Posts Tagged ‘Marc Goldstein’

Public Enemy #1 for Male Fertility: Anabolic Steroids

Anabolic steroids, such as testosterone and its derivatives, are often taken by athletes to get “pumped.”

But these drugs have a unique side effect — they can shrink a man’s testicles and drastically reduce his fertility.

One of the more serious side effects of these poisonous chemicals is on male reproductive organs, says Marc Goldstein, MD, director of the Center for Male Reproductive Medicine and Microsurgery and surgeon-in-chief of male reproductive medicine and surgery at Weill Cornell Medical Center.

“Because of the high level of circulating testosterone caused by the steroids, the testicles no longer need to manufacture this hormone, so they being to shrink.

This reduces sperm production and may lead to both impotence and sterility,” says Dr. Goldstein.

In a new article posted on the American Fertility Association website, Stanton C. Honig, MD, Associate Clinical Professor of Surgery/Urology and Obstetrics and Gynecology at the University of Connecticut School of Medicine, examines how anabolic steroids affect male fertility.

“The use of anabolic steroids historically has been used by athletes in major sports, such as weight lifting, baseball and football,” writes Dr. Honig, who is also a Staff Urologist at Yale New Haven Hospital and the Hospital of St. Raphael in New Haven, CT.

“Because these so-called ‘role models’ use these drugs, anabolic steroid use or abuse has filtered down and is being used by recreational weight lifters, college, and high school athletes.”

The good news is that in many cases this problem is reversible, Dr. Honig says.

Once performance enhancing drugs (PEDs) such as steroids are stopped, sperm production may start again and sperm will return in the ejaculate, usually in about 3 months.

However, for those who have used steroids for years, this may take up to 2 years.

Once steroids are stopped, medical therapy may help enhance the ability of a man’s body to restart sperm production.

What’s more, PEDs can also cause sexual dysfunction, Dr. Honig notes.

When testosterone levels crash, this may lead to tiredness, loss of energy, and loss of sex drive.

“The most important point here is if you want to have children at some point in your life, DON’T USE ANABOLIC STEROIDS!!!” Dr. Honig admonishes.

And Dr. Goldstein agrees: “If you want to preserve your fertility, do not use anabolic steroids.”

In fact, testosterone has been successfully used as a contraceptive for men, he notes.

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.”

Some Surprising Causes of Male Infertility

A number of lifestyle factors play a role in a man’s fertility.

About 25% of the time, a man could have avoided infertility by being more aware of lifestyle choices that can harm sperm, says male fertility expert Marc Goldstein, MD, in a new article in the Wall Street Journal about the surprising causes of male infertility.

The article highlights certain lifestyle factors, specifically an adolescent groin injury, cigarette smoking, heavy drinking, intense cycling, and even using a laptop directly on the lap.

In A Baby at Last!, Dr. Goldstein and co-author Zev Rosenwaks, MD, fertility experts at New York Presbyterian/Weill Cornell Medical College, provide a list of lifestyle factors that can impair a man’s fertility.

These include:

–smoking cigarettes

–heavy drinking

–stress

–excessive weight

–exposure to heat

–recreational drug use

–sexually transmitted diseases

–genital infections that lead to sperm busters called antisperm antibodies

–drugs to improve sexual performance

–health kicks such as too-strenuous exercise

On Dr. Goldstein’s Cornell Institute for Reproductive Medicine website, he describes “10 Tips to a Fertile Lifestyle” that provide guidelines on how a man can maintain his fertility.

In their book, the two fertility doctors suggest what a man and a woman can do to “upgrade” their fertility.

Their take-home messages for men are:

• To optimize your chances of producing viable sperm, live a fertile lifestyle: don’t smoke, limit your drinking, minimize stress, be physically active, maintain a healthy weight, eat lots of fresh fruits and leafy, green vegetables, take fertility-enhancing vitamins, and avoid recreational drugs.

• Protect yourself from damage from sexually transmitted diseases.

• If you take prescription medications regularly or you need cancer therapy, talk with your doctor about strategies to preserve your sperm.

• Reduce your exposure to environmental hazards.

• If you are a man, avoid activities that raise the temperature of your testicles, ask your doctor for help with erectile problems, and don’t take hair-growth pills.

Adopting these healthy lifestyle habits, and avoiding negative habits, will help preserve your fertility and increase your chances of fathering a child.

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.

Cancer Survivors Can Father Children

Men who have a zero sperm count from cancer treatments may still have a chance to father a child.

“We can usually retrieve sperm from the testicles of 30-50% of men who had chemotherapy even 15 or more years ago. Using ICSI, about 20% take home a baby,” write Weill Cornell Drs. Zev Rosenwaks and Marc Goldstein in A Baby at Last!

Sperm can be extracted using a procedure called microdissection testicular sperm extraction (TESE), a procedure that was developed by Weill Cornell researchers.

The procedure enables doctors to identify small areas in the testicles where sperm are made and then carefully extract these healthy sperm cells, even in men whose testicles have been severely damaged by chemotherapy. These sperm are then directly injected into a woman’s egg using an advanced in vitro fertilization (IVF) procedure called ICSI, which stands for intracytoplasmic sperm injection.

In a new study published online in the Journal of Clinical Oncology on March 14, Weill Cornell researchers report on more than 1,000 TESE procedures on nearly 900 men, including 73 cancer patients.

The researchers retrieved sperm in 27 (37%) of the cancer survivors, which led to the birth of 20 children using IVF techniques.

If you have cancer, the type of cancer and type of chemotherapy you receive affects your chances of successful sperm retrieval. For men with testicular cancer who received platinum drugs, the sperm retrieval rate was 85%. Men with lymphoma treated with an alkylating agent such as cyclophosphamide had lower retrieval rates, ranging from 26-36%. Sarcoma patients had the lowest retrieval rate, only 14%.

“When we started this study, we thought sperm retrieval rates would be close to zero among the group of cancer survivors, but we were surprised to discover that in many cases small areas of testicular tissue survived and resumed sperm production over a period of several years,” said lead author Peter Schlegel, MD, chairman of the Department of Urology at Weill Cornell Medical College, in a press release about the study.

“This study gives men a new way to achieve fertility and the potential of parenthood. Survivors of childhood cancer should be made aware of options besides using banked sperm, adoption or donors if they want to be fathers,” noted Lisa Diller, MD, Associate Professor of Pediatrics, Harvard Medical School, in the release.

Because the numbers of sperm retrieved from the testicles of cancer survivors are low, TESE is best performed at the time of egg retrieval so that fresh sperm can be immediately injected into the egg using ICSI. Any extra sperm can be frozen and preserved for future use.

No Need to Stress Out Over Fertility

Does stress affect fertility?

A body of evidence continues to build about the effects of chronic stress on a woman’s ovulation and a man’s sperm production. Stress may lead to a cascade of hormonal events that led to inhibition of the body’s central reproductive hormone signal, and subsequently disturb ovulation or sperm production and sexual activity, write Weill Cornell fertility doctors Drs. Zev Rosenwaks and Marc Goldstein in A Baby at Last!

Humans are designed to endure acute stress. That’s a part of life. But the significant amount of stress couples endure, cycle after cycle, as they attempt to conceive may disrupt reproductive function. Normal fitness and diet routines may fall by the wayside, leading to a more frazzled, stressed lifestyle. Putting this into Eastern philosophic terms, if you are not in harmony with yourself and your culture, you are stressed.

However in studies attempting to make a direct connection between stress and lower in vitro fertilization success rates, the results are mixed.

A new meta-analysis of 14 studies and more than 3,500 infertile women undergoing assisted reproductive treatment found emotional distress did not affect their chances of becoming pregnant. In the Feb. 24, 2011 online edition of the British Medical Journal, Cardiff University psychologists conclude: “The findings of this meta-analysis should reassure women and doctors that emotional distress caused by fertility problems or other life events co-occurring with treatment will not compromise the chance of becoming pregnant.”

We still need more information to determine the exact relationship between stress and its effects. It may be helpful for couples to know that anxiety and depression won’t necessarily ruin their chances of having a baby.

Double Your Sperm Count?

In his new best-selling book, The 4-Hour Body: An Uncommon Guide to Rapid Fat-loss, Incredible Sex, and Becoming Superhuman, Tim Ferriss sets out to rewrite the rules on how to reshape your body. He describes how he developed a minimalist approach to fitness and health, using himself as a human guinea pig to test every fad, diet, supplement, and workout he could find to identify the things that really work.

The back cover boasts about a dozen things you will learn (in less than 30 minutes), including how to double your sperm count. Ferriss has some interesting ideas here, which I ran by Marc Goldstein, MD, who is the Director of the Center for Male Reproductive Medicine and Microsurgery at Weill Cornell Medical Center, and one of my co-authors of A Baby at Last!.

Ferriss had his sperm tested in his early 30s after a friend developed testicular cancer. Even though he was in top physical shape, his sperm count was borderline normal. After researching the medical literature, he hit upon the effects of cell phone radiation on sperm. So the first thing Ferris did was to remove the cell phone from his pants pocket and carry it either in an armband or in the front pocket of a backpack.

Good idea says, Dr. Goldstein: “I agree with that. Rat studies were randomized controlled studies and indicate live cell phones near testicles might have a negative effect. I give that advice to my patients. I include this in my updated list of lifestyle changes to preserve a man’s fertility.”

In addition, Ferriss started cold treatments, taking short ice baths and/or cold showers 10 minutes upon waking and before bed, even though he admits that the effects on sex hormones are largely untested. And he began eating Brazil nuts, which contain selenium, a mineral Dr. Goldstein says has been shown to increase sperm production and sperm quality.

After 11 weeks, Ferriss had his sperm tested again, and says he nearly tripled his motile sperm (the number of good swimmers) per ejaculate. His ejaculate volume increase by 44%, motile sperm per millimeter by 100%, and motile sperm per ejaculate by 185%.

“The increases in his numbers are well within the large range of variability seen in multiple semen analysis in the same man,” says Dr. Goldstein. “They could have nothing to do with the changes he made unless he didn’t mention that he also stopped drinking heavily and using drugs.” Ferriss doesn’t say anything about limiting alcohol or drug use.

Ferriss also recommends that men over age 30 highly consider storing their sperm because, in general, men are becoming more infertile, many medical conditions and procedures can render men infertile, and men may change their minds about wanting kids, so why not do it?

Dr. Goldstein’s advice is not so liberal: “Only store your sperm if you are going to be treated for cancer, or already have a critically low sperm count.”

Ferriss has other intriguing ideas in The 4-Hour Body I’ll comment about in the future.