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Male Infertility continued

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Over the last few weeks, we have been dealing with the topic of male infertility. We established that, in order to fix the problem, we have to know what caused it and for that we have to take a thorough history and make a full clinical examination. After that, we analyze the semen and do a full hormone profile.{{more}} We can usually make a fairly accurate diagnosis as to the cause of the infertility. The cause can be due to no or low sperm count, in which case a hormone profile is done. If the sperm count is normal, then other causes of the interaction of the man and the woman have to be investigated. By that, I mean the interaction of the male sperm with the female mucus or the sexual encounter episodes.

The treatment of male infertility therefore depends on the cause, and since there is no one single cause in all cases, then there is no single treatment. The treatment also depends on the age of the woman and the couple’s financial resources. All cases of azoospermia need some kind of surgical intervention, followed by assisted fertilization. Oligospermia can be treated with surgical intervention or medication, depending on the cause. In some cases these are combined with assisted fertilization. Let’s start with surgical and medical treatment that, if successful, would make assisted fertilization unnecessary. In this country, we do not offer assisted fertilization, so medication and surgery are the mainstay of treatment.

We use antibiotics to treat cases of infertility caused by previous sexually transmitted infections like gonorrhea or chlamydia. These infections can cause low sperm count and, if treated, can lead to attainment of a normal count 2-3 months after finishing the course of antibiotics and vitamins. Vitamins are used alone or in conjunction with other treatments. Vitamins are invaluable in cases of normal sperm count with low motility or a high percentage of bad sperms, i.e. Astheno or teratospermia. These changes are usually due to exposure to toxins such as heat, alcohol or smoking. These toxins can also cause low sperm count. Vitamins C, D and E are the antioxidant, detoxifying vitamins. In cases of low hormone levels i.e. Hypogonadism, hormone replacement therapy is given, not in the form of testosterone, but in the form of its parent stimulating hormone, since giving testosterone alone will tend to shut down the sperm-making mechanism, as testosterone is rarely even absent by itself. It is usually absent with other hormones which also need to be replaced. Medications are also used to treat a condition called hyperprolactinemia. As we said before, prolactin is used to shut down the sperm-making mechanism and too much prolactin can cause very low sperm counts. We give men medication to reduce prolactin levels, which in turn raises the sperm count. Most of these medications have to be given for at least 6 months. First, to correct the hormone level, then to allow that corrected hormone level to raise the sperm count. Men may be on treatment for at least 1-2 years before they may see a change in the sperm count.

Surgical treatment of male infertility is limited to the treatment of varicoceles and the reversal of vasectomies or bypassing blocked tubes caused by previous infections. Varicoceles or varicose veins around the testicle keeps the testicles too warm and reduce the sperm count. Ligating or “tying” these veins can cause a reversal of the low sperm count. This condition can affect up to 40% of men suffering from low sperm count. The operation is done as a day case and the men are back to work within a week. Bypassing blockages in the sperm tubes or vas deferens also constitutes surgery to effect fertilization. This is surgery done with microscopes or magnifying glasses and, like the treatment of varicoceles, can be done as a day case. The other aspect of the surgical intervention in the treatment of infertility involves the harvesting of sperms from the testicle to help to fertilize the egg for couples undergoing in-vitro fertilization (test tube babies).

There is an aspect of infertility treatment that is hardly mentioned. That is the aspect of toxins and nutrition. Most cases of mild to moderate low sperm count or other minimal abnormalities like slow swimming or abnormally formed sperms are caused by toxins such as cigarette and marijuana smoking. Other toxins like excessive alcohol and exposure to petroleum products, pesticides and herbicides can also cause infertility; therefore, in treating such patients avoidance of such toxins is stressed. It’s amazing how often patients who are infertile due to smoking or excessive alcohol just wants a “pill” to help them be fertile, but do not want to stop smoking or abusing alcohol. The same goes to the exposure to other toxins, where their use is continued, without any protection, despite information to desist. These patients expect that the pills and vitamins will work without any input from them. The same goes for nutrition, where we encourage patients to reduce the intake of animal fats and processed foods (which can contain hormones and steroids) and increase the intake in foods rich in vitamins C, D, E, zinc and selenium. This includes the taking of a multivitamin, among other things. Most patients will ignore dietary advice, only to be told to do so by their herbalist or alternative “healer”. We also encourage them to drink more fruit juices, water and eat more vegetables and fresh fruits. Next week, we look at assisted fertilization.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com

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