Download - Fertility Lifelines

IN
THE
KNOW
What No One Tells You
About Male Fertility
Table of Contents
Understanding Male Infertility.................. 3
Can This Be Fixed.......................................11
Getting Through the Stress.....................15
Your Game Plan..........................................19
IN
THE
KNOW
2
Understanding Male
Infertility
It seems no matter where you go or what you do, you’ll see
stereotypes of men who can’t stop thinking about sex – from
television and movies to advertising. The need to reproduce
is natural and the male anatomy is there to do its job.
When it doesn’t and the reproductive functions fail, it can
be difficult to accept. You may even think it’s an assault on
your sexuality if you’re the cause for the failure to conceive.
Getting your partner pregnant shouldn’t be this hard, right?
Despite what cartoons might lead you to believe, sperm
are not simple, tadpole-type creatures. Furthermore, those
little swimmers aren’t all that tough, but the journey they
undertake from ejaculation to fertilization certainly is. The
following may shed some light on their inner workings.
Sperm Production
Sperm are highly specialized cells comprised of a head, where
genes are stored, and a tail, which enables movement. Sperm
are produced by the testes (testicles), located in the scrotum,
and then passed along to the epididymis, an organ that stores
and nourishes them as they mature and develop movement.
The sperm then start a two- to three-month process of
3
development and movement. From the testes, they travel
through the epididymis and into the vas deferens. This duct,
which extends from the scrotum through the groin and into
the pelvis, connects the epididymis to the urethra. Seminal
fluid is added by the prostate and other glands as the sperm
flow outside the body through the penis.1
During intercourse, sperm combine with fluid from the
seminal vesicle and prostate gland to create semen. Once
deposited into the woman’s vagina, sperm can live for three
to five days within the female reproductive tract, while
retaining the ability to fertilize an egg.2 The average man
has between 20 and 150 million sperm per milliliter (mL) of
ejaculate. 3 If the sperm concentration falls below 15 million
per mL, a man’s ability to impregnate his partner naturally
decreases significantly.4
Of the millions of moving sperm normally deposited into the
4
vagina, only a few hundred get close enough to the egg for
fertilization. Normal anatomy of the male reproductive organs
and balanced hormones are important for fertility.
Possible Causes for Male Infertility
There are various factors that can affect male fertility. Consider
the following list:
Medical History
•
History of sexually transmitted disease (STD)5
•
History of cancer treatment including surgery,
chemotherapy, or radiation6
•
Use of anabolic steroids6
•
Previous abdominal or urologic surgery (such as renal
surgery, kidney stone removal, etc), or surgical sterilization5
•
History of genital or prostate infection6
•
Family history of cystic fibrosis or other genetic disorders7
•
Chronic medical condition, such as high blood
pressure or diabetes6
•
Certain types of prescription drugs5
You may want to discuss your medical history and any concerns
with your physician.
5
Lifestyle and Environment
Certain lifestyle factors can impact your fertility. Talk to your
doctor to see if changing one of these aspects of your life
could make a difference:
•
Prolonged exposure to high heat (e.g., hot tubs,
whirlpools) can lower sperm quality6
•
Alcohol consumption and smoking have been shown
to compromise fertility in men6
•
Many lubricants, including petroleum jelly or vaginal
creams, may affect sperm quality9
•
Exposure to toxic substances such as pesticides,
radioactivity,
abnormalities
•
Increased
or
X-rays
may
lead
to
sperm
(e.g.,
prolonged
6
scrotal
temperature
sitting and use of laptop computers on your lap) may
hurt sperm production6
•
Use of illegal drugs, such as cocaine, or inappropriate
use
of
prescription
drugs,
can
affect
sperm
production and function6
Physical Changes to the Body
Additional medical issues that could contribute to infertility
include:
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•
Age — male fertility decreases with age; the older the
man is, the longer it takes the couple to get pregnant,
and the more likely the partner is to miscarry8
•
Cancer — a small percentage of patients who
present with male infertility may have an underlying
cancer 10 (testicular germ cell cancer), which can be
identified by a thorough physical examination by a
male fertility specialist
7
•
Varicocele (large veins around the testicles) — the
most common cause of identifiable male infertility
occurs when varicose veins are present around one
or both testicles, which can hinder sperm number
and movement or function6
•
Erectile dysfunction — the inability to get or sustain
an erection6
•
Undescended testes — testes that do not reach
the normal position in the scrotum may function
abnormally, and potentially not produce sperm11
•
Retrograde ejaculation — ejaculate containing the
sperm flows backwards into the bladder instead of
leaving the penis6
•
Atrophy of the testes — could be a sign of abnormal
genes that cause infertility or a hormone imbalance12
The Bottom Line: Once diagnosed, many of these
causes may be treatable, so talk to your doctor as
soon as possible.
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All About Sperm
Several factors play a role in determining success, including:13
•
Sperm count (number of sperm)
•
Sperm motility (ability to move)
•
Forward progression (quality of movement)
•
Sperm morphology (size and shape)
•
Semen volume (amount of fluid released)
9
Bio 101 — The Birds
and the Bees
IN
THE
KNOW
10
Can This Be Fixed?
After you’ve reviewed your medical history in detail and
completed a physical exam, including a blood and semen
analysis and any other tests you might need, your doctor
may recommend starting treatment. While it may not be the
answer you want to hear, it is a positive first step.
Ways to Treat Male Infertility
Minor Procedures to Fix Varicoceles
Repair of varicoceles, the big veins around the testes, results in
improved sperm quality6
Hormone Therapy
Medication may reverse hormone imbalances and improve
sperm production.6 Some hormone treatments, such as pure
testosterone, 6 can worsen male infertility, so discuss this
thoroughly with a fertility specialist.
Treat Infections of the Genital Tract
Some infections may harm sperm, but can be treated with
appropriate antibiotic therapy or non-steroidal anti-inflammatories.6
11
Reconstructive Procedures
These treat blockages of the male reproductive tract in the vas
deferens, epididymis and ejaculatory duct.6
Sperm Retrieval
Obtains sperm from the testes or epididymis. The retrieved
sperm then is processed to identify and prepare the
healthiest sperm for intrauterine insemination (IUI) or in vitro
fertilization (IVF).6
Intrauterine Insemination (IUI)
The insertion of sperm directly into the uterus near the
time of ovulation. IUI may be used for low sperm count and
movement problems, and other causes of infertility.14
Assisted Reproductive Technology (ART)
ART treatments involve obtaining sperm through normal
ejaculation, surgical extraction, or from donor individuals,
depending on your specific case and wishes. The sperm is
then inserted into the female genital tract, or used for in vitro
fertilization or intracytoplasmic sperm injection.14
In Vitro Fertilization (IVF)
Used to overcome a variety of fertility difficulties, particularly
tubal problems and severe sperm deficiencies. During IVF,
medications are often used to stimulate the development,
and release, of a woman’s eggs. The eggs and sperm are
then collected and placed together in a laboratory dish to
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fertilize. If successful, the embryo(s) is transferred into a
woman’s uterus for implantation.14
Intracytoplasmic Sperm Injection (ICSI)
This is a procedure in which a lab technician, using a
microscope, attempts to inject a single sperm directly into
each egg. ICSI is often used as part of the IVF process if the
male partner has a very low sperm count, low sperm motility,
or poor-quality sperm. If fertilization occurs after ICSI, the
embryo(s) are transferred into the uterus.14
Remember, there are many treatments and options available to
build your family. Plus, treatment options depend on the factors
causing your infertility. Learn as much as you can, and don’t be
afraid to ask questions.
The Bottom Line: Your doctor will help get you through
the medical jargon and your treatment; there are other
resources like Fertility LifeLines™ and the Society for
the Study of Male Reproduction to help get you
through the rest.
13
IN
THE
KNOW
14
Getting Through
the Stress
Before you agree to undergo any treatment, take some time to
think about what questions you have for your doctor. There’s a
list starting on page 20 to help get you started.
Knowing that you might have fertility issues can impact your
sense of masculinity. Unfortunately, the added anxiety you
might feel while going through all of this can also affect your
sex life.15 Going through reproductive issues can be extremely
nerve-racking and even lead to low self-esteem, depression,
and marital problems.15 You may lose the urge for sex, or when
you try, you may struggle to achieve or maintain an erection.16
Fortunately, this problem is typically only temporary, and
treatment is available.
It’s been found that a lack of knowledge combined with fear
might be an underlying factor in men’s reluctance to seek or
continue medical treatment for this condition.17 Additionally,
men struggling with infertility have reported fearing others will
judge them as inadequate.17 While it might seem easier to keep
it all to yourself – and men often want to skip this part, hoping
to be able to take decisive action and move on – you should be
proactive. By taking some small steps, you may improve your
sex life and your relationship, all while working toward finding
a solution to your fertility problems.
15
Use these tips to help you get through those tough times:
•
Take control. By taking the initiative to educate yourself,
you’re taking control of the problem. Understand the
process as best as you can by asking questions at the
doctor’s office and learning more through Web sites
such as FertilityLifeLines.com, SSMR.org, and ASRM.org.
•
Find a way to blow off steam. Do something to get your
blood pumping and shake off those thoughts of selfdoubt. Work out. Shoot hoops. Go running. When you
release stress this way, you also release endorphins18
and might even give your libido a boost.
•
Have the difficult conversation. We all know that men
and women communicate differently, but infertility is
something you’ll have to deal with together. Women
may want to discuss infertility at every turn – not only
the medical aspects and decisions, but also all of their
feelings, and yours too. Be upfront when you need a
break from the topic, but be open to talking about it as
well. You need to tell your partner when YOU want to
talk, or when you just want to vent.
•
“What I need from you to get through this is…”
•
“What can I do to best support you throughout
this process?”
•
“What are we willing to tell our family and
friends?”
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•
“How do you want me to handle it if my family’s
pushing us for answers?”
•
Give your partner some “TLC.” You may have only
recently started entertaining thoughts of what fatherhood
will be like, but chances are your partner has been thinking
about having children since she was much younger. When
that prospect seems out of reach – even temporarily – it
can take its toll. Acknowledge the stress of the situation
and assure her that you’re in this together. You can’t take
the pain away, but just being there for your partner will
help. Let her talk, cry, and share her feelings. Surprise her
with flowers, plan a date night, or weekend getaway. Have
sex for the pleasure of it – not just when the time and
temperature are right. It will remind her – and you – that
you were a couple before you wanted to have a baby, and
you’re still one.
•
Get support. This is a lot to deal with, so if you need to talk
to someone, that’s okay. There are a lot of great support
groups and counselors out there. See page 19 for a list of
organizations that can help, and ask your doctor’s office
about where you can get additional support if you need it.
The Bottom Line: If your stress interferes with your daily
routine or is having a negative impact on your sex life or
your relationship, take the steps to see how you can turn
this around.
17
IN
THE
KNOW
Your Game Plan
Many couples become overwhelmed trying to sort out the
medical jargon and insurance coverage. To help ease your
frustrations, below is your game plan – a checklist of questions
and resources to help focus your attention on what’s important.
Where to Turn for Help
The following organizations provide information and support:
Fertility LifeLines™
www.FertilityLifeLines.com
Society for the Study of
Male Reproduction
www.ssmr.org
Men’s Health Network
www.menshealthnetwork.org
American Society for
Reproductive Medicine
www.asrm.org
RESOLVE: The National
Infertility Association
www.resolve.org
Path2Parenthood
www.path2parenthood.org
Livestrong Fertility
www.livestrongfertility.org
Conceive
www.conceiveonline.com
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Questions for Your Doctor
•
What specific tests would you recommend to diagnose
our infertility?
•
Based on the test results, what are my treatment
options and how much do they cost?
•
What should I expect from each treatment option
and are there any risks?
•
What’s the national success rate for those treatments
in terms of live births?
•
How long have you been doing this and what’s your
success rate?
•
What’s the time frame for moving on to the next
phase of treatment, if needed?
•
How will I communicate with you during this whole
process?
•
Can you confirm what’s covered by my health insurance
policy?
•
Do you offer a payment plan or work with any
organizations that do?
•
Does your center work closely with a male fertility
specialist to help determine the cause of my infertility
and rule out any associated serious medical conditions?
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•
Does your center provide emotional counseling or can
you refer me to a counselor who deals with fertility
problems?
•
How will my sex life be impacted by my infertility or
treatment?
Questions for Advocacy
Organizations
•
What kinds of programs and services do you offer?
•
Are there any materials or programs specifically for men?
•
Do you have a local chapter or any upcoming events
in my area?
•
Do you offer any financial assistance programs?
21
References
1.
Urology Care Foundation. What is male infertility? http://www.
urologyhealth.org/urology/index.cfm?article=29&display=1.
Accessed February 13, 2017.
2.
Mayo Clinic. Getting pregnant. http://www.mayoclinic.org/
healthy-living/getting-pregnant/expertanswers/pregnancy/faq20058504. Accessed February 13, 2017.
3.
Medline Plus. Semen Analysis. 2017. http://www.nlm.nih.gov/
medlineplus/ency/article/003627.htm. Accessed February 13,
2017.
4.
Mayo Clinic. Low sperm count.http://www.mayoclinic.com/health/
low-sperm-count/DS01049/DSECTION=tests-and-diagnosis.
Accessed February 13, 2017.
5.
Medline Plus. Infertility. 2017. http://www.nlm.nih.gov/
medlineplus/ency/article/001191.htm. Accessed February 13, 2017.
6.
Mayo Clinic. Low Sperm Count. 2015. http://www.mayoclinic.com/
health/low-sperm-count/DS01049/DSECTION=causes. Accessed
February 13, 2017.
7.National Heart, Lung and Blood Institute. Living with Cystic Fibrosis.
2013. https://www.nhlbi.nih.gov/health/health-topics/topics/cf/
livingwith. Accessed February 13, 2017.
8.
De La Rochebrochard E, McElreavey K, Thonneau P. J Androl.
2003;24:459-65.
9.
Anderson L, Lewis SEM, McClure N. Hum Reprod. 1998;13:3351-6.
10. Walsh TJ, Croughan M, Schembri M, et al. Arch Intern Med.
2009;169:351-6.
11. Medline Plus. Undescended Testicle. 2015. http://www.nlm.nih.gov/
medlineplus/ency/article/000973.htm. Accessed February 13, 2017.
12. Kobayashi H, Nagao K, Nakajima K. Adv Urol. 2012;2012:823582.
13. American Society for Reproductive Medicine. Diagnostic Testing for
Male Factor Infertility. 2008. http://www.asrm.org/uploadedFiles/
ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_
Info_Booklets/Testing_Male-Fact.pdf. Accessed February 13, 2017.
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14. American Society for Reproductive Medicine. Infertility: An
Overview. 2012. http://www.reproductivefacts.org/uploadedFiles/
ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_
Info_Booklets/infertility_overview.pdf. Accessed February 13, 2017.
15. RESOLVE: The National Infertility Association. Men and Emotions.
2013. http://www.resolve.org/about-infertility/medical-conditions/
men-and-emotions.html. Accessed February 13, 2017.
16. Clay, RA. American Psychological Association. Monitor on
Psychology. 2006;37(8):44. http://www.apa.org/monitor/sep06/selfblame.aspx. Accessed February 13, 2017.
17. O’Donnell E. Sexuality, Reproduction & Menopause. 2007.
http://mindingmatters.clevespace.com/wp-content/
uploads/2012/07/making-room-for-men-in-IF-counseling-1.pdf.
Accessed February 13, 2017.
18. Mayo Clinic. Stress Management. 2015. http://www.mayoclinic.com/
health/exercise-and-stress/SR00036. Accessed February 13, 2017.
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