8 Ways to Boost Male Fertility and Improve Sperm Health

Posted June 23, 2023

(BPT) – Written by: Dr. Sina Abhari, Medical Director and board-certified reproductive endocrinology and infertility specialist at CCRM Fertility of Newport Beach

This article is a repost which originally appeared on LI HERALD.COM.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Key Points

‧ Recent surveys show up to 40% of men are concerned about fertility.

‧ There are many individual things someone can do to improve their fertility health.

‧ Checking with a fertility specialist is recommended if problems are suspected.

With studies reporting a significant decline in sperm counts across the globe, fertility health has been a top-of-mind concern for many men in recent years. In fact, a recent survey of 1,000 men, ages 25-54, found that nearly 40% of men are currently concerned with their fertility health.

While some causes of male fertility are genetic or structural and require help from a fertility doctor, there are lifestyle considerations and changes you can factor into your everyday routine to improve your wellness and optimize reproductive health.

Here are some tips to help improve male fertility:

1. Maintain a healthy weight

Having a higher body mass index (BMI) may have a negative impact on sperm production. Research suggests that if your BMI is on the higher side, you might be at a greater risk of experiencing fertility issues and sometimes pregnancy outcomes are negatively impacted. So, it’s worth keeping an eye on your BMI and taking steps to maintain a healthy weight if you’re planning to start a family. Focus on eating well-balanced meals, exercise three to four days a week, and aim for a BMI between 21 to 26.

2. Eat a nutritious diet

Consume a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fat and include foods high in antioxidants, such as berries, leafy greens, nuts and seeds, which can help protect sperm from damage. Certain vitamins and supplements can also affect sperm health. Taking a multivitamin can provide additional antioxidants such as zinc, selenium and vitamin C — all of which are used by the testes to support sperm production.

3. Avoid tobacco

Smoking tobacco can take a serious toll on your overall health and wellness, and this includes negatively impacting your fertility. A meta-analysis of 20 studies with 5,865 participants found that smoking tobacco reduces sperm count and motility (how the sperm move/swim). If you smoke and are trying to conceive, it is time to kick the habit. Here are some tips from the CDC on how to quit smoking.

4. Consume alcohol in moderation

Excessive alcohol consumption can lower sperm counts, lower testosterone, and can disrupt reproductive hormone balance. So, what amount of alcohol is considered okay? The results from studies are inconsistent and there is no one study that gives direction on how much alcohol you should drink before your fertility is negatively impacted. But generally, fertility specialists recommend consuming less than four to six glasses of wine (or the equivalent) a week.

5. Exercise regularly

Some studies show that getting regular physical activity can increase testosterone levels and better sperm quality. However, excessive exercise may have a negative impact, so strike a balance.

6. Limit heat exposure

Avoid prolonged exposure to high temperatures, such as hot tubs, saunas, or tight-fitting underwear, as they can raise scrotal temperature and affect sperm production.

7. Minimize exposure to toxins

Reduce exposure to environmental toxins and chemicals that can harm sperm, such as pesticides, heavy metals, and certain workplace chemicals. Use protective clothing and follow safety guidelines if you work in a potentially hazardous environment.

8. Get enough sleep

Sleep deprivation has been correlated with a number of health concerns, including male fertility problems. Sufficient rest (aim for seven to eight hours each night) promotes hormonal balance and overall well-being.

If you’re concerned about your fertility, it is best to consult a fertility specialist. They can provide a thorough evaluation and recommend appropriate treatments or interventions based on your specific situation.

Ejaculation and Male Fertility

By Jerry Kennard Updated on May 18, 2023
Medically reviewed by Chioma Ndubisi, MD
Fact checked by Sarah Scott

This article is a repost which originally appeared on verywell health

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Key Points

‧ Semen is composed of different substances.

‧ Men can experience multiple orgasms.

‧ Seek out a medical professional if you suspect you may have fertility issues.

Ejaculation is the climactic point of male sexual arousal. During ejaculation, semen is ejected from the penis. How ejaculation occurs, what makes up semen, and how semen is produced are common questions.

This article looks at ejaculate, its composition and production, and its role in male fertility.

How Semen is Produced and What it’s Made Of

Ejaculation occurs when semen is released from the penis. It typically takes place during orgasm.

Before it occurs, a small amount of pre-ejaculate is usually released. This is sometimes called pre-cum. It drips from the head of your penis when you are aroused.

Pre-ejaculate is made up of one or two drops of alkaline fluid. This fluid comes from the Cowper’s glands, two small glands beneath the prostate. The alkaline fluid neutralizes acid that remains in the urethra after you urinate.3 The urethra is the tube that carries urine and semen to the outside of your body.

Orgasm is the final stage of male sexual arousal. During orgasm, semen flows from the urethra. It first comes out in a gush and then diminishes in volume.

Around 50% to 65% of the semen in an ejaculation comes from the seminal vesicles. These are two small glands located above the prostate. Another 20% to 30% comes from the prostate and gives semen its characteristic smell. The rest of your ejaculate is made up of other body fluids.

Sperm gives semen its milky appearance. The more sperm is in the semen, the more opaque it becomes.

Recap

Semen is produced in the seminal vesicles and prostate. Sperm is what gives semen its milky appearance.

What Happens When You Ejaculate

When you ejaculate, semen is expelled out of the penis through the urethra. The word “ejaculate” can also be used as a noun meaning “semen.”

Most males ejaculate an average of 2 ml to 3 ml of semen. This is roughly equal to a teaspoon.

How Common Are Multiple Orgasms?

Multiple orgasms are rarer for males than for females. The ability to ejaculate repeatedly varies greatly from person to person. It also begins to decline almost immediately after puberty.

Most males can have only one ejaculation within a period of one to two hours. This is called the refractory period.

Some can have a second ejaculation within two hours, and some can have three or four, though this is uncommon. The well-known sex researcher Alfred Kinsey recorded one male who was able to ejaculate six to eight times in a single session.

Ejaculation and Male Fertility

Depending on the underlying factors, the volume of ejaculate may affect your ability to get someone pregnant. That being said, conception can still occur with a small amount of semen. This is why withdrawing before orgasm may still lead to pregnancy.

Generally speaking, a sperm count of under 39 million per ejaculation or 15 million per milliliter reduces the chance you will get someone pregnant.

If you and your partner are trying to conceive, there are things you can do to improve your odds- including minimizing risk factors such as scrotal heat, cigarette smoking, and ensuring health dietary intake and optimizing management of any medical conditions. The female partner should also have a work-up with an OB/GYN to ensure her reproductive system is functioning normally.

If you’re struggling with fertility, ask your doctor about a semen analysis. This will help you understand if your semen is contributing to the problem.

Summary

Semen is primarily produced in the seminal vesicles and prostate. When you ejaculate, it is released from your body through your urethra.

It only takes a small amount of semen to get someone pregnant. If you are trying to conceive, a semen analysis can help you understand what your sperm count is, so you can take steps to improve your odds.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Alwaal A, Breyer BN, Lue TF. Normal male sexual function: emphasis on orgasm and ejaculation. Fertil Steril. 2015;104(5):1051-60. doi:10.1016%2Fj.fertnstert.2015.08.033

Killick SR, Leary C, Trussell J, Guthrie KA. Sperm content of pre-ejaculatory fluid. Hum Fertil (Camb). 2011;14(1):48-52. doi:10.3109%2F14647273.2010.520798

National Cancer Institute. SEER Training Modules. Accessory Glands.

Alwaal A, Breyer BN, Lue TF. Normal male sexual function: emphasis on orgasm and ejaculation. Fertil Steril. 2015;104(5):1051-60. doi:10.1016%2Fj.fertnstert.2015.08.033

Lawrentschuk N, Ptasznik G, Ong S. Benign prostate disorders. Endotext [Internet]. South Dartmouth, Mass: MDText.com, Inc.; 2021.

Wibowo E, Wassersug RJ. Multiple orgasms in men-what we know so far. Sex Med Rev. 2016;4(2):136-148. doi:10.1016/j.sxmr.2015.12.004

Kinsey AC, Pomeroy WB, Martin CE. Sexual behavior in the human male. Indiana University Press; 1998.

Mahdi BM. Semen analysis and insight into male infertility. Open Access Maced J Med Sci. 2021;9(A):252-256. doi:10.3889/oamjms.2021.5911

International Planned Parenthood Federation. Myths and Facts About the Withdrawl Method.

 

 

 

Men’s Health: Dos & Don’t Of Diet For Better Fertility In Men

This article is a repost which originally appeared on DOCTOR NDTV

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

The ability of a person to reproduce naturally is referred to as fertility. When a man’s chances of getting his female spouse pregnant are poor, this is known as male infertility. Usually, it depends on how good his sperm cells are. Infertility can sometimes be related to sexual function, and it can also occasionally be related to the quality of the semen.

Male fertility really depends on a healthy sperm count. Sperm count can be affected by a variety of elements, such as nutrition and way of life. You can increase sperm count and overall fertility by incorporating particular nutrients into your diet. We’ll look at some fundamental dos and don’ts that have been demonstrated to have an impact on sperm count below.

Dietary do’s & don’ts to boost fertility in men:

Do’s

  1. Eat a balanced diet that includes plenty of fruits, vegetables, whole grains, lean proteins, and healthy fats.
  2. You certainly already know that vitamin C can strengthen the immune system. According to some research, consuming antioxidants like vitamin C may increase fertility.
  3. Cut back on processed and fast food, as they contain high levels of unhealthy fats, sugars, and artificial additives that can negatively impact fertility.
  4. Increase your intake of antioxidants such as vitamin E, and selenium, as they can help protect sperm from damage.
  5. Fertility in both men and women can benefit from vitamin D. Another vitamin that might raise testosterone levels is this one. Men who were vitamin D deficient had a higher likelihood of having low testosterone levels, according to one observational study.
  6. Fenugreek is an appreciated herb for both cooking and medicine. Supplements containing fenugreek have been demonstrated to considerably raise testosterone levels.
  7. One of the foundational elements of male fertility is getting adequate zinc. Additionally, taking zinc supplements may prevent the lower testosterone levels linked to overdoing it on high-intensity exercise.
  8. Ashwagandha is a herb used for medical purposes which can be added to your diet. According to studies, ashwagandha may increase testosterone levels, hence enhancing male fertility.

Don’ts

  1. Avoid or limit foods that are high in saturated and trans fats, such as red meat, fried foods, and baked goods, as they can decrease sperm count and motility.
  2. Reduce intake of soy products. Soy is abundant in isoflavones which causes an oestrogenic effect that drops the levels of testosterone.
  3. Avoiding consuming predator fish such as tuna and swordfish. These fish are high in mercury which can negatively affect our reproductive health and lead to fertility issues.
  4. Reduce your caffeine intake, as high levels can negatively impact sperm quality.
  5. Avoid or limit alcohol intake, as excessive consumption can decrease testosterone levels and impair sperm production.
  6. Avoid smoking and exposure to secondhand smoke, as they can damage sperm DNA and decrease sperm count.
  7. Don’t skip meals, as it can negatively affect hormone levels and overall sperm health.
  8. Foods in cans and tins are lined with a substance called bisphenol (BPA). Since bisphenol mimics oestrogen in the human body, it can have consequences akin to too much soy.

Follow these dietary dos and don’ts to improve your fertility and increase your chances of conceiving.

 

Do men have biological clocks? It’s not just women who have to worry about age and fertility, experts say.

Kaitlin Reilly
January 30, 2023

This article is a repost which originally appeared on yahoo!life

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Key Points

‧ There is not as much data on male fertility compared to female fertility.

‧ Certain birth risk factors go up as men age.

‧ Increased medication use as men age can contribute to fertility problems.

When it comes to fertility, the focus tends to fall on women and their (loudly ticking) biological clocks. Yet it’s not just women who have to take age into account when considering when to have children. Experts agree that men’s fertility also depends on their age.

According to Dr. Jane L. Frederick, a reproductive endocrinologist, women get most of the attention because they have a finite number of eggs at birth and must contend with changes in egg quantity and quality starting at age 35.

“Women play an obvious role in reproduction, leading us to believe that the topics of fertility, pregnancy and childbirth are women’s issues, void of male involvement after they provided sperm,” she explains. “However, older men over the age of 45 are much more likely to have children than four decades ago, and yet few men recognize their biological clock is ticking as well.”

A 2017 study from Beth Israel Deaconess Medical Center and Harvard Medical School looked into IVF patients and found that while women of age 40 to 42 had the most difficult time conceiving, the chance of a live birth decreased with older men — even those whose parters were younger women. Exactly why that is, however, remains to be researched.

Dr. T. Mike Hsieh, the director of UCSD Men’s Health Center and professor of urology, tells Yahoo Life that although there is “not as much data” on male fertility as for females, it’s clear that “increased paternal age is associated with decline in sperm count, sperm quality, semen volume, testosterone and ability for sexual activity or erectile dysfunction.” While there isn’t a “specific cutoff,” what’s generally accepted as advanced paternal age starts at around 45.

Dr. Paul Turek, a urologist and expert on fertility in men, adds that men in their late 50s and 60s experience a “definite decline” in fertility compared with younger men. The cause of this decline, he says, may not only be a body’s biological clock, but also the fact that certain risk factors go up as men age. As he notes, “a body has to be very healthy to be normally fertile.” He adds that the “quality of the DNA package” is “altered or reduced” as men age.

“That means that when the DNA payload gets delivered to the egg at the time of fertilization, it is broken into single strands, rather than intact, in double strands,” Turek explains. “Eggs try as hard as they can to ‘fix’ the DNA early on after fertilization, but if the load of damage is in excess of the egg’s capacity to repair it, then there will be no pregnancy or possibly a miscarriage — another case, at a biological level, of women cleaning up the messes that men make.”

Frederick also points out that “the risk of developing a medical condition or being exposed to environmental toxins increases with age for men,” which may make them less fertile.

“A history of chronic illness, such as sickle cell disease, chronic kidney failure, liver conditions like cirrhosis or malnutrition may have an effect on sperm production,” she notes. “Men who develop medical problems later in life may be taking medications that can affect sperm function in an adverse way.”

Men’s testosterone levels steadily decline over time, which can also affect their ability to father a child.

“Declining testosterone levels in men may cause a decline in sexual desire, problems with erection and difficulty in achieving ejaculation — all contributing to the couple’s infertility,” Frederick explains. “The level of testosterone does appear to influence the sexual function and desire in a man, and testosterone replacement improves erectile function, but also causes sperm production to go down and lead to infertility.”

Ultimately, however, Frederick notes that this field has a long way to go. “Many unknowns remain with regards to the older male and infertility,” she says. “Further research will give us a better understanding of age and its impact on all areas of male infertility.”

 

 

 

 

 

 

 

Male Fertility: Here’s How Diet And Exercise Can Help Boost Fertility In Men

Mild to moderate exercise helps in releasing feel-good neurochemicals from the brain, improves libido, improves sleep quality, and may enhance fertility and sexual function.

By: Dr. Uma Maheshwari M Updated: Nov 24, 2022 11:11 IST

This article is a repost which originally appeared on DOCTOR NDTV.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our takes:

‧ Testosterone levels play a large part in sperm count.

‧ Obesity can decrease testosterone and increase estrogen in males.

‧ Regular exercise can improve testosterone levels and sperm count.

The sperm count, motility, structure, integrity of the DNA contained in the sperm and physicochemical properties of the semen are the determining factors of male fertility. The environment for sperm production must be improved as much as possible in order to maximize a man’s reproductive potential. Sperm count and quality are substantially impacted by factors affecting testosterone levels.

Sperm count can also be impacted by illness, including cancer and its treatment, infections and certain genetic abnormalities.

Obesity reverses the normal ratio of testosterone to estrogen in an estrogen-dominant milieu. Falling/reversal of testosterone to estrogen ratio brings about decreased libido, reproductive potential and sexual dysfunction in men.

However, healthy lifestyle choices like adequate sleep, regular exercise, maintaining optimum weight, and a balanced diet can boost the hormones that regulate sperm production and improve fertility.

Role of exercise in male fertility

Men can benefit from regular exercise by achieving and maintaining a healthy weight as well as improving their cardiovascular health. There are certain limitations, but mild to moderate exercise can help improve semen parameters and increase male reproductive potential. Before beginning an exercise regimen, men with existing health issues must consult their doctor.

Mild to moderate exercise helps in releasing feel-good neurochemicals from the brain, elevates mood, improves libido, enhances metabolism, loses/maintains weight, improves sleep quality, enhances cardiovascular health, and may enhance fertility and sexual function.

The best exercises for maintaining a healthy lifestyle and optimising fertility involve a good mix of resistance and cardiovascular activity.

Exercises that can bother the prostate and strain the reproductive organs should be done in moderation, such as triathlons and competitive cycling. Excessive exercise & extremes of physical strain decrease testosterone. Moreover, methods of safeguarding fertility are also crucial, such as using crotch shields during contact sports, avoiding saunas, or upgrading to a better-quality ergonomic bicycle seat that relieves excess pressure on the male pelvic anatomy.

Exercising in sunlight will also provide the benefit of improving vitamin D levels in the body.

Role of diet in Fertility

Choice of a healthy source of complex carbohydrates, class 1 proteins & polyunsaturated fats are essential in consideration with individual dietary choices and preferences.

The ratio between carbohydrates, proteins, and fat should be maintained. Fiber is an essential part of each meal. It improves satiety.

Foods with low glycemic index should be favoured.

Antioxidant-rich rainbow diet with nuts, fresh fruits, and vegetables with adequate amounts of all essential minerals, vitamins & micronutrients is best for general health and fertility.

The calorie intake should be commensurate with the level of physical activity.

Adequate hydration is integral to a good diet.

Processed food high in fats, carbohydrates, sodium, and sugar, and poor in fiber is detrimental to health. However, enjoying an occasional indulgence will motivate you to follow a healthy diet.

Healthy snacking is to be encouraged. So, it is important to be disciplined in following a healthy diet.

Men should be advised to quit smoking and minimise alcohol intake.

A healthy lifestyle, weight management, adequate cardiovascular activity, and dietary support are crucial to guide the male partner in maximizing his fertility and attaining parenthood. It will take time, commitment, and dedication to making these lifestyle adjustments. These are minor adjustments that need to be adopted and adapted to. These measures will eventually navigate the path to general fitness and enhanced fertility.

Sperm counts are decreasing, study finds. What might it mean for fertility?

Karen Weintraub
USA TODAY

This article is a repost which originally appeared on USA TODAY.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Key Points

‧ A new study found men are likely to have lower sperm counts than 50 years ago.

‧ The reason? Experts say it’s hard to tell but may be due to environmental exposures, chemicals or changes in weight.

‧ Being healthy overall is important for reproductive health, experts said. Men should talk to their doctor if they’re concerned about their sperm count.

Sperm counts and concentration are down all over the world, according to a new study that updates previous research and raises questions about exposures and men’s health.

From 1973 to 2000, sperm counts dropped by 1.2% per year, “which is a lot,” said Hagai Levine, who helped lead the research. From 2000 to 2018, the decline was 2.6% per year, “which is an amazing pace.”

The United States is part of this larger trend.

“In the U.S., due to availability of good data, we have the highest certainty that there is a strong and sustainable decline, but it’s similar globally,” Levine said.

It’s unclear why sperm counts have been falling.

“We don’t understand why we’re seeing this pattern, so I think it’s hard to be alarmist for an individual,” said Dr. Michael Eisenberg, a urologist focused on male fertility and sexual function at Stanford University and Stanford Health Care in California. He was not involved in the new study.

“But at a policy level, this should be a wake-up call to try and understand,” Eisenberg said.

Experts say falling sperm counts might mean it takes longer to have children. Here’s what to know.

What’s the evidence?

The new study is a meta-analysis, which means it combined findings from more than 250 previous studies. It also updates a previous meta-analysis the team published in 2017, adding data on sperm counts from 2011 to 2018 and regions in South America, Asia and Africa, where data had been incomplete before.

Men in the global south have seen the same significant decline in sperm count and concentration as the team showed in 2017 among men in North America, Europe and Australia, whose sperm counts and concentrations continued to fall, according to the new study.

Sperm count is a imperfect measure of fertility, but there is a threshold below which a low sperm count affects the chances of reproduction. On a population level, the study suggests that median sperm counts have dropped from 104 to 49 million per milliliter over five decades.

That means more men are likely to have sperm counts below the fertility threshold than was the case 50 years ago, said Levine, an epidemiologist and public health physician at the Braun School of Public Health, at Hadassah University Medical Center.

What’s the impact on fertility?

But Amy Sparks, a reproductive physiologist at the University of Iowa, who was not involved in the research, cautioned that sperm counts are falling, but not enough to affect the human population.

The paper is not “suggesting that our sperm concentrations are crashing at a rate that is going to lead us out to every man needing to walk into an infertility center. Heavens to Betsy, no.”

People have raised questions about sperm counts for generations. Sparks said she found a 1974 study of 390 men at the University of Iowa that raised concerns about low sperm counts.

“We can’t ignore that things are changing. Lifestyles have changed. Dietary patterns certainly have changed,” she said. “Through these changes, we are exposing our body to altered conditions. In response to those altered conditions, we’re seeing a decrease in sperm concentration.”

Levine, however, sees the drop in sperm count as a problem for today’s families, not just future ones.

Although most American couples can manage to have the one or two children they want, it may take them longer now than in the past. In Israel, some religious families want 10 or more children. Slower fertility may mean they run out of time before they can have that many, he said.

It’s challenging to study sperm counts and fertility is even harder, said Dr. Bruce Redmon, a professor at the University of Minnesota Medical School, who was not involved in the research but studies male reproductive disorders.

It’s not really feasible, he said, to sample sperm in a randomly selected population of men every year for decades. And men who seek help for fertility problems are not reflective of the entire population.

But overall, Redmon said, the new study was a reasonable way to look at the issue.

“It’s probably something we have to continue to take seriously and look at,” he said.

Why are sperm counts falling?

Studies haven’t yet explained why sperm counts are falling, but Levine has a few ideas.

Total sperm capacity is determined during fetal development, so exposures to human-made chemicals, stress and poor diet during pregnancy might all be contributing factors, Levine said.

Environmental exposures of the father before conception may also be related to poor fetal outcomes. In a man’s adult life, his sperm count can also be reduced by exposure to pesticides, lack of physical activity, poor diet, smoking and obesity, he said.

Excess weight changes hormone levels, adding more estrogen to the male body, Sparks said. And extra fat around male reproductive organs could increase heat there, which will decrease sperm production.

Sparks doesn’t think any one thing is causing the drop. It’s happening too fast to blame on reproductive technologies. But the world’s population is carrying more weight, spending more time spent sitting at a computer, eating more processed foods and packing those food in plastic. Any or all of those could be driving the drop in sperm count, she said.

“We need to be motivated to invest in the research to work on this,” she said. “It points to a need.”

What can men do to boost their sperm count?

Men concerned about their fertility should to talk to their doctor, Eisenberg said. It’s important to be evaluated and determine whether there are specific treatments that may help.

Being healthy overall is important for reproductive health. Eisenberg suggests a healthy diet, regular exercise and smoking cessation.

“I always tell men there’s a strong link between fertility and health, so anything that’s good for your heart is good for fertility,” Eisenberg said.

A few other tips:

►Alcohol use: Moderate alcohol use is OK, Eisenberg noted, with studies suggesting that semen quality drops only after about 20 drinks a week.

►Avoid extreme heat: There’s no strong link between what kind of underwear men wear – boxers or briefs. But heat exposure isn’t good, so he advises avoiding hot tubs and saunas while trying to conceive.

►Taking testosterone: He also discourages his patients from using testosterone, which has been tested as a contraceptive, because it reduces sperm production.

 

 

 

 

 

 

How Men Can Boost Their Fertility For Better Odds Of Conception – Exclusive

By Brynna Standen/Updated: Oct. 7, 2022 12:49 pm EDT

This article is a repost which originally appeared on Health Digest.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· Only 30% of fertility complications are due to complications in the woman alone.

· There’s a cultural stigma against infertility in men.

· Male fertility can be caused by a number of factors.

While in theory, the idea of trying to get pregnant sounds like a whole lot of fun (wink, wink), for some couples it can start feeling a little more like one of the Sphinx’s riddles — difficult to navigate and laden with pressure and high stakes. In the U.S., one in eight couples have difficulty conceiving (per Fertility Answers). While fertility experts agree that only 30% of these cases can be attributed to a complication in the woman alone, society often seems to be in silent agreement that fertility issues start and end with women.

This unspoken consensus seems to point toward a gender bias within the medical field. A 2006 review published in Medical Anthropology Quarterly found that out of 157 articles published on the topic of fertility, only one was centered around men. Adding to this, a 2016 study published in the American Journal of Preventive Medicine reports that in federally funded clinics that offer family planning services, 81% of them educate women on preconception care, while only 38% of them provide the same education opportunities to men.

Health Digest sat down for an exclusive interview with Dr. Justin Dubin — a urologist and men’s health specialist practicing in South Florida, and co-host of the men’s health podcast “Man Up: A Doctor’s Guide to Men’s Health” — who gave us the scoop on the stigma surrounding male fertility and offered advice on how men can boost their fertility, giving them and their families the best chance at conception.

Shifting the focus

Well aware of the societal bias surrounding fertility struggles, Dr. Dubin wants men to understand their role in family planning. “When it comes to fertility and family planning, it’s important for guys to remember that it takes two to tango,” he asserts. While there are certainly times that fertility issues solely fall on the female, Dr. Dubin points out, “In couples struggling with fertility, 50% of the time there is a male factor component to the couple’s fertility problems. In fact, 30% of the time, a couple’s fertility issues are strictly due to the male! Despite these statistics, there continues to be an unfair focus and pressure on female partners when it comes to family planning issues.”

When it comes to examining why a couple is having trouble conceiving, Dr. Dubin notes, “Women are often the only ones to see a doctor for a fertility workup. Guys need to know that if their partner is getting evaluated for fertility, they should too. Not only does it take some pressure off your partner, there is a chance that getting evaluated by a urologist can help you achieve your family planning goals. It’s time we shift the focus of fertility away from women and back to the couple as a whole,” he declares, adding with encouragement, “Guys, see a doctor!”

The stigma of infertility in men and how to get tested

Women aren’t the only ones who face stigmas surrounding infertility. “Most men don’t like seeing a doctor, especially when it comes to discussing topics like fertility that they often associate with masculinity,” says Dubin. “Fortunately, the fertility workup is fairly straightforward. Typically, when you see your doctor there are three components to a male fertility workup.” He explains that it starts with semen analysis. “A semen analysis is a test in which you provide a semen sample. It is the gold standard for a male fertility evaluation. Basically, we look at the amount and quality of the sperm in your sample to assess your fertility status.” For men still intimidated by the process, Dr. Dubin offers, “Based on both your comfort level and access to facilities, the sample can be collected either at home or in a lab.”

Next, Dr. Dubin explains that blood work is useful. “Like female fertility, there are certain sex hormones that play a role in male fertility and sperm creation. Testosterone is an example of a common hormone we look at.” Men should also get a physical exam, and give their doctors a detailed medical history, while they’re at it. “Male fertility can be impacted by so many different things that it is important for your doctor to hear your story,” Dr. Dubin says. “In addition to a good history, getting a physical exam helps with the big picture of what is going on.”

Expert tips on boosting male fertility

When it comes to male fertility, it’s not as simple as playing with the cards you were dealt. “Male fertility is interesting because lifestyle choices can actually make a big difference on some men’s fertility. When it comes to overall health, it is important to remember: what’s good for your heart is good for your parts. Men who smoke cigarettes, are overweight, inactive, and eat poorly are more likely to have low testosterone and fertility issues. Eating healthy, exercising, and losing weight can help improve fertility.” While low testosterone can play a role in the struggle toward conception, Dr. Dubin reveals, “One important medication that can compromise your fertility is taking testosterone. If you are considering having kids at any point, I would not recommend starting without talking with a doctor.”

While we may have assumed this one was an old wives’ tale, Dr. Dubin clarifies, “If you are actively trying to conceive, you should avoid exposure to wet heat, [like] saunas and hot tubs. The heat can create a less favorable environment for sperm and temporarily cause a decline in sperm numbers.” Last but not least, let’s talk lube. “If you are a couple who uses lubrication during intercourse, the kind of lubricant that you use can make a difference. Most lubricants do not provide favorable environments for sperm and can potentially compromise fertility. When it comes to lubricants that are good for family planning, we recommend using Pre-Seed.”

Finding support at home

Because of the sensitive nature of fertility — especially when it is proving to be an issue — Dr. Dubin stresses the importance of communication between couples. “Fertility is a sensitive topic for men to discuss as most guys associate it with their masculinity and what they consider makes them a man. At the same time, conception and family planning is a two-way street and if there are concerns about their sexual health or fertility status, it is important that their partner talks with them about it. Communication is key for couples struggling with fertility.” Offering one final tip to couples who may be having a hard time, Dr. Dubin says, “Focusing on the fact that this is a couple’s issue, not a male or female issue, should help relieve specific pressures and should motivate both partners to be active in the process and hopefully each get evaluated.” Teamwork makes the baby-dream work!

 

 

 

 

 

 

 

 

 

 

 

 

Male sexual health and reproductive medicine: All that glitters is not gold

September 19, 2022
Navid Leelani, DO, Scott D. Lundy MD, PhD

This article is a repost which originally appeared on Urology Times.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· Telehealth is an increasingly popular method for obtaining medical services

· More studies need to be done in the areas of male sexual and reproductive medicine.

· Studies cite the prevalence of ED as high as 52%!

“With the average cost of treatment ranging from $2600 to $3900 per cycle, clinics offering radial wave therapy have an obvious financial incentive to continue marketing despite the lack of evidence of its effectiveness,” write Navid Leelani, DO, and Scott D. Lundy, MD, PhD.

With the intensified direct-to-consumer marketing of male sexual medicine treatments, the recent legislative changes in reproductive rights and their unknown long-term effect on assisted reproduction availability for infertile men, and the explosion of telehealth, the practice of male sexual medicine is evolving at a breakneck pace. Specialists in male sexual and reproductive medicine have been tasked with digesting the evolving literature and forming evidence-based treatment guidelines for men with erectile dysfunction, Peyronie disease, infertility, and a host of other conditions. Compared with other areas of urology and medicine in general, male sexual and reproductive medicine has a disappointingly small number of well-designed prospective studies, along with a significant gap in funding for male reproductive health compared with female reproductive health. Several manuscripts published in 2022 started to narrow this gap and provide valuable level 1 evidence supporting (or discounting) key areas within sexual medicine and infertility.

For men with severe male factor infertility and nonobstructive azoospermia, surgical intervention is often indicated to retrieve sperm. Testicular sperm aspiration (TESA) and microdissection testicular sperm extraction (mTESE) are 2 commonly used approaches. A recent study by Jensen et al compared the efficacy of these 2 approaches in one of the few prospective randomized-controlled trials in male infertility.1 In the study, 49 patients were randomly assigned to mTESE with a sperm retrieval rate of 43%, and 51 patients were randomly assigned to TESA with a sperm retrieval rate of 22%. Men with failed TESA then went on to salvage mTESE with a combined sperm retrieval rate of 29%. Participants in the mTESE arm, however, had decreased postoperative testosterone levels, and 24% of participants experienced de novo hypogonadism at 6 months. Prior literature has suggested the testosterone drop is transient and that it will likely recover by 12 months. In summary, the study results showed that mTESE remains the gold standard for treatment of nonobstructive azoospermia, but patients should be counseled on the risk of de novo hypogonadism.

Despite this, mTESE success rates remain modest and are subject to the expertise and skill level of the laboratory and andrologist processing the tissue. Multiple hours can be spent trying to find the few viable sperm hidden among a sea of distractors. A recent study by Lee et al examined the power of artificial intelligence to detect human sperm in semen and mTESE samples using bright-field microscopy for nonobstructive azoospermic (NOA) patients.2 They first trained the program to identify sperm from semen samples of fertile patients. After validating the effectiveness of their algorithm, they retrained it to identify sperm in tissue from NOA patients that had been spiked with large amounts of sperm. When testing it on samples containing 3000 to 6000 sperm among other cell types, they achieved 84.0% positive predictive value and 72.7% sensitivity. Finally, without retraining their algorithm, they tested it on samples containing 10 to 200 sperm, replicating the “rare sperm” phenomenon seen in patients with NOA. Their model was able to detect 2969 sperm cells out of a total 3517 with an 84.4% PPV and 86.1% sensitivity. The clinical applications of artificial intelligence and machine learning in medicine continue to expand and have made their way to male infertility. Although this is not ready for immediate clinical use, it does highlight the need for further work to harness the power of technology to improve workflow of andrologists and in turn increase the success of infertility care for patients.

There has been a rapid rise in the need for male sexual health and reproductive specialists as the population ages and the number of comorbidities rise, although certain disease processes that fall within this specialty may be able to be addressed by a general urologist. In an analysis of the current educational landscape, Asanad et al call attention to the need for a structured educational curriculum in residency for male infertility.3 In a survey of urology residents, 54 of 72 respondents (75%) reported that male infertility comprises less than 10% of their training. Compared with residents who did not learn from infertility-trained faculty, residents who were exposed to infertility-trained faculty were 14.4 times more likely to feel confident performing infertility procedures (P < .001) and were more likely to feel confident performing fertility procedures after residency (P = .001).3 For trainees, their career depends on what they are exposed to. Smaller subdisciplines within urology may be more difficult to teach uniformly, and perhaps there are ways to improve the exposure to these areas for motivated residents (eg, visiting other programs).

Within male sexual health, one disease process that all urologists should be able to diagnose and initially manage is erectile dysfunction (ED). With studies citing the prevalence of ED as high as 52%, the demand for providers to manage ED remains sky high. Current treatment options include phosphodiesterase type 5 inhibitors (PDE5is), intracavernosal injections, vacuum erection devices, and penile prosthesis. A newcomer to the field is shock wave therapy, which uses controlled energy to induce angiogenesis.

The short-term effectiveness of focused shock wave therapy for patients with moderate ED was investigated in a double-blind, randomized, sham-controlled trial.4 In this study of 70 patients with moderate ED, 35 were randomly assigned to low-intensity shock wave therapy (LiST) and the other 35 were randomly assigned to sham therapy. After a 4 week washout from PDE5i, patients underwent LiST or sham twice weekly for 6 weeks. One month after treatment completion, 59% patients in the LiST group experienced an International Index of Erectile Function (IIEF) score improvement of at least 5 points, compared with 1 patient (2.9%) in the sham group (P < .001). This effect remained present at 3 months post treatment. Thus, the short-term data for LiST are compelling and suggest this may be a viable option in the management of vasculogenic ED for men with mild/moderate ED. Further studies are desperately needed to validate these findings, and urologists have an obligation to provide patients with an honest assessment of the data and only recommend treatments where the risks (including the financial burden) are outweighed by the benefits.

In stark contrast to focused therapy, radial shock wave therapy uses low-pressure radial shock waves to treat ED. In order to characterize its effectiveness, a randomized, double-blind, sham-controlled clinical trial enrolled 80 men with mild to moderate ED.5 Patients were treated weekly with either radial wave therapy or sham therapy for 6 weeks, and the primary outcome measured was change in the IIEF score between baseline and after treatment. Study results showed that there was no significant difference in IIEF scores between groups at 6 weeks or 10 weeks after randomization. Study results displayed the lack of evidence to support the use of radial wave therapy.

Despite the evidence of their ineffectiveness in managing ED, shock wave therapy and particularly radial wave therapy have been heavily marketed directly to consumers in the US. A recent article using a “secret-shopper” method found troubling marketing and practice trends in the US. The authors noted that patients often are not adequately educated on the different types of treatments and may not know if the administrator is a licensed medical professional.6 With the average cost of treatment ranging from $2600 to $3900 per cycle, clinics offering radial wave therapy have an obvious financial incentive to continue marketing despite the lack of evidence of its effectiveness.

Recent advancements in the field of male sexual health and reproduction present a bright future for the field with new diagnostic and therapeutic options on the horizon. However, it is apparent that demand still outpaces supply for men’s health specialty care. Urologists must work diligently to fill this void to not only increase access for patients to receive evidence-based care, but also to prevent men from falling to prey to practices looking to take advantage of this unmet demand and a vulnerable patient population.

References

1. Jensen CFS, Ohl DA, Fode M, et al. Microdissection testicular sperm extraction versus multiple needle-pass percutaneous testicular sperm aspiration in men with nonobstructive azoospermia: a randomized clinical trial. Eur Urol. Published online May 19, 2022. doi:10.1016/j.eururo.2022.04.030

2. Lee R, Witherspoon L, Robinson M, et al. Automated rare sperm identification from low-magnification microscopy images of dissociated microsurgical testicular sperm extraction samples using deep learning. Fertil Steril. 2022;118(1):90-99. doi:10.1016/j.fertnstert.2022.03.011

3. Asanad K, Nusbaum D, Fuchs G, Rodman JCS, Samplaski MK. The impact of male infertility faculty on urology residency training. Andrologia. 2022;54(8):e14457. doi:10.1111/and.14457

4. Kalyvianakis D, Mykoniatis I, Pyrgidis N, et al. The effect of low-intensity shock wave therapy on moderate erectile dysfunction: a double-blind, randomized, sham-controlled clinical trial. J Urol. 2022;208(2):388-395. doi:10.1097/JU.0000000000002684

5. Sandoval-Salinas C, Saffon JP, Martínez JM, Corredor HA, Gallego A. Are radial pressure waves effective for the treatment of moderate or mild to moderate erectile dysfunction? A randomized sham therapy controlled clinical trial. J Sex Med. 2022;19(5):738-744. doi:10.1016/j.jsxm.2022.02.010

6. Weinberger JM, Shahinyan GK, Yang SC, et al. Shock wave therapy for erectile dysfunction: marketing and practice trends in major metropolitan areas in the United States. Urol Pract. 2022;9(3):212-219. doi:10.1097/UPJ.0000000000000299

Penises are shrinking because of pollution, warns environmental scientist

It may sound like a joke, but this research shows the full extent of how much we are damaging reproductive health.

By Marthe de Ferrer • Updated: 13/12/2021

This article is a repost which originally appeared on euronews.green

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· Pollution is proving to causing penis shrinkage and decreasing fertility worldwide.

· Some scientists believe the trend of infertility and smaller penises will qualify humans as becoming an endangered species.

· Phthalates which are now found in the environment are disrupting endocrine systems.

Pollution is causing human penises to shrink, according to one scientist.

A leading epidemiologist and environmental expert has published a book that examines the link between industrial chemicals and penile length.

Dr Shanna Swan’s book, Count Down, argues that our modern world is altering humans’ reproductive development and threatening the future of our species.

The book outlines how pollution is leading to higher rates of erectile dysfunction, fertility decline, and growing numbers of babies born with small penises. Though the headline fact about shrinkage may sound like a laughing matter, the research paints a bleak portrait of humanity’s longevity and ability to survive.

“In some parts of the world, the average twenty-something today is less fertile than her grandmother was at 35,” Dr Swan writes, dubbing the situation a “global existential crisis” in the book.

“Chemicals in our environment and unhealthy lifestyle practices in our modern world are disrupting our hormonal balance, causing various degrees of reproductive havoc.”

According to the book, humans meet three of the five possible criteria used to define whether or not a species is endangered. “Only one needs to be met,” writes Dr Swan, “the current state of affairs for humans meets at least three.”

How is pollution causing problems with fertility?

According to Dr Swan’s research, this disruption is caused by phthalates, chemicals used in plastic manufacturing, which can impact how the hormone endocrine is produced.

This group of chemicals is used to help increase the flexibility of a substance. They can be found in toys, food packaging, detergents, cosmetics, and many more products. But Dr Swan believes that these substances are radically harming human development.

“Babies are now entering the world already contaminated with chemicals because of the substances they absorb in the womb,” she says. Much of Dr Swan’s recent work has focused on the effects of phthalates, initially looking at phthalate syndrome in rats.

In 2000, however, there was a breakthrough in the field, and it became possible to measure low doses of phthalates in humans.

Since then Dr Swan has authored papers on how these chemicals can pass between parents and their offspring, the impact on female sexual desire, and – most recently – on penile length.

One of her most famous studies examined the intersection between sperm count and pollution in 2017, in ground-breaking research which looked at men’s fertility over the last four decades. After studying 185 studies involving almost 45,000 healthy men, Dr Swan and her team concluded that sperm counts among men in Western countries had dropped by 59 per cent between 1973 and 2011.

But there is some good news. Since the creation of the European Environment Agency, European citizens are exposed to 41 per cent less particulate pollution than we were two decades ago. It’s believed that these regulations have gifted Europeans an extra nine months of life expectancy, on average.

“A demand for change from citizens and subsequent strong policies have helped to clear the air in parts of Europe before, and can continue to do so to ensure that high pollution today does not need to be tomorrow’s fate,” says Michael Greenstone, director of the Energy Politics Institute at the University of Chicago.

So if pollution reduction measures can be properly implemented, there is still hope for the future and humanity’s fertility.

 

Breakthrough into the cause of male infertility

Scientists at Newcastle University have identified a new genetic mechanism that can cause severe forms of male infertility.

Our Takeaway:

  • Scientists collected and studied DNA from 185 infertile men and their parents. They identified 145 rare protein-altering mutations that are likely to negatively impact male fertility.
  • As many as 29 of the mutations affect genes directly involved in processes related to spermatogenesis — the process of sperm cell development.
  • Experts have found that mutations occurring during the reproduction process, when the DNA of both parents is replicated, can result in infertility in men later in life.
This article is a repost which originally appeared on ScienceDaily
Newcastle University - JANUARY 10, 2022
Edited for content and readability - Images sourced from Pexels
Source: https://www.ncl.ac.uk/press/articles/latest/2022/01/maleinfertilitystudy/

This breakthrough in understanding the underlying cause of male infertility offers hope of better treatment options for patients in the future.

The study, published today in Nature Communications, shows that new mutations, not inherited from father or mother, play a major role in this medical condition.

Improving understanding

It is hoped that this new knowledge will help to provide more answers in the future about the cause and best treatment options available to infertile couples.

Professor Joris Veltman, Dean of Newcastle University’s Biosciences Institute, UK, led the research which involved patients from Newcastle Fertility Centre and Radboud University Medical Centre in the Netherlands.

He said: “This is a real paradigm shift in our understanding of the causes of male infertility. Most genetic studies look at recessively inherited causes of infertility, whereby both parents are a carrier of a mutation in a gene, and the infertility occurs when the son receives both mutated copies, resulting in problems with their fertility.

“However, our research has found that mutations which occur when the DNA is replicated during reproduction in parents plays a significant role in the infertility in their sons.

“At present, we don’t understand the underlying cause in the majority of infertile men, and this research will hopefully increase the percentage of men for whom we can provide answers.”

Scientists collected and studied DNA from a global cohort of 185 infertile men and their parents. They identified 145 rare protein-altering mutations that are likely to negatively impact male fertility.

As many as 29 of the mutations affect genes directly involved in processes related to spermatogenesis — the process of sperm cell development — or other cellular processes related to reproduction.

Experts identified mutations in the gene RBM5 in multiple infertile men. Previous research carried out in mice has shown that this gene plays a role in male infertility.

Importantly, these mutations mostly cause a dominant form of infertility, where only one mutated gene is required. As a consequence, there is a 50% chance that infertility caused by these mutations will be passed on to the man’s child (if assisted reproductive technologies are used) and this may result in infertility, particularly in sons.

Millions of children have already been born through assisted reproductive approaches as a result of infertility. This research indicates a significant proportion of these children may inherit infertility from their father.

Professor Veltman said: “If we are able to obtain a genetic diagnosis, then we can start understanding better male infertility problems and why some infertile men still produce sperm that can be used successfully for assisted reproduction.

“With our information, and the research others are doing, we hope clinicians can improve counselling for couples and recommend what is the best course of action in order to conceive, either by proposing an appropriate medically-assisted procedure or in cases where none is suitable, provide appropriate alternatives.”

Infertility problems

It is estimated that up to 7% of men are affected by infertility and 50% of fertility problems within a heterosexual couple are due to the man. In around half of male infertility cases, the cause is unexplained.

Moving forwards, the scientists want to expand their work by studying thousands of patients and their parents in a large international consortium.

They will follow-up their research by conducting further studies into the role these newly identified mutated genes have on the impact of spermatogenesis and on the overall fertility in humans.