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

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.

Turing On Your Laptop May Turn Off Your Sperm Count

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.

Stress Getting You Down-It May Also Be Affecting A Man’s Fertility

Stress just may have an impact on a man’s sperm quality. Men with higher levels of stress and anxiety have lower sperm counts. Also those with the highest anxiety levels were also more like to have sperm that are less motile or have the ability to swim through the cervical canal to find an egg in the tubes connecting the ovary to the uterus. This report appeared in the February 13, 2013 issue of Fertility and Sterility.

Bottom Line: Want to have a baby and your partner is not getting pregnant? Then consider chilling out and find ways to reduce your stress level. It just may help those sperm reach the egg and get your family started. If you have questions regarding male infertility, see your urologist and get a semen analysis. It’s a test that every couple with an infertility problem should do.

Your Chance of Having a Baby Decreases If You Are a Couch Potato

A study has lined time watching viewing TV to a decrease in sperm quality in young men. This study from the British Journal of Sports Medicine (February 4, 2013) revealed a positive association between physical activity and sperm quality. Study participants reported their TV viewing habits and the estimated number of hours and physical activity engaged in for the previous three months. The report demonstrated that men who engaged in the most moderate to vigorous physical activity and those who watched the least TV had the highest sperm counts.

Bottom Line: Want to improve your chance of having a baby? Get off of the couch and get moving!

Sperm Counts May Decrease With Excessive TV Watching

Watching TV may be relaxing but it may affect your sperm count and your fertility

Men, here’s another reason to work up a sweat: It boosts your sperm count.

Couch potatoes who watch lots of TV have fewer sperm than men who exercise moderately or vigorously each week.

Men who reported exercising more than 15 hours a week had 73 percent higher sperm counts than men who exercised fewer than 5 hours a week. And men who watched more than 20 hours of TV had 44 percent lower sperm counts than men who watched little to no TV.

It is possible that exercise produces more antioxidant enzymes that can prevent a natural process called oxidative stress from damaging cell membranes in the body. This damage can disrupt the creation of new sperm cells. Another possibility is that when men watch TV, their scrotums get squished against their bodies, making that region hotter and possibly preventing new sperm from being made.

Research has shown that sperm production slows if the scrotum temperature rises 1.8 to 3.6ºF (1 to 2ºC) above normal body temperature.

Bottom Line: If you want to improve your sperm count, you should get active and get off of the couch.

Nuts For Your Nuts!-Walnuts and Sperm Quality

Walnutes May Improve Sperm Counts

Eating just 2.5 ounces of walnuts per day can improve your testicles ability to produce quality sperm. Walnuts contain high quantities omega-3 fatty acids which some studies have linked to improved sperm quality.

This study appeared in the journal Biology of Reproduction in August 2012. I might also add that the California Walnut Commission sponsored the study.

Bottom Line: For men with abnormal or low sperm counts and are trying to achieve a pregnancy, consider a handful of walnuts every day. It may not help but it certainly won’t hurt.

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!

Retrograde Ejaculation or Shooting Blanks

Most men experience the joy of ejaculation when the semen, sperm mixed with prostatic fluid, travels outside of the body at the time of orgasm. Retrograde ejaculation occurs when semen goes into the bladder instead of leaving the penis during ejaculation. Retrograde ejaculation isn’t harmful but it can impair fertility since it affects the delivery of sperm to the vagina during intercourse.
During normal ejaculation, internal muscles, called sphincters, close off the opening of the bladder to prevent semen from entering as it passes through the urethra. In retrograde ejaculation, the bladder opening doesn’t close properly and some or all of the semen is allowed to enter the bladder instead of being ejected out the tip of the penis. As a result, semen mixes with urine in the bladder and leaves the body during the next urination.
Retrograde ejaculation does not interfere with a man’s ability to have an erection or an orgasm. Men often first become aware that they have retrograde ejaculation when fertility problems arise. The condition also occurs after prostate surgery where the sphincters can be damaged or injured during the surgery. A common sign indicating retrograde ejaculation is if a man’s urine appears cloudy after sexual climax.
Retrograde ejaculation may occur either partially or completely. Men with incomplete retrograde ejaculation may notice a decrease in semen that comes out during ejaculation. Complete retrograde ejaculation can also be called dry orgasm or dry ejaculation since there is orgasm without the discharge of semen.
Since retrograde ejaculation isn’t harmful, it typically doesn’t require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause.
If your doctor discovers that a prescribed medication, such as alpha blockers, is the cause, switching to a comparable medication or discontinuation of the drug often restores normal ejaculation.
Unfortunately, if retrograde ejaculation is caused by surgery or diabetes, it is often not correctable. However, some medications have been shown to improve muscle tone of the bladder neck and therefore reduce the loss of semen into the bladder during ejaculation. These medications include: epinephrine sulfate and epinephrine-like drugs (such as pseudoephedrine, imipramine, midodrin, desipramine and brompheniramine maleate).
Alternatively, men are sometimes encouraged to ejaculate when their bladder is full since having a full bladder can increase bladder neck closure.
If the above measures are not options or are not successful and fertility is still a concern, it is also possible for an urologist to retrieve sperm from a man’s urine following an orgasm and use it for artificial insemination.
It is also possible for men, prior to receiving treatments or surgeries that bring the risk of retrograde ejaculation, to have their semen cryopreserved (frozen) for insemination later.

Bottom Line: Retrograde ejaculation or sperm going backward into the bladder is not a very common problem but can be a problem if a man wishes to achieve a pregnancy with his partner. The condition does not need treatment unless a man wishes to achieve a pregnancy.

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!

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.