JANUARY 15, 2008


For infertile men, keeping cool is key

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 of days.

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 walls.

"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 abnormalities.

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 his fertility.

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 obese.

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.



back to top of page




© Parkhurst Publishing Privacy Statement
Legal Terms of Use
Site created by Spin Design T.