Posts Tagged ‘Infertility’

Obese, Overweight Men Have Inferior Semen

Men who are overweight or obese have lower sperm counts and lower ejaculate volumes, according to the results of the first study to make this association in men who were trying to conceive, but who did not have known infertility.

“Our study provides further data showing the link between being overweight and sperm quality,” said lead author Dr. Michael Eisenberg of Stanford University School of Medicine.

“Most prior studies examined infertile men only, while our study examines all men who were trying to conceive.

Moreover, we looked at both body mass index (BMI) as well as waist circumference to determine the relationship with sperm production.”

Dr. Eisenberg and colleagues examined data from the Longitudinal Investigation of Fertility and the Environment Study, a population-based, prospective cohort of more than 500 couples attempting to conceive in Texas and Michigan.

They analyzed data from 468 men, mean age 32, the majority of whom (82%) were overweight or obese.

More than half said they participated in physical activity less than once a week.

Fewer than 10% had a low sperm count.

The researchers reported their results online on December 4, 2013 in the journal Human Reproduction.

When the researchers examined semen parameters, they found that ejaculate volume declined with increasing BMI and waist circumference.

Similarly, the total sperm count showed a linear decline with waist circumference.

A man in the normal BMI range had an ejaculate volume of 3.3 mL, compared with 2.8 mL for men who were severely obese.

Men with the largest waists, more than 40 inches, had about 22% lower total sperm count compared with men who had waist measurements under 37 inches.

The percentage of men with abnormal volume, concentration, and total sperm increased with increasing body size.

There was no significant relationship seen between body size and other fertility factors, including semen concentration, motility, vitality, morphology, or DNA fragmentation index.

“Body size as measured by BMI or waist circumference is negatively associated with semen parameters, with little influence of physical activity,” Dr. Eisenberg noted.

The Heavier Man, The Lower the Sperm Count

The heavier the man, the higher the chances of a low sperm count, he suggested.

“I think bringing attention to another adverse outcome of obesity is important,” Dr. Eisenberg said.

“Men need to know that in addition to health aspects, obesity may also impair reproductive goals.”

It’s still unknown what a reduction in body weight does to the sperm counts of men starting with a low sperm count, Dr. Eisenberg noted.

“We don’t have a good answer at this point,” he said.

“However, we do know that weight loss helps overall health, so at a minimum we can expect a health benefit for an overweight man who loses weight.”

Dr. Eisenberg stated that primary care physicians need to “bring awareness to this relationship.

This may provide another motivation for men to change lifestyle habits, knowing that it can impact fertility.”

In addition, as men discuss plans for starting a family, this study can provide important information as to who may be at risk for impaired fertility, he noted.

Upgrading Fertility Status with Varicocele Repair

The most common identifiable cause of infertility in men is a varicocele.

Approximately one third of infertile men who have never fathered a child have a varicocele, and up to 80% of men who were once fertile, but are now infertile, also have a varicocele.

Varicoceles are abnormally enlarged veins draining the testicles.

They cause pooling of blood in the scrotum and a rise in testicular temperature.

Even one degree rise in temperature in the scrotum can have an adverse effect on sperm production and testosterone function.

The good news is that varicoceles are treatable, writes Marc Goldstein, MD, who is the Matthew P. Hardy Distinguished Professor of Reproductive Medicine and Urology at the Weill Cornell Medical College of Cornell University, and Surgeon-in-Chief, Male Reproductive Medicine and Surgery at the New York Presbyterian Hospital, Weill Cornell Medical Center in New York, in a blog for the American Fertility Association.

“Dozens of reports have been published demonstrating the benefit of varicocele surgery to improve sperm counts,” writes Dr. Goldstein, who is also co-author of the book A Baby at Last!.

“Yet, varicocele repair remains controversial, particularly for small varicoceles that can’t be seen or felt on a physical exam.

Studies have shown greater improvements in semen quality for repair of large varicoceles compared with smaller ones.”

Dr. Goldstein details how he developed a microsurgical technique of varicocele repair using an operating microscope.

This technique can help couples achieve a 43% pregnancy rate after 1 year.

Microsurgical varicocele repair also:

— decreases sperm fragmentation, or the breaking up of DNA strands into pieces

— may cost less than in vitro fertilization with a single sperm injection (intracytoplasmic sperm injection, or ICSI)

— can induce sperm formation and help achieve pregnancy for couples in which the man has a zero sperm count (azoospermia) or a severely low sperm count and low sperm motility

— improve testosterone levels in two-thirds of men

“In conclusion, varicocele repair is a cost-effective treatment of infertility,” writes Dr. Goldstein.

“Men can upgrade to normal semen, which can allow for a natural pregnancy, or upgrade to semen of adequate quality for intrauterine insemination.

Men with azoospermia may produce ejaculated sperm adequate for ICSI.

Even if a man remains azoospermic, varicocele repair may enhance spermatogenesis allowing enough sperm production for ICSI.

Finally, microsurgical varicocelectomy will improve testosterone levels in a majority of men, which is a men’s health issue aside from fertility.”

Early Chemotherapy Can Compromise Female Fertility

A number of chemotherapy or anticancer medications may compromise a woman’s fertility.

Now it appears that the earlier the cancer diagnosis, the higher the risks for later infertility.

Some chemotherapy medicines, like those in the alkylating agents group, can cause infertility.

These types of chemotherapy medicines can be used to treat many different kinds of cancer, not just cancers that affect the reproductive organs.

Chemotherapy mostly causes infertility by reducing the number of eggs in your ovaries or by causing early menopause.

Many women who receive chemotherapy and radiation for Hodgkin’s disease go into premature menopause because of damage to their eggs or follicles.

Those exposed to both therapies suffer more damage than those who receive only one therapy.

Focusing on longer-term, age-specific outcomes associated with chemotherapy, researchers at the University of California at San Francisco have found that the younger a woman is when diagnosed with cancer, the more likely she will experience early menopause.

Key findings from a survey of more than 1,000 women in a California cancer database, now available online in the journal Cancer, include:

* From 5-10% of women reported acute ovarian failure, which increased significantly with age at diagnosis.

* The incidence of infertility increased significantly with age at diagnosis.

For example, for women with Hodgkin’s disease, 18% were infertile at age 20 compared to 57% at age 35.

* Using age as a predictor of early menopause in non-Hodgkin lymphoma, more than half of women age 20 at diagnosis experienced menopause early compared to one in 6 who were age 35 at diagnosis.

“We noted proportions of infertility among cancer survivors that appear considerably higher than those in the general United States population,” said lead author Joseph Letourneau, MD.

Not all women who are having cancer treatment have the opportunity to talk with a fertility specialist before beginning treatment.

Yet there are several options to preserve a woman’s fertility, including freezing embryos, eggs, or tissue from her ovaries before she goes for cancer treatment.

If you have received a cancer diagnosis, particularly if you had cancer in your 20s, ask your oncologist how you can preserve your fertility.

Does Mind Over Body Delay Premature Ejaculation?

Premature ejaculation is a common sexual dysfunction found among men with infertility.

Between 50-75% of men with infertility report having problems maintaining an erection long enough to ejaculate.

Researchers have linked premature ejaculation to a variety of conditions, including anxiety, a malfunctioning ejaculation reflex, prostate disease, and chemical imbalances in the brain, as well as possibly to genetics.

Sex therapy can help couples with emotional issues about sex, and also teach “stop-start” techniques that help men learn more control.

While famous sex researchers Masters and Johnson reported early success with behavioral therapy, a new systematic review found it’s not so easy to teach men to control their bodies with their minds.

The new Cochrane Collaboration review of 4 trials involving 253 premature ejaculation patients finds the effectiveness of psychological interventions for the treatment of premature ejaculation to be “weak and inconsistent.”

Medical therapy may be a better way to go.

Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), paroxetine (Paxil), or fluoxetine (Prozac), can be effective in treating premature ejaculation.

That’s because one of the side effects of these drugs is to delay ejaculation.

A low dose of an SSRI several hours before sexual intercourse may be enough to improve a man’s symptoms.

However, SSRIs may have a negative impact on semen quality.

Studies at Weill Cornell Medical College in New York have shown that SSRIs can reduce semen volume and increase damage to the DNA in sperm, which is called DNA fragmentation.

Or you may prefer to use a topical anesthetic cream applied to the penis to delay ejaculation.

These creams contain lidocaine or prilocaine to dull sensations on the penis.

A man applies the cream just before intercourse and wipes it off when his penis has lost enough sensation to delay ejaculation, which can take up to 45 minutes, and puts on a condom.

However, some men and women say using topical anesthetic creams reduces their genital sensitivity and their sexual pleasure.

For fertility purposes, as long as the man is capable of ejaculating, the couple could also use artificial insemination to achieve a pregnancy.

“Klingon Cloaking Device” May Be Key to Male Infertility

The lack of a protein that normally coats sperm may be the reason why some sperm don’t reach the egg to fertilize it.

This protein acts as a “Klingon cloaking device” to allow sperm to swim through cervical mucus and avoid the immune system on its long journey to the egg, says Gary Cherr, a professor at the UC Davis Bodega Marine Laboratory and Center for Health and Environment.

The protein DEFB126 is generated by a specific gene, and men with two copies of the defective gene do not produce the protein, the researchers reported in a study published online on July 20 in the journal Science Translational Medicine.

Some 70% of men have infertility that can’t be explained based on their sperm count and quality, say the researchers.

This discovery may help explain a significant portion of this infertility.

In tests of men worldwide, they found about half of all men carry 1 defective copy.

One quarter have 2 defective copies and therefore make sperm that are poor at swimming through cervical mucus.

In studying about 500 couples in China who were trying to become pregnant, they found that men with 2 copies of the abnormal gene were 30% less likely to father a child over about a 2-year period.

And it took nearly 2 months longer for the couples to have a baby if the man had 2 copies of the abnormal gene.

The researchers are now looking to develop a test for the mutation.

If a couple found that the man has a double mutation, they could go directly to single-sperm injection with intracytoplasmic sperm injection, or ICSI, to inseminate the woman’s egg.

Choosing a healthy sperm becomes crucial to ICSI success.

In a natural conception, only the fittest and healthiest sperm makes the arduous journey to the egg.

ICSI bypasses this natural selection barrier, so the chances of a genetically abnormal sperm fertilizing an egg are higher.

A new test for sperm DNA damage could help select the best sperm for a single-sperm injection.

Infertile Couples Can Cope with Family Gatherings

The media treat Mother’s Day as a news peg to publish articles about happy families celebrating having children.

Headlines recount tales of how couples celebrate Mother’s Day after in vitro fertilization (IVF) treatments for endometriosis and blocked fallopian tubes or to overcome production of too few eggs.

Other articles tell of dozens of IVF moms gathering at a fertility clinic to form their own support group.

But infertility may cause a tremendous amount of strain on relationships with family and friends, particularly on Mother’s Day.

Family gatherings may be particularly painful as you deal with loss and grief.

Some families and friends are supportive, while others just add to your stress.

This may make you angry or cause you to isolate yourselves from them.

You may feel jealous of friends and relatives who have babies.

Friends and relatives may aggravate the situation by repeatedly asking you when you plan to have a baby, or by unwittingly talking endlessly about their own children.

Some family members may want to help, but don’t know what to do or say, while others may prefer to avoid the topic completely.

Many people feel uncomfortable discussing infertility because it relates to having sex.

The older generation may be ignorant of modern technology and new methods of conception.

Siblings and friends may flaunt their own fertility, intentionally or unintentionally.

If you feel a lack of understanding, you may not want to go home for the holidays or may decide to avoid anything having to do with children.

But you don’t want to sacrifice your social networks just when you need them the most, say Weill Cornell fertility experts Drs. Zev Rosenwaks and Marc Goldstein, the co-authors of A Baby at Last!.

If you put a temporary limit on contact with insensitive family members and friends, seek out help from other more supportive friends and family members, therapists, or online or in-person infertility support groups, they write.

Also, a family gathering may be the right time to share your experiences with family members.

The doctors suggest you might speak to one or two family members ahead of time and let them spread the word, or simply answer probing questions honestly.

Be aware of who is capable of being understanding and supportive, and increase your time with those people.

Reduce your time with those who cannot provide the support you need.

Also, take heart that more and more fertility treatment are now available to couples.

Half of all women under age 35 going through one IVF cycle at Weill Cornell take home a baby.

Bust an Infertility Myth

This week (April 24-30) is National Infertility Awareness Week® (NIAW), a federally recognized health observance designed to raise awareness about infertility.

RESOLVE, the largest nationwide non-profit improving the lives of people diagnosed with infertility, founded NIAW more than 20 years ago to encourage people to take charge of their reproductive health.

This year the organization has added social media to its public education campaign with a Bust an Infertility Myth Blog Challenge.

The goal of the challenge is to bring together bloggers from the infertility community as well as other bloggers interested in the topic to answer the question: What is the biggest infertility myth and how has it affected your life or the life of your friends and family members?

Blogs can be based on your own experience with infertility, the experience of a friend or family member, or even just to explore the topic.

So far, more than 70 bloggers have taken up the challenge.

The blog topics range from “Relax! You’ll get pregnant when you’re supposed to!” to “It will happen if it was meant to be” to “The second one’s easier”.

RESOLVE busts a myth every day this week. Today’s Busted Myth of the Day is “You waited too long to have kids.”

Busted!: While it is true that fertility decreases with age, youth does not guarantee fertility. Many men and women in their 20’s have infertility. And women in their early 40’s can get pregnant and deliver healthy babies. However, if you know that you want to have children, the earlier you try, the less likely it is that you will have trouble.

If blogging is not your thing, you can still get involved in support of infertility. There are more than 50 infertility awareness events happening this week, along with 18 RESOLVE support groups and 2 RESOLVE TeleSeminars and Educational Programs.

Fertility Options Move Beyond Sperm and Embryo Banks

Cancer treatments such as chemotherapy and radiation can cause a woman to experience premature menopause and diminish her chance of getting pregnant. Similarly, chemotherapy, radiotherapy, or radical pelvic surgery can reduce a man’s ability to produce sperm.

In fact, 140,000 men and women younger than 45 years old face a cancer diagnosis each year.

But all is not lost for those who suffer from infertility caused by cancer treatments. Many survive treatment and are still young enough to have children.

There are ways to preserve a woman’s fertility, including freezing embryos, freezing her eggs, or freezing tissue from her ovaries before she goes for cancer treatment.

In the first and most effective method, a woman can undergo an IVF stimulation cycle, and the retrieved eggs can be fertilized with her partner’s or donor sperm.

The newly created embryos are then frozen with the anticipation that she will have the embryos replaced back to her uterus when she is cured.

That’s just what Ewelina and Dominic Saputo did.

Ewelina received a leukemia diagnosis when she was 23, and she and her then finance went through the process to create and freeze embryos, according to a recent Detroit Free Press article.

Six years later, the young couple from Sterling Heights, MI, just north of Detroit, went through an IVF procedure, and they now have twin, 10-month-old boys, Julian and Antonio.

For men, sperm collected before cancer treatment can be saved for many years.

World-renowned cyclist Lance Armstrong became a father for the fourth time after his sperm were preserved before his treatment for testicular cancer.

One of the innovative techniques available to men is to obtain tissue samples with a tiny needle and then use them to fertilize an egg stored for later use, which is called testicular sperm extraction.

The newspaper article includes a nice chart of simple or minimally invasive techniques available or coming soon to leading fertility programs for both men and women.

If you receive a cancer diagnosis, ask your oncologist how you can preserve your fertility.

New IVF techniques have taken fertility preservation to a whole new level.


NY Resident magazine book review

Welcome to my new blog. My current news is the positive responses I’ve been getting regarding my latest book, A Baby At Last!

A very favorable review ran in this month’s issue of the Resident magazine.

A Couples’ Guide to Getting Pregnant

“Everyone seems to know someone who has a fertility problem…”  That’s the start of  A Baby At Last!: The Couples’ Complete Guide to Getting Pregnant—from Cutting-Edge Treatments to Common Sense Wisdom by Mark L. Fuerst, Zev Rosenwaks, M.D., and Marc Goldstein, M.D.

This book is for every couple seeking a solution to fertility problems. It conveys the knowledge that you are not alone and much can be done. You’ll learn when to seek help, how to find doctors and ask the right questions, what tests are worth having and why. The book covers up-to-date therapies and provides support for the emotional rollercoaster of fertility treatments.

Céline Dion’s many failed attempts at in-vitro fertilization were heartbreaking but in October 2010 the 42-year-old singer gave birth to twin boys. She said, “When I think about Dr. Rosenwaks and the extraordinary talent and intelligence that allows him to combine nature and genius to create new life, I am in awe and forever grateful for his talent.”

“Sugar” Ray Leonard, six-time world boxing champion, said, “One of my toughest fights was to father children with my loving wife, Bernadette. After two failed surgeries, I found Dr. Goldstein. My greatest victories are my Olympic gold medal, my world titles, and my family, the last one with thanks due to Dr. Goldstein.”

Mark L. Fuerst’s writing talents shine. Publishers Weekly said, “The text is reader-friendly and accentuated with informative ‘Take Home Messages’ that will help couples expand their knowledge and foster fertility success.”

About the Authors

Mark L. Fuerst is a health and medical writer and coauthor of ten books including The Couple’s Guide to Fertility. His many articles on fertility have appeared in major magazines.

Zev Rosenwaks, M.D. and Marc Goldstein, M.D. are fertility experts at the NewYork-Presbyterian/Weill Cornell Medical Center, a leading pioneer in treating infertility.

By Dorri Olds