol is bad but it’s advisable to stay away from it as much as possible, especially heavy drinking.

Oxidative Stress
Another thing that can cause male infertility is oxidative stress. This is linked to lifestyle factors such as obesity, diet, pollutants, smoking and alcohol. Taking antioxidant supplements such as vitamin E, vitamin C, folic acid etc. is said to increase fertility.

Poor Diet
A healthy diet will help maintain a healthy sperm count and an poor diet otherwise. It is advisable that men eat foods that will guarantee the general health of the body such as fresh fruits and vegetables, whole grains, and a minimum of red meat.

Excessive Exercise
Exercise is good for the body but its excess especially when it is combined with body building steroids can decrease the production of testosterone and thereby lower sperm count.

Frequent Sex
Too much sex can decrease the quality of sperm cells. It is advised that couples wishing to conceive should limit intercourse to every two or three days.

Exposure To Heat
Heat from laptops, wearing tight underpants and other things that could increase the temperature around the testicles could cause low sperm count. As much as possible, it is advised that the general crotch area should be kept cool and men use boxer underwear.

Untreated Infection
When STIs are not treated on time, it could result in infertility. Chlamydia infection, gonorrhea, mumps etc can affect fertility and even cause sterility.

Exposure to Pesticides and other Chemicals
It has been found that exposure to harmful chemicals can affect sperm quality and quantity. Agricultural workers and fumigators in Nigeria need to be mindful of this. Some other chemicals like paints, adhesives and coatings have also been found to double the risk of fertility problems. Men working with chemicals are therefore advised to wear the appropriate protective gear and reduce their exposure to the chemicals as much as possible.

Doping
Sniffing drugs like cocaine and cannabis can impair fertility in males. It is said that cannabis seems to have a dramatic effect on sperm quality. Some prescribed drugs can also affect fertility; it is advised that a man seeking to conceive should consult the doctor before taking any drug.

Bottom Line: Other things that could cause male infertility include stress, aging, radiation (x-rays, radiotherapy etc.), and obesity. With this understanding, it would be wise for men especially those seeking offspring to take note of the things that could be responsible for infertility so that they can play their part in making sure they also reproduce in life.

Common Causes of Infertility in Men

August 28, 2013

Sperm making contact with egg

Sperm making contact with egg


About 10 percent of reproductive-age couples in the United States will have difficulty getting pregnant. About 30 percent of cases are due to fertility problems in the man, 30 percent to fertility problems in the woman, and the rest to unexplained causes or multiple factors involving both partners.

If you’ve had regular, unprotected sex for more than a year (or six months if you’re over 35) without conceiving, see your doctor. The National Infertility Association says at least half of those who have an infertility evaluation and treatment will be able to have a successful pregnancy.

A reproductive urologist can identify male fertility issues, recommend treatment options, and help couples decide which options to pursue. You also may want to see a genetic counselor. Sometimes, there’s a genetic reason for male infertility that could be passed down to children. A genetic counselor can help couples understand their options for conceiving.

Read on to learn about the common causes of infertility and available treatments. Keep in mind that success rates may vary because one couple can have multiple fertility problems.

Lifestyle factors. Making healthy choices can improve your fertility. You may be at greater risk of having trouble conceiving if you:

• Smoke;
• Drink alcohol heavily; Use drugs;
• Take anabolic steroids;
• Take certain medications, including testosterone replacement therapy;
• Have been treated for cancer;
• Have poor nutrition;
• Are significantly over- or underweight;
• Are exposed to toxins, such as pesticides or lead.

If you have any of these risk factors, be sure to tell us about it during your consultation.

Blockages. A small percentage of men have a blockage in their ejaculatory duct that prevents sperm from getting into ejaculate fluid. If your vas deferens or epididymis tubes are blocked or damaged, they can prevent your sperm from getting to your partner’s egg. Infection, injury, congenital defects, or a vasectomy could cause this blockage.
• Possible solutions: Surgery to repair an obstruction or reverse the vasectomy, or surgery to remove sperm for in vitro fertilization (IVF).
• Varicocele. Varicoceles (enlarged veins, similar to varicose veins, in the scrotum) raise the temperature in the testes, which may affect sperm production.
Possible symptoms: Some men have scrotal pain, and others have no symptoms. (The problem can be detected through a physical exam or ultrasound.)
Possible solutions: Surgery to repair the varicocele, artificial insemination, or IVF.

Irregular sperm. If you have little to no sperm, poor sperm motility (ability to move), or abnormally shaped sperm, your sperm may not be able to fertilize your partner’s eggs.
Possible solutions: fertility drugs; artificial insemination with donor sperm (or with your own if your count, shape, and motility are not too abnormal), or intracytoplasmic sperm injection (ICSI).

Fertility-Steps To Improve Your Chances

August 21, 2013

Common Causes of Infertility in Men

Hoping for a child

Hoping for a child


About 10 percent of reproductive-age couples in the United States will have difficulty getting pregnant. About 30 percent of cases are due to fertility problems in the man, 30 percent to fertility problems in the woman, and the rest to unexplained causes or multiple factors involving both partners.

If you’ve had regular, unprotected sex for more than a year (or six months if you’re over 35) without conceiving, see your doctor. The National Infertility Association says at least half of those who have an infertility evaluation and treatment will be able to have a successful pregnancy.

A reproductive urologist can identify male fertility issues, recommend treatment options, and help couples decide which options to pursue. You also may want to see a genetic counselor. Sometimes, there’s a genetic reason for male infertility that could be passed down to children. A genetic counselor can help couples understand their options for conceiving.

Read on to learn about the common causes of infertility and available treatments. Keep in mind that success rates may vary because one couple can have multiple fertility problems.

Lifestyle factors. Making healthy choices can improve your fertility. You may be at greater risk of having trouble conceiving if you:

Smoking can be deleterious to your fertility

Smoking can be deleterious to your fertility

• Smoke;
• Drink alcohol heavily; Use drugs;
• Take anabolic steroids;
• Take certain medications, including testosterone replacement therapy;
• Have been treated for cancer;
• Have poor nutrition;
• Are significantly over- or underweight;
• Are exposed to toxins, such as pesticides or lead.

If you have any of these risk factors, be sure to tell us about it during your consultation.

Blockages. A small percentage of men have a blockage in their ejaculatory duct that prevents sperm from getting into ejaculate fluid. If your vas deferens or epididymis tubes are blocked or damaged, they can prevent your sperm from getting to your partner’s egg. Infection, injury, congenital defects, or a vasectomy could cause this blockage.
• Possible solutions: Surgery to repair an obstruction or reverse the vasectomy, or surgery to remove sperm for in vitro fertilization (IVF).

Varicocele. Varicoceles (enlarged veins, similar to varicose veins, in the scrotum) raise the temperature in the testes, which may affect sperm production.
Possible symptoms: Some men have scrotal pain, and others have no symptoms. (The problem can be detected through a physical exam or ultrasound.)
Possible solutions: Surgery to repair the varicocele, artificial insemination, or IVF.

Sperm making contact with egg

Sperm making contact with egg


Irregular sperm. If you have little to no sperm, poor sperm motility (ability to move), or abnormally shaped sperm, your sperm may not be able to fertilize your partner’s eggs.
Possible solutions: fertility drugs; artificial insemination with donor sperm (or with your own if your count, shape, and motility are not too abnormal), or intracytoplasmic sperm injection (ICSI).

Where Have All the Young Sperm Gone? Decreasing Fertility of the Millennial Man

July 17, 2013

Normal appearing male sperm

Normal appearing male sperm


Where Have All the Young Sperm Gone? Decreasing Fertility of the Millennial Man
A recent article in the Wall Street Journal (Tuesday July 16, 2013) points out that there by a “sperm crisis” because they believe men’s sperm counts have been decreasing for a decade or more.

A 15 year study in France reported that the sperm concentration of men decreased by nearly one-third between 1989 and 2005. In the U.S., some historical data suggest a decrease in sperm count among American men, but no published recent data exist.
Suspected causes include exposure to pesticides, endocrine-disrupting chemicals like Bisphenol A and lifestyle habits like sitting for too long contribute to the proposed sperm crisis. Also, I reported how men who use lap top computers on top of their genitals for long periods of time, increase the heat to the testicles and the cells that are responsible for sperm production.

In general, men produce upward of 60 million sperm per milliliter of semen. As long as the count is roughly greater than 40 million per ml, men are considered fertile and have the same chance of getting their partners pregnant as someone who produces a higher count. But below that threshold and particularly under about 20 million per ml, their ability to conceive decreases.

Accumulating evidence suggests that early life influences make a difference. Some researchers say that there is a vulnerable period, perhaps between eight and 14 weeks of gestation, in which influences are irreversible. One of the most robust links with decreased sperm count is maternal smoking during pregnancy.

The male’s own current marijuana use was also linked to lower sperm count.

In additional to maternal smoking, there are environmental and lifestyle factors that can affect sperm count which include: shampoos containing phthalates found in plastic bottles, sedentary jobs especially for over hours at a time, hot water such as frequent hot baths which increase scrotal temperature, fatty food appear to contribute to a low count but this impact is potentially reversible.

Bottom Line: By adopting a healthy, balanced diet and lifestyle in pregnancy, you can give your developing baby the very best start in life which will minimize the risk of future decreases in sperm counts.