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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: 6 www.FertilityLifeLines.com • 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. 8 www.FertilityLifeLines.com 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 12 www.FertilityLifeLines.com 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?” 16 www.FertilityLifeLines.com • “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 19 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? 20 www.FertilityLifeLines.com • 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. 22 www.FertilityLifeLines.com 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. 23 www.FertilityLifeLines.com © 2017 EMD Serono, Inc. All rights reserved. US-NON-0714-0014(1)