After a year of trying, the couple
in your office still hasn't been able to conceive. You
do the battery of tests from blood to urine to
semen analysis and determine there's a problem
with your male patient's plumbing. Any number of things
can lead to male infertility, says urologist Victor
Mak, one of Canada's top experts in the field. But whether
it's varicose veins, sperm volume, sperm quality or
hormone problems that are preventing conception, there
are many things you can do to help put your patient
on the road to fecundity.
"Varicoceles are the most common cause of male infertility,"
says Dr Mak. "In infertile couples, roughly 40% of the
men have them." Those swollen varicose veins in the
scrotum which aren't usually treated unless they're
painful or causing fertility problems raise the
testicles' temperature, which affects sperm development.
Both the count and the quality drop. And since testosterone
production also happens in the testes, the hormone's
level goes down. A grand slam for infertility.
Check for varicoceles Ask
your patient if he's feeling pain or heaviness in his
testicles, that's one tipoff for varicoceles. The left
testicle offers another clue. "They mostly occur in
the left testicle, so check if it is smaller in size
than the right one," Dr Mak advises. Once diagnosis
is confirmed, reassure your patient there are quick
and simple ways to fix them.
Get the surgical fix Your
patient can have the offending veins "tied-off" in an
outpatient procedure with a choice of minimally
invasive techniques such as ligation or embolization
and return to normal activity within a couple
Fight with fibre Varicoceles
come back in nearly a quarter of cases, but a diet adjustment
can help prevent recurrence. Remind your patient that
a low fibre diet slows down the bowels and leads to
constipation. This puts stress on the pelvic floor and
pressure on the veins in the area, leading to the return
of varicoceles. Also tell your patient to go easy on
processed foods, says Dr Mak, and opt for flavonoid-rich
fruits and veggies instead, as they strengthen the vessel
"In any fertile union, there's probably a significant
number of males who have sperm abnormalities," says
Dr Mak. "But because the female compensates for the
male, they'll never know they have this problem." The
same doesn't hold true for infertile couples, where
sperm shape and motility make a difference.
Have sex daily For years
patients were told to "store it up" for a couple of
weeks, then have sex to maximize their sperm quantity.
But a study in September's Fertility and Sterility found
that doing so actually lowers sperm quality. A sperm
cell with a crooked head or a kinky tail has less chances
of fertilizing an egg, so tell your patient "he should
try every day around the time of his partner's ovulation,"
says Dr Mak.
Vitamins for virility "Vitamin
C and E supplements may help," says Dr Mak. The two
antioxidants protect the sperm against damage, and vitamin
C boosts motility as well. Coenzyme Q10, selenium
which is found in whole grains and fish and vitamin
B12 all help keep the sperm tail wagging, according
to Dr Mak.
"Some men could have zero sperm and feel perfectly fine,"
says Dr Mak. "It comes as a shock to them to find out
they have a very low or non-existent sperm count." Dr
Mak has simple tips to jack up the count.
Quit smoking Dr Mak
tells his smoker patients. Smoking produces free radicals
in the body which play a nasty turn on sperm cells.
They reduce the sperm count significantly and, evidence
suggests, they cut into sperm motility and cause sperm
Cool it "Tell your patient
to stay away from the hot tub and don't wear tight underwear,"
says Dr Mak. Sperm in the testicles enjoy a balmy 32
degree temperature. Even a slight increase in the temperature
of the testicles can kill off sperm, so your patient
should keep them cool.
A sharp drop in testosterone, either due to a disease
like diabetes, varicoceles or other factors, quells
a man's sex drive, his ability to have erections and
Lose weight Obesity slashes
testosterone levels, but this is reversible. Studies
show that once the weight comes off, the hormone levels
go back to normal, so tell your patient to watch his
weight if he's already overweight, and to diet if he's
Reduce stress "Stress plays
a significant part in fertility according to some studies,"
says Dr Mak. Some suggest it reduces hormone levels
and libido. So tell your patient to relax and take the
time to get in the mood.
"Some of the things we tell our
patients may have no scientific basis, but they certainly
may help," says Dr Mak. Cycling is one example. Any
activity, like sitting on a bicycle seat, that causes
rubbing in that area will heat up the testicles and
kill sperm. And you can offer your patient one last
unscientific tip: try harder in winter cooler
temps might dampen his ardour, but most doctors believe
his sperm production will be at its peak.