By Amos Grunebaum
WebMD Live Events Transcript
If you're trying to conceive, or even just planning a pregnancy, remember it takes two to tango! Did you know that 50% of fertility problems involve the man? WebMD Fertility Clinic medical director Amos Grunebaum, MD, talked about the male side of trying to conceive on WebMD Live.
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.
Member question: What's your take on Sperm Survival Studies? After TTC No. 1 for over a year my husband just failed his with zero motility by 24 hours. We have done three IUIs tries with Clomid and injectables and now they are recommending IVF with ICSI as our only hope. I was wondering if you think we are jumping into IVF too soon or if we are on the right path.
Dr. Amos: I really can't say much about sperm survival studies. They are not well accepted among urologists. Most urologists feel that the sperm analysis provides you with the best information. And after three unsuccessful IUIs your chances getting pregnant are best with IVF.
Member question: I was wondering if saliva does kill sperm?
Dr. Amos: There have been many studies done on what influences sperm survival. And most studies show that saliva can have a negative effect on sperm. If he has enough sperms then it's unlikely to make a major difference, but if he has a low sperm count then you need every single sperm.
Member question: Dr. A, there are a lot of differing opinions regarding the morphology of sperm, what is your take on this issue? I have "poor" morphology (9% normal forms) but good motility.
Dr. Amos: There are different numbers considered abnormal when it comes to morphology. Some want at least 30% normal; others say 12% is the lowest cutoff. It also depends on what the TOTAL count is. So if you have 20% normal morphology and 100 million moving then there are 20 million normal moving. But if you have 10% normal morphology and 300 million moving, then you have 30 million even with a lower normal morphology. You may want to take all data into account before making a decision on normal or abnormal.
In the WebMD Fertility Center we have a sperm calculator. You plug in the data and it shows you how many normal and moving sperm there are.
Member question: When male factor is an issue when do you suggest a couple move from IUI to IVF? How many cycles of IUI should a couple try?
Dr. Amos: You need to be a little more specific for me to understand what the exact problem could be, but with 'male issues' IUI is often much less successful, so your chances of getting pregnant are much higher with IVF and ICSI, which stands for intra cytoplasmic sperm injection. A sperm is taken and directly injected into the egg, so all that is needed is one single sperm.
Member question: If a man uses smokeless tobacco does it affect his sperm count and motility?
Dr. Amos: Any nicotine or drug can affect the sperm production, so you may want to ask him to stop using it if he is interested in improving his fertility. You may also do a sperm count to find out whether and how much it's affecting him.
Member question: Does a man taking folic acid really help reduce birth defects?
Dr. Amos: Not much is known about the man taking folic acid and prevention of birth defects, but it can't hurt to take a multivitamin supplement while TTC.
Member question: I had a miscarriage in November and my husband uses smokeless tobacco; could the miscarriage have had anything to with his sperm being defective because of the tobacco?
Dr. Amos: Not much is known about tobacco used by him and miscarriages. Most early miscarriages are because there are chromosome problems in the embryo, and most of the time it's related to something that cannot be controlled either by her or him.
Member question: My DH had his sperm analysis done this morning. What kind of numbers would be considered good?
Dr. Amos: There is so much information in a sperm count it's impossible to list it all. The major information is:
- His volume (normal = over 2 cc)
- His count (normal = well over 20 million per cc)
- Morphology (normal = over 30%)
- Motility (normal = over 50%)
Member question: So just because a man ejaculates that doesn't always mean that there is sperm in the ejaculation or there is always some sperm in the ejaculation?
Dr. Amos: Correct. The ejaculate consists of many different fluids coming from different glands. Just because there is fluid doesn't necessarily mean that there are enough sperms inside the fluid.
Member question: If a doctor was concerned that a man's sperm was not penetrating an egg, would that be because of poor motility or morphology?
Dr. Amos: It is usually another problem altogether. You may want to ask your doctor exactly how she or he came to this conclusion. It's difficult to make this diagnosis unless you do specific tests, and many specialists do not pay too much attention to this finding anyway. Nowadays, with IVF and ICSI most problems can be easily solved, and the success rate for getting pregnant with IVF/ICSI is well over 50% with these problems.
Member question: What would cause my husband's SA to come back as "not enough cells to test?" We abstained three days beforehand and got the sample there within half an hour.
Dr. Amos: I am unsure about this finding. You should ask what "cells" means. Were there no sperms at all? Did they look at other things? You are usually told exactly how many sperms there were, what the volume was, etc. I personally have never seen a finding of "no cells." "No sperms," maybe, but not "no cells." I suggest you get the information from your doctor who can explain better what it could be.
Member question: Does hypothyroidism in a male affect his fertility?
Dr. Amos: Hypothyroidism is an underactivity of the thyroid. In any hormone system, both male and female, the thyroid plays an important role. So with an underactive thyroid that is not treated correctly there is an increased chance of sperm production problems. But once the thyroid issue is resolved most sperm problems will resolve too.
Member question: Is it true that Mountain Dew and Mello Yellow lower sperm count?
Dr. Amos: NOT TRUE! It's an urban myth. There is no scientific evidence that these lower the sperm count. I am unsure where this comes from, but no reliable studies can confirm it.
Member question: What about a hot shower? Does that lower sperm count or have any negative effects?
Dr. Amos: Hot showers should not lower the sperm count. The body temperature does not usually increase with a shower, though it may increase with a sauna or a long hot tub stay. So those are not suggested when you actively TTC. Please remember that it takes sperms 10-11 weeks to be produced, so anything that happens today will affect the count potentially for the next three or so months.
Member question: So are you saying that a long hot tub or sauna stay can reduce sperm count?
Dr. Amos: Long stays in hot tubs or saunas can increase the temperatures in his testes. This could affect his sperm production. When you TTC you may want to shorten these activities.
Member question: Can sperm only swim in fertile cervical mucus?
Dr. Amos: Sperm LOVE fertile cervical mucus. That's where they thrive best and survive the longest. They can also move through drier mucus, but not as well. If there is a problem with mucus some doctors suggest IUI. This bypasses the mucus and deposits sperm directly inside the uterus.
Member question: My husband is an amateur cyclist and decathlete. He had a sperm analysis in January that came back slightly below average, but he also had a fever in late December for a week and was sick with the flu. We are TTC and have been referred to fertility specialist. I don't know how much negative effect cycling one to two hours a day has on his count/motility.
Dr. Amos: Prolonged and active cycling with tight pants can theoretically affect his sperm count. You may want to repeat the count to see if it was the fever that may have been the problem.
Member question: If a man has fairly good counts does that mean he will always have sperm in the ejaculation, or can he still "miss out" sometimes?
Dr. Amos: Obviously the human body changes. And just because there was a good count on one day doesn't mean it's good forever. Testes can be damaged, there may be excessive heat, or he may take drugs affecting his count.
Member question: What can a man do to increase his sperm production, short of medical treatment?
Dr. Amos: Unfortunately there is no magic pill for a man to increase his count. Living healthily, eating healthily with a well-balanced diet, and making sure his testes don't overheat are the best recommendations. There are some studies showing that adding zinc to the diet could improve his count. Though there is no known magic number, taking zinc and vitamin C is not a bad idea.
When there is a low count you may want to get examined by an urologist. Sometimes the reason for the low count is a varicocele. That's an enlargement of veins inside his scrotum where the testes are. Performing surgery to remove this varicocele sometimes improves his count.
Moderator: Thanks to Amos Grunebaum, medical director of the WebMD Fertility Center, for joining us.
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