Boxers or Briefs - Male Infertility -- Larry Lipshultz, MD -- 09/25/02

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The opinions expressed herein are the guest's 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.

Male infertility contributes to 50% of all infertility cases, according to Larry Lipshultz, MD. Learn about the causes of and potential treatments for male infertility. As part of National Infertility Awareness Week, WebMD joined with RESOLVE: The National Infertility Association to bring you the Trying to Conceive Cyber Conference. Larry Lipshultz, MD, joined us to discuss male infertility.

Moderator: Joining us now is Larry I. Lipshultz, MD, professor of the Scott Department of Urology at the Baylor College of Medicine. He specializes in male infertility and male reproductive disorders.

Member: The chat title is "Boxers or Briefs" -- so which is it?

Lipshultz: It doesn't make any difference whether a man wears boxers or briefs. However, heat-retaining clothing should probably not be used excessively because of the known affect of heat on sperm production.

Member: Is a high pH level in a semen analysis any cause for concern?

Lipshultz: Most laboratories do not do pH monitoring anymore. We know that the prostate fluid is acidic and the other sex glands are basic. The higher the pH, the more basic the solution. A high pH might indicate too much seminal vesicle fluid or too little prostate fluid. But the test is very insensitive and, as I said, often not done in many labs.

Member: A fertility clinic recommended Fertility Blend for Men (dietary supplement) to optimize sperm quality and fertility health. The key ingredients are L-carnitine, folic acid, vitamins C and E, selenium, and zinc. Are there data that prove this improves sperm quality, or is it just a gimmick on the market?

Lipshultz: Each one of the substances in this over-the-counter preparation could have a potential beneficial effect on semen quality. However, I am not aware of any data that show conclusively that this really works. L-carnitine in two forms combined can be purchased as a food supplement called Proceed, which seems to have wide popularity and seems to have been effective in some European studies in increasing sperm count and especially motility. However, U.S. studies are in progress and the results still pending.

Member: My husband was ill in August and on antibiotics. Two weeks ago, he got an SA. Numbers were 9 ml/cc with half mobile. Is it possible the low count is due to that, and if so, can we expect it to improve when hubby goes back for a second SA in two weeks?

Lipshultz: It's known that high fevers can have an affect on sperm quality. Whenever a patient has a high fever or viral illness and then gets an initial semen analysis that is especially low, it is best to wait three months (the time for normal sperm production) to get another sample.

Member: Would the heat from a tanning booth affect sperm count, motility, etc.?

Lipshultz: We know that local applied heat to the testicle, for example from a hot tub, can temporarily lower sperm production. Environment heat, such as living in an extremely hot climate, does not appear to have a significant affect in decreasing sperm production. The tanning booth is an interesting issue because there is fairly intense heat for a short period of time. I've seen no studies on this but think it wise to keep the reproductive organs covered to avoid increased local heat.

Member: Are there any advances in sperm antibodies? My husband has 100% but we conceived one child with IUI and sperm washing. Not working now. Anything other than IVF available?

Lipshultz: Anti-sperm antibodies is a difficult problem to treat. We know that 70% of men after a vasectomy to have anti-sperm antibodies, but many of these men can still initiate a pregnancy after a vasectomy reversal. It's important to prove that the antibodies really are affecting the sperm's function. One way to do this is by looking at a postcoital test to see if the woman's mucus immobilizes otherwise active sperm. If this is clearly a problem, i.e. the sperm stop moving in the mucus, then the antibodies are very likely significant.

Sperm washing followed by IUI has been used but with questionable results, as has the use of oral prednisone. The only way to get around significant anti-sperm antibodies in a consistent manner has been shown to be IVF with ICSI (intracytoplasmic sperm injection).

Member: Are there any "natural" ways to augment sperm production? Herbs, exercise?

Lipshultz: In general, anything that's good for your health is most likely beneficial for sperm production. For example, moderate exercise, a well balanced diet, sufficient sleep, and minimal use of alcohol. There are really no proven herbs or supplements that have been show to be beneficial. In fact, some herbs can actually hurt sperm quality, and in general I would advise just sticking to antioxidants and a good daily vitamin.

Member: My doctor recommends testing the level of sperm DNA fragmentation prior to beginning IVF. Do you think testing sperm DNA fragmentation is a good idea?

Lipshultz: Yes. There has been increasing interest in DNA fragmentation assays. Most andrology laboratories are starting to offer this test in a variety of forms. One has to be sure that the laboratory that runs the test has established its own range of normals using pregnancy-proven donors.

Member: Bilat varicocelectomy for morph (0%) / mot (13%). 4 / 6 month post surgery improvements of 2 /3 % morph, 49% mot (and 1 IUI preg!...early mc). However, 9 / 10 mo IUI washes -- mot: 10%/17% pre, 39% post wash (25 tot motile). What could attribute to all these now immotile sperm from 50% mot 3 months earlier? Recent physical trauma (i.e. fever, heat)?

Lipshultz: All of the above possibilities exist, but we do not know whether any of them happened. It is possible that the varicocele has recurred or is persistent. This can be determined with a color flow ultrasound of the testes. One should also make sure there are not excess white blood cells or oxidants in the semen since this could be affecting the motility.

Member: Heat has a negative effect on sperm quality, but what about cold? My sister is convinced that she finally got pregnant because her partner swam a lot in a cold lake the months before they conceived.

Lipshultz: While heat is bad for sperm production, there's certainly no evidence that excess cold is good. The success following swimming could have just been as likely to the individual exercising more and being generally healthier.

Member: Is it true that you can increase your chances of TTC if you have sperm antibodies by the woman giving fellatio to her partner and ingesting.

Lipshultz: I don't think this is true. In fact, it would seem that the production of antibodies by the female should be something to be avoided since we do know that women with anti-sperm antibodies in their blood may have more difficulty conceiving. I'm sure this theory was a man's.

Member: Can you elaborate on the comment "sperm washing followed by IUI has questionable results?" Is that only related to antibody problems? Could you please explain?

Lipshultz: I was primarily addressing the issue of sperm washing and it's ability to decrease anti-sperm antibodies.

Member: my wife and I have been trying for five years to have a baby. She has been checked out completely and I have a 9-year-old daughter. Is there anything that could have happened with me to cause me to become less fertile?

Lipshultz: Yes. It is well known that one of the most common reasons for secondary infertility is a man's progressive loss of good semen quality due to varicoceles. An individual over a 9- to 10-year period could certainly develop other problems that might lead to poor sperm production. For example, the development of an ejaculatory duct obstruction, epididymitis. Having established one pregnancy in the past does not ensure that one's semen quality will remain perpetually the same. You still need to be evaluated.

Member: Is the reoccurrence of varicocele common after a varicocelectomy? If so, what is the time frame of reoccurrences?

Lipshultz: I generally tell my patients that a varicocele can recur in 5% to 10% of patients. However, this is a very general figure, and much depends on the technique that was originally used. It seems that adolescent varicoceles for some reason have a much higher recurrence rate. Actually what I think is termed a recurrent varicocele is really a persistent varicocele that may have been missed postoperatively. If one needs to have the varicocele corrected again, there is the option of embolization by an interventional radiologist who has experience with this somewhat difficult technique.

Member: My husband had a sperm chromatin test done and it came out normal. How reliable is this test?

Lipshultz: A sperm chromatin assay is not a widely performed test. I think if one is concerned about chromosomal quality, then a DNA fragmentation assay would be preferable.

Member: Can a high pH level cause an allergic reaction to seminal fluid in a woman?

Lipshultz: While there have been reports of women getting allergic reactions to semen, it has never been shown that the acidity of the semen is a contributing factor. One has to be sure that the problem is not due to lubricants used at the same time.

Member: Does the sperm count have to be at least 20 million in order for IUI to be successful?

Lipshultz: Most laboratories that perform IUI do have limits below which they advise that IUI is unlikely to be successful. These limits are usually based on the total motile sperm available after sperm processing, and it is not uncommon for a laboratory to set a lower limit of 5 million motile sperm. Twenty million seems to be very high and may represent the laboratory's prerequisite prior to sperm processing. But the sperm motility is even more important than the count.

Member: How does DNA fragmentation in sperm affect the situation? Does it affect fertilization? Embryo development? Please clarify.

Lipshultz: It can affect both of the activities you mentioned. Some centers feel that if the DNA fragmentation is above a predetermined limit, even ICSI will not likely be effective. However, DNA fragmentation assay has only recently become more widely used. I would be hesitant to deny a couple's access to an IVF cycle based on one laboratory test.

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

Lipshultz: I appreciate all the questions, and it's reassuring that so many people realize that infertility is not just a woman's problem.

Moderator: We are out of time. Thanks to Larry Lipshultz, MD, for joining us this hour. To learn more about male infertility, visit Dr. Lipshultz's web site at www.infertility-male.com. For more information about this and other fertility issues, be sure to explore all the TTC info here at WebMD, including our message boards and regular live chats with Dr. Amos Grunebaum.



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