Two to Tango: The Male Side of Fertility

WebMD Live Events Transcript

With up to half of all infertility cases involving the male partner, any look at a couple's conception concerns has to include our friends the sperm. We looked at the causes and potential treatments of male infertility when nationally known male reproductive urologist Larry Lipshultz, MD, was our guest, as part of the Preserving Your Fertility Cyber Conference, on Sept. 29, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MEMBER QUESTION:
If I wanted my husband to get tested to see how fertile he is, how would he go about this?

LIPSHULTZ:
He would go to a urologist who has a stated interest in male reproductive medicine and have a thorough physical exam, history, and a semen analysis. But you have to remember that a semen analysis is not a test of fertility. The only way to truly judge fertility is to see whether or not a couple conceives. A semen analysis is an analysis of testicular function.

MEMBER QUESTION:
What are some tried and true ways to boost a man's sperm?

LIPSHULTZ:
There are several known causes of "poor sperm quality." These would include some causes that are correctable, such as:
  • Correcting a varicose vein of the testicle
  • Making sure the patient stays out of hot tubs
  • Avoiding excessive use of alcohol, tobacco, or recreational drugs
  • Having no known occupational risks, such as exposure to specific pesticides and solvents

A generally healthy lifestyle is important for better semen quality. There are no specific vitamins or supplements that are proven to be significantly effective.

MEMBER QUESTION:
January will make one year for my husband and me trying to get pregnant. I've had all my checkups and I'm OK. How early should he start infertility testing?

LIPSHULTZ:
Now.

MEMBER QUESTION:
My husband has low motility. Does Proxeed really help in this situation?

LIPSHULTZ:
It can't hurt. But as you may know, Proxeed is basically amino acids found in high concentration in the male reproductive tract. Taking them does not guarantee that sperm quality will improve. Make sure your husband does not have:

  • Antisperm antibodies
  • Excessive white cells in his semen
  • Excessive oxidants in the semen
  • Other risk factors that might impair sperm production
"It is now thought that many men have genetic problems causing poor quality."

MEMBER QUESTION:
Can a man strengthen his sperm?

LIPSHULTZ:
If one is interested in "strengthening" one's sperm, I'm assuming there is an indication that they are "weak." This would probably be seen as sperm with poor activity, or sperm that have not established a pregnancy despite a normal female evaluation. Make sure the male is tested for causes of poor sperm quality such as excessive white cells in the semen, excess oxidants, exposure to toxic substances, and that in general he has a healthy lifestyle.

MEMBER QUESTION:
If my husband's semen analysis came out above average, is it better to have intercourse every other day or every day close to expected ovulation? I have heard mixed ideas. Is it more beneficial to refrain from intercourse until you are close to ovulating?

LIPSHULTZ:
Don't refrain from intercourse, but establish a regular pattern of sexual relations. Around ovulation, every other day has been shown to be most effective.

MEMBER QUESTION:
My husband has sperm issues. The reason has not been established after many tests and urologist visits. What can he do to boost his fertility, aside from the basics (boxers instead of briefs)? He has been taking Proxeed. It improved his counts, but he is still on the low end. We have undergone 2 cycles of IVF/ICSI.

LIPSHULTZ:
You must remember that close to 30% of men with poor semen quality will remain undiagnosed. It is now thought that many men have genetic problems causing poor quality. Make sure your husband is tested for chromosome deletions as well as a study of all his chromosomes, known as high-resolution karyotyping. It is also important that he does not have a high DNA fragmentation percentage. These tests can all be done through up-to-date andrology laboratories.

MEMBER QUESTION:
Does smoking pot affect the sperm? And for how long once you quit?

LIPSHULTZ:
Marijuana does have a bad effect on sperm quality. No "effect" level has been determined, so it is best to stop smoking marijuana when trying to conceive. Since it takes sperm almost three months to form, you may not see improvement in semen quality until four months after stopping marijuana use.

MEMBER QUESTION:
I know caffeine adversely affects a woman's ability to conceive. What about its effects on a man's sperm?

LIPSHULTZ:
Caffeine does not appear to have a bad effect on a man's sperm.

MEMBER QUESTION:
What effect could a low-carb diet have on male fertility?

LIPSHULTZ:
Any overly restrictive caloric diet can impair the production of cells that are rapidly reproducing, like sperm. I would not think there's anything specific about a low-carbohydrate diet, but I might be concerned about a very low fat intake since testosterone is a derivative of cholesterol.

MEMBER QUESTION:
I have a low sperm count of only 7m. Can I still be able to make my wife conceive without any drugs/treatment?

LIPSHULTZ:
This is a very low sperm count. But as long as there are any active sperm, conception is possible. However, you require a thorough male evaluation by a urologist specializing in the area of male reproductive medicine and surgery. If you wait too long before evaluation, matters will be complicated by your wife's advanced age.

MEMBER QUESTION:
My husband has a strict Krueger morphology of 4%. IUI hasn't worked, but we did get pregnant naturally on a cycle following IUI. I had a chemical pregnancy. Could the low morphology of the sperm have caused the chemical pregnancy?

LIPSHULTZ:
Sperm with low morphology can still fertilize. There is no reason to think that after fertilization these sperm would increase the miscarriage rate. Morphology only describes the outside packaging of the sperm, which has nothing to do with successful embryo development.

"Since it takes sperm almost three months to form, you may not see improvement in semen quality until four months after stopping marijuana use."

MEMBER QUESTION:
Dr. Lipshultz, when is a Krueger test indicated? We have been TTC since November 2003. I have a normal workup. My husband has had one normal semen analysis by WHO criteria; morphology was 37%.

LIPSHULTZ:
Now. The WHO criteria for morphology are very superficial, and it's important that more sophisticated testing be performed. Also remember that a semen analysis is not a test of sperm function. Speak to your doctor about such tests as Krueger strict morphology, sperm penetration, and even tests to look at the genetics of male infertility.

MEMBER QUESTION:
What are the differences between the WHO and the Krueger tests?

MEMBER QUESTION:
How imperative is a Krueger analysis to confirm a previous normal (by WHO criteria) when finances are an issue? Are certain clinics less expensive (RE vs. independent)?

LIPSHULTZ:
WHO analysis of sperm shape "morphology" is fairly crude and just requires inspection of the sperm and determining at least 30% are normal in shape. The Krueger criteria require actual measurement of five different aspects of each sperm cell. Usually 200 cells are counted. Consequently, the Krueger test is a much more time consuming test, and expensive.

The question remains, however, as to how definitive are the findings from a Krueger analysis. Some labs have a normal Krueger analysis greater than 4%. Other labs use greater than 14%. However, these end points are not absolute; they are relative. Patients can conceive who have a lower Krueger morphology than a particular lab describes. These tests should always be done more than once, and the results interpreted by a physician experienced in sperm testing.

MEMBER QUESTION:
Generally speaking, if a man has produced other children with little or no problem then the problem is then not considered his?

LIPSHULTZ:
Certainly having fathered children in the past is a good sign that previous fertility was present, but many things can change over the passage of years. Be sure your husband is thoroughly evaluated despite his past history of positive fertility.

MEMBER QUESTION:
My husband had an undescended testicle when he was younger and did not have surgery to correct it until his teens. Now he has a low count. Thoughts?

LIPSHULTZ:
Men with even one-sided undescended testes do have lower sperm counts than the normal population. This is due to the fact that the opposite testis, despite normal position at birth, is often abnormal in function. It is now thought best to correct these undescended testes before 2 years of age. However, we cannot change what has already been done.

Make sure your husband examines himself once a month for evidence of changes in the testes, since he is at higher risk for testicular cancer in both testicles. In addition, he should have a thorough urology workup for fertility since there can be other causes other than the undescended testicle.

MEMBER QUESTION:
My husband is a couch potato. He doesn't exercise; he has high cholesterol, and is around 15 pounds over his ideal weight. Will that affect his fertility?

LIPSHULTZ:
It can. Fatty tissue can change male hormone to female hormone. And by upsetting the normal balance between the hormones, testicular function may be impaired. Make sure that he is tested for his testosterone, as well as estrogen levels the next time he's seen by his doctor. In addition, men who are in general out of shape, tend to have other lifestyle issues that can affect infertility. Doing what's healthy can only be a plus towards improving semen quality.

MEMBER QUESTION:
What affect does cigarette smoking have on sperm?

LIPSHULTZ:
Cigarette smoking has been shown in numerous studies to decrease semen quality. This can be seen as low sperm motility and/or decreased sperm morphology. We also know that cigarette smoking likewise can affect ovarian function. So it would stand to reason that similar problems can be seen in the male.

"In order to evaluate 'sperm quality' one has to go beyond the routine semen analysis and perform a test for sperm function."

MEMBER QUESTION:
What quantity of alcohol has detrimental affect on sperm? Are three or four glasses of wine on weekends only OK if no alcohol is drunk during the week?

LIPSHULTZ:
We don't know the "no effect" level of alcohol use. We know that excess alcohol can impair sperm quality, so it's best to keep alcohol consumption under control when trying to conceive. I would not think that several glasses on the weekend would be a problem if there's no alcohol use during the week.

MEMBER QUESTION:
Is it true a woman can be allergic to a man's sperm? If so, what can be done for this?

LIPSHULTZ:
Yes. It is true but uncommon. A true allergy to sperm has even been shown to cause anaphylaxis. There also may be a generalized irritation due to the components of semen, which does not truly represent an allergy. If this is a concern, then a potential allergic problem should be discussed with an allergist.

MEMBER QUESTION:
Does a sperm analysis cover everything about the sperm? Mobility, quality, etc?

LIPSHULTZ:
Mobility, yes. Quality, no. In order to evaluate "sperm quality" one has to go beyond the routine semen analysis and perform a test for sperm function. This will require the analysis being done in an up-to-date andrology/urology laboratory. Frequently these labs are associated with IVF programs. Don't assume a routine analysis is the end of a male's sperm testing. MEMBER QUESTION:
I've heard of men taking Clomid. Why and what does it do for them?

LIPSHULTZ:
Clomid blocks the estrogen receptors in the brain and causes increased production of the pituitary hormones FSH and LH. In the male, this can cause increased testosterone production. The theory, therefore, is that with increased testosterone production, as well as increased FSH and LH, sperm quality should improve. However, the use of clomiphene in the male in well-controlled studies has shown very controversial data. Clomiphene should not be used in place of a thorough evaluation of the male including hormone testing, semen analysis, and tests of sperm function.

MEMBER QUESTION:
My husband and I each have normal karyotypes; however, we produce genetically abnormal embryos. We are looking into donor egg or sperm, but we are wondering if there is a way to alter or improve the quality of the sperm to help produce genetically normal embryos?

LIPSHULTZ:
Two thoughts. Your husband's sperm can be tested to see if it has the normal compliment of chromosomes. This is done through fluorescent in situ hybridization, or "FISH." This test can be done in many genetic laboratories. It's also possible, as I'm sure you've been told, to biopsy the embryos prior to implantation.

MEMBER QUESTION:
Is there any reason to have my husband get any tests since we plan to start TTC within the next year? Or only if there seems to be a problem?

LIPSHULTZ:
Only if there seems to be a problem. However, if the woman is over 35, or if the man has a previous history that would put him at risk for poor semen quality, e.g. undescended testes, testicular torsion, testicular cancer, delayed puberty, etc., then it would make sense to at least get a semen analysis earlier than other situations.

"Men should understand that sperm production in no way reflects their masculinity or sexual function."

MEMBER QUESTION:
Can you talk about the over-the-counter sperm tests? Are they a good starting point for those squeamish about having an exam and lab analysis done, or should they simply be avoided?

LIPSHULTZ:
I think they should be avoided. The potential problem is that the male may be lulled into thinking that all is OK when the test really only tells us about sperm numbers. The sperm count is the least predictive aspect of the semen analysis. If there's any question, please get a complete semen analysis, and have it interpreted by an expert.

MEMBER QUESTION:
My husband is 34. Does sperm count go down with age?

LIPSHULTZ:
There is a statistical decrease in sperm count in men over 50. But it does not appear to be clinically significant.

MEMBER QUESTION:
What the best way to support a male with a low count?

LIPSHULTZ:
Men should understand that sperm production in no way reflects their masculinity or sexual function. All too often, this is confused. In fact, men who are under pressure to conceive may experience situational erectile dysfunction -- that is, an inability to perform during their wife's ovulatory period. It's important to minimize pressure and to make sure that your husband has a thorough evaluation to exclude treatable conditions.

MODERATOR:
We are just about out of time, Dr. Lipshultz. Do you have any final comments for us?

LIPSHULTZ:
My parting message would be male fertility is just as important as female infertility, because it takes a couple to have a baby. So both partners should be evaluated at the same time, and a positive outcome will be faster in coming.

MODERATOR:
Thanks to Larry Lipshultz, MD, for joining us. For more information about male fertility issues, you can visit Dr. Lipshultz at his web site, www.infertility-male.com. For fertility information from A to Z, be sure to explore all the TTC info here at WebMD, including our message boards and regular live chats with Dr. Amos Grunebaum. You can also explore the web site of RESOLVE: The National Infertility Association, at www.resolve.org.

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