Male Infertility Probed
By Ralph Cipriano
Reviewed By Charlotte Grayson
Jan. 1, 2001 -- Every morning before he goes jogging at 5 a.m., John Harrist grits his teeth and gulps down a few ounces of a citrus-flavored dietary supplement that the manufacturer says is "specifically designed to optimize sperm quality."
"It's not something that tastes great, I'm not gonna lie to ya," says Harrist, 32, a health officer for the city of Pearland, a suburb south of Houston.
Besides the taste, there's the cost. The supplement, called proXeed, costs $600 for a six-month supply. But Harrist thinks it's worth it: He and his wife, Laurie, have been trying for four years to have a baby, without success. The problem, according to Harrist's urologist, Larry L. Lipshultz, MD, is low-quality sperm.
That's why Lipshultz advised Harrist to start taking proXeed, an over-the-counter product manufactured in Italy for a Maryland company. Lipshultz is the director of the first U.S. clinical trial for the dietary supplement. Researchers are eager to find out if it works as they gain more knowledge into the nature of male infertility.
"We need to raise awareness of male infertility," says Lipshultz, director of the proXeed study and head of the Division of Male Reproductive Medicine and Surgery at Baylor College of Medicine. He ticks off statistics from a 1998 government study: 1.1 million U.S. women per year make appointments with their gynecologists for infertility. Of those cases, only 20% of male partners, some 250,000 men, were referred for evaluations, he says.
The main ingredients in proXeed -- levocarnitine and acetyl-L-carnitine -- have been "around for a long time," Lipshultz says. The ingredients have been tested many times in Europe -- where they have been used for some 30 years -- and while the results were encouraging, the tests were poorly done, he says. ProXeed also is being tested at The Jones Institute of Reproductive Medicine at Eastern Virginia Medical School in Norfolk, Va., site of the nation's first in vitro fertilization procedure.
In healthy people, levocarnitine is responsible for carrying fats into cells and also is a source of fuel, according to proXeed's manufacturer. Fats are the major source of energy for sperm movement. Acetyl-L-carnitine, the firm says, is important for the development of cell membranes, another important component of sperm that allows them to fertilize the egg. ProXeed also contains fructose, a major energy-yielding substance in semen, and citric acid, a key intermediary in energy production, according to the company.
A "Very Treatable" Condition
John Harrist is a typical male partner in an infertile relationship, Lipshultz says. Doctors couldn't find anything wrong with Laurie Harrist, so two years ago, they asked her husband to come in for an exam. Males often are overlooked in infertile couples, Lipshultz says, because they are seen as "just sperm producers." But almost half the time, it's the man who has the infertility problem, and male infertility is "very treatable."
Harrist was shocked when he found out he flunked his sperm test. The normal male is supposed to have between 60 million and 120 million sperm per milliliter of semen. Harrist's count was only 180,000 per milliliter. Also, his motility (the swim-like movement of sperm) was only 5%, meaning that just five of every 100 sperm were active. "I was scared to death," Harrist says. His wife had to leave work that day because "she was crying so hard."
Lipshultz determined that Harrist had circulation problems and performed a bilateral varicocele repair, relocating veins on either side of the testicles. The operation improves blood flow and lowers body temperature in the groin region. Harrist was sore for a few days but says the operation was "well worth what I hope it will accomplish" because test results showed dramatic improvement. Harrist's sperm count in November 1998 rose to 3.3 million, and motility increased to between 35% and 40%, according to the patient's medical files. But the numbers still weren't high enough, so Lipshultz recommended proXeed.
Harrist has been on the drug for four and a half months, taking it twice a day, seven days a week. His recent sperm counts have ranged between 3.5 million and 4.2 million, and his motility has varied from 30% to 40%. "I would definitely say it's helped me," Harrist says.
Harrist, however, is not a participant in the ongoing study of proXeed. He was disqualified because of his operation.
Harrist's sperm quality has improved while he has been on proXeed, Lipshultz says. Sperm quality is the subjective evaluation of how well sperm move. It's scored on a scale from 0 to 4.0, which is considered perfect. Harrist scored a 2.0 on sperm quality before his surgery, Lipshultz says. After the surgery, Harrist's score briefly rose to 2.5, then dropped again to 2.0. After he went on proXeed, Harrist's score rose again to 2.5, Lipschultz says.
Harrist is a former military policeman in the U.S. Army reserves who still answers questions with "Yes, sir" and "No, sir." He's in great condition, at a muscular 247 pounds on a 6-foot-6 frame. Nevertheless, a man's ability to produce quality sperm can vary greatly from month to month, and also can be affected by changes in health, diet, and hormone levels, says Lipshultz.
Harrist is on medication for high blood pressure but doesn't smoke or drink. He says he's probably had five beers in his entire life. He gets plenty of exercise. Five days a week, he goes jogging for three miles on suburban streets; then he goes to the gym to lift weights for 45 minutes.
He and his wife desperately want a baby. "My wife and I are both Christians who love children very much," he says. "We think we would be good parents."
It's gotten to the point where Laurie Harrist can't go to baby showers any more. "She couldn't go through the pain of going there," her husband says. "She would go to those things and cry and cry and cry."
Her period was 12 days late last month, but it was a false alarm. So John continues to work out, watch his diet, and take proXeed. And he and his wife keep praying.
"I know God will make it happen," he says.
Ralph Cipriano is a freelance writer from Philadelphia. He is a former staff writer for the Los Angeles Times and the Philadelphia Inquirer.
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