Fertility News Bulletin
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Dr. Bastuba and his patients in a recent TV live interview. (TV interview air date 6/13/07)
Spring/Summer 2006
The Connection Between Male Fertility and Sexual Problems
Reduced Risk of Multiple Pregnancies with IVF
The Biological Clock for Men – Is it Real?
A Closer Look at IVF Success Rates
Use of Insecticides May Cause Infertility
Men Hesitant to Seek Treatment for Sexual Dysfunction
Fall/Winter 2005/2006
Sperm Allergies: Another Possible Cause for Infertility
Male Fertility May be Affected Before Birth
Stress and Alternative Medicine When Trying to Conceive
Spring/Summer 2005
IVF and Sperm Retrieval Techniques
Excellent Source of Information for Cancer Patients
Molecular Explanation for Male Fertility
Male Fertility at Risk With Frequent Laptop Use
Winter 2004/2005
Why Male Fertility Work-up is SOO .. Important
Obesity in Men May Cause Male Infertility
Marijuana Dangerous for Male Fertility
Sperm Storage Techniques in the Future
Fall 2004
Healthy Lifestyle Improves Male Fertility
Sexually Transmitted Disease Dangerous for Male Fertility
The Male Partner's Role During Fertility Treatment
Summer 2004
Hot Topic: Is Vasectomy Reversal Right for Me?
Previous Children no Indication for a Man’s Fertility
Look for High Standards When Choosing an Andrology Lab
Acupuncture Boosts Male Fertility
Feel like watching a video? Dr. Bastuba has had numerous interviews in the local news. Watch the videos in our collection.
The Connection Between Male Fertility and Sexual Problems
When diagnosing male infertility, Dr. Martin Bastuba sometimes discovers a couple’s underlying problems of sexual dysfunction. Studies showed that 5% of infertile couples have a history of sexual problems. During the diagnosis, Dr. Bastuba determines if the sexual problems are a contributing factor or a result of a couple’s struggle to conceive.
There are signs of sexual dysfunction associated with male infertility, such as erectile problems, or simply the loss of desire, which leads to an overall decrease in sexual activity and proactivity.
A significant prolonged decrease of desire may be associated with a low testosterone level, which can be associated with male infertility disorders. A work-up is recommended.
Premature or retarded ejaculation, a man’s difficulty to ejaculate intravaginally or not at all, may play a role in a couple’s struggle to conceive. One of the less known issues is retrograde ejaculation, which men experience as a “dry” orgasm and the sensation of muscular contraction and feeling of an orgasm without producing an ejaculate. The reason is an improperly functioning bladder neck, causing the ejaculate to flow backwards into the bladder rather than externally. In this case, a simple urine test after ejaculation will check for the presence of sperm in the urine.
In some cases, sexual dysfunction is a result of a couple’s infertility. The stress factor of infertility and treatment may affect the sexual relationship of a couple. Infertility stress may cause a response of anger, panic, grief and despair. The feeling of having to perform under pressure can adversely affect his sexual health. Men who experience two or more failures to perform may develop a fear of failure leading to further failures. Therefore, Dr. Bastuba asks a few simple questions about sexual activity to develop a diagnosis for male infertility. He emphasizes the importance of an infertile couple being given the opportunity to discuss recent changes in sexual activity, which might hold the key to successful fertility treatment.
Reduced Risk of Multiple Pregnancies with IVF
Many couples are hesitant to try IVF when unable to conceive because of the risk of having twins or triplets. However, there are a series of recent advances in assisted reproductive technology (ART), that reduce the risk of multiple pregnancies significantly. Overall, ART techniques have improved, which lead to fewer multiples over the past years. According to the Center of Disease Control (CDC), the multiple pregnancy rate dropped from 7% in 1996 to 3.2% in 2003. Better lab equipment allows a better evaluation of embryo quality, increasing the chance of success for fewer embryos transferred. Having high-quality embryos develop into blastocysts before transfer also eliminates the necessity to transfer more embryos back into the uterus. In addition, ultrasound guided transfer of embryos enables the physicians to better place the embryos in the uterus at the time of transfer. The American Society for Reproductive Medicine (ASRM) recommends a transfer of no more than two embryos for patients under 35 in normal circumstances. On a fresh cycle with the best diagnosis and chances to become pregnant, a transfer of one single embryo should be considered.
The Biological Clock for Men – Is it Real?
When thinking of the “biological clock”, most people associate the phenomenon with women’s advanced reproductive age after the age of 30. However, recently conducted studies suggest that men may also have a biological clock, which is associated with declining fertility, decreasing hormone levels and increasing risk of genetic defects starting after the age of 30. Data from studies in the last decade show a trend of a worldwide increase in male infertility. This is mainly due to the fact that not only women but men also wait longer to have children than 30 years ago, and that the aging process in a man affects his fertility. Over the last 30 years, there was a 50% increase in fathers older than 35. Researchers Kidd* and Ford** et al showed that men older than 35 are twice as likely to be infertile as men younger than 25. In addition, men older than 35 years had a 50% lower pregnancy success rate when undergoing fertility treatment intrauterine insemination (IUI) than younger men under 30 years of age. The good news is that the decrease of men’s sex hormone levels is not as rapid and significant as in women. There is about a 1% yearly decrease in testosterone levels after age 30, which is called “andropause” or more appropriately “hypogonadism”. Hypogonadism is associated with symptoms of decreased sperm quality, libido, muscle mass and strength, weight gain and erectile dysfunction. It is also linked to type II diabetes, insulin resistance, central obesity and the metabolic syndrome.
Up to this day, only increased maternal age was the considerable factor for increased risk of genetic abnormalities in a child. However, studies show that the age of the male can also matter for these cases. A study conducted by Malaspina et al showed that schizophrenia occurs twice as likely in children whose father is older than 40 years. Research conducted in 2003 suggested that 50% of cases in children with Down syndrome are related to the paternal age over 35. There is an increased risk of miscarriage and genetic defects when mother and father both are over the age of 35 and the father’s influence increases with rising age similar to that of the mother’s.
So, men can now stop the finger pointing to the women when it comes to the biological clock. It will take a while until awareness about the male biological clock spreads to the general population. In the meantime, effects are unknown to “rewind” the male biological clock.
*Kidd: Effects of male age on semen quality and fertility: a review of the literature. Fertility & Sterility, 75: 237, 2001.
**Ford, et al: Increasing paternal age is associated with delayed conception in a large population of fertile couples: evidence for declining fecundity in older men. Human Reproduction, 15: 1703, 2000.
A Closer Look at IVF Success Rates
Every beginning of the year, new, verified IVF success rates of the U.S. fertility clinics are released by the Society of Assisted Reproductive Technology (SART). Fertility patients notice that the current data is based on success rates for the year 2003, which doesn’t always satisfy the need for current information.
However, SART requires a thorough and time-consuming verification process for the benefit of fertility patients. Fertility patients often use success rates to evaluate and choose a fertility program for their treatment. SART set mandatory advertising guidelines specifically for their member’s success rates, which are not followed by every fertility clinic. For example, many fertility clinics tend to publish their own preliminary success rates for current cycles. This is frowned upon at SART, especially if the success rates are based on pregnancy success only instead of live births as required. In addition, IVF patients should be suspicious if applicable time periods are not specified. With a label like “2005”, physicians might base their success rates on their best month of the year and the patients won’t even know it. SART also doesn’t allow their members to mislead the public by not reporting cycles. The total number of cycles within a specific time frame must be published that lead to the percentage of live births. SART states “A comparison of clinic success rates may not be meaningful, because patient medical characteristics and treatment approaches may vary from clinic to clinic”.
For more information about IVF success rate statistics, please visit www.sart.org.
Use of Insecticides May Cause Infertility
A new published study lead by Dr. John Meeker at the University of Michigan indicated that exposure to over-the-counter insect spray may have an impact on a man’s fertility. Dr. Meeker’s research showed that environmental exposure to insecticides containing chlorphyifos, or its metabolite known as TCPY, may lower a man’s testosterone levels. In addition, the breakdown product of carbaryl, called 1-naphthol (1N) found in lawn and garden insecticide known as Sevin may cause decreased sperm concentration, lower sperm motility and increased DNA damage in sperm cells. Meeker discovered that men with higher levels of TCPY and 1N found in the urine had lower levels of testosterone. He also found evidence that higher TCPY and 1N levels may be linked to decreased levels of luteinizing hormone (LH) and a lower level of free androgen index in men. Even though chlorpyrifos’ use at residential homes was restricted in 2000 by the Environmental Protection Agency (EPA), recent tests suggest that the American population is still exposed to the substance. Dr. Bastuba agrees with Dr. Meeker when suggesting that more studies will be necessary to confirm the findings, but in the meantime caution is suggested.
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Men Hesitant to Seek Treatment for Sexual Dysfunction
Even with the availability of effective therapies for sexual dysfunction, most men with ED problems do not mention the issue to their doctor. That’s the result of a study conducted to observe the behavior of men visiting their family practice doctor or their internist for other symptoms related to erectile dysfunction. Men, who were trying to avoid talking about sexual dysfunction problems were given a questionnaire to explain the reason for their barrier. Overall, 44% of those men said, that they would accept it as a natural part of aging and 31% were hoping that the problem would go away on its own. Only about 27% of those men didn’t want to discuss it because of embarrassment. Mostly younger men and men with severe erectile dysfunction problems were ashamed to talk about the problem.
The study was conducted in 6 different countries: United States, Germany, United Kingdom, France, Italy and Spain. The results among those countries varied a lot. While men with erectile dysfunction in Germany and Italy are the least likely to seek treatment (only 27% and 28%, respectively), men in the US had the highest proportion of patients with 56% who sought treatment. The study also showed that the main predictor for seeking treatment is the desire to have sex, and most men who seek treatment are self-motivated.
Sperm Allergies: Another Possible Cause for Infertility
Data from numerous studies suggest that 25% of couples having problems conceiving is due to some form of sperm allergy. When the body develops antibodies that inhibit hte sperm's motility (movement), a sperm allergy may be the cause of a couple's infertility.
Both men and women can become allergic to sperm. It has not been determined what causes women to develop sperm allergies. Possible causes for men to become allergic to their own sperm are a vasectomy, a severe infection or testicular trauma.
Unfortunately, there are no noticeable warning signs or symptoms that a patient is allergic to sperm, unless a couple is trying to get pregnant and seeks professional help to diagnose the allergy. Treatment can involve anti-inflammatory agents, inseminations or even IVF in the most severe cases.
Male Fertility May be Affected Before Birth
For the first time, researchers at the University of Rochester, New York, found evidence that commonly used chemicals might be linked to male infertility. The study, published in the journal "Environmental Health Perspectives" this summer, focused on prenatal exposure of male fetuses to phhalates. Phthalates (pronounced THAL-ates) are a family of chemical substances used in everyday consumer products such as cosmetics. Research data was collected from 85 women who were pregnant with boys. Results showed that the women's prenatal urinary phthalate levels correlated wit a higher than normal number of abnormalities observed the the boys' male reproductive development after birth. These findings support the suspicion that the chemical might be responsible for the rising number of cases of male genital abnormallities in the past century. Abnormalities might develop in the form of a smaller scrotum and penis, undescended testicles, malformation of the urinary tract and testicular cancer.
Phthalates are found in cosmetic products such as lotion, shampoo, make-up, nail polish, perfume and hair spray. It is believed that the phthalates in cosmetics gets absorbed into women's bloodstreams through the skin or inhalation. It is through the bloodstream that teh unborn mael child gets exposed to the chemical, which may suppress normal reproductive development in males. In Europe, phthalates had been classed as "reproductive toxins" years ago and are strictly prohibited in European consumer products. For details about the study, go to the website of the Environmental Health Perspectives at http://ehp.niehs.nih.gov/docs/2005/8100/abstract.html.
Stress and Alternative Medicine When Trying to Conceive
Stress might hae an impact in fertility. According to the ASRM, a woman under stress has higher levels of stress hormones like cortisol and prolactin, which have a negative effect on a woman's ovulation. Permanent stress for a man might interfere with his sperm production and erections. There are simple ways to reduce stress in your life. Try to reduce the long work hours and reserve a little time for yourself in teh day to unwind. 20 to 30 minutes of physical activity is a great way to reduce stress. Switch off your phone, get a massage, do some yoga, meditate or try reflexology to relax and enjoy life.
Many of our fertility patients consider alternative therapies such as ancient Chinese medicine and treatments for infertility before coming to our practice. One very popular route is acupuncture, alone or combined with infertility treatment. Studies have suggested a positive impact on blood flow and stress reduction. Others might try herbal supplements like fertility herbs to increase their chances to conceive. However, Dr. Bastuba recommends to always check with a physician before taking Chinese remedies.
It is important to be aware of preexisting fertility issues. If you know that it might be more than just a "stress" factor that is keeping you from conceiving, Dr. Bastuba recommends consulting with a physician after 12 months of trying on your own if the woman is younger than 35 years. If she is 35 years or older, a fertility check up after 6 months of trying to conceive is recommended. Dr. Bastuba states that stress factors have not been scientifically proven to affect sperm directly, though many people suspect some relationship between the two. Stress can definitely affect erectile function and thus affect fertility in this manner.
IVF and Sperm Retrieval Techniques
Sperm is not always present in the ejaculate (azoospermia). Using today's minimally invasive techniques, sperm can be obtained from men who have had a vasectomy, failed vasectomy reversals, absence of the vas deferens, or uncorrectable blockages anywhere along the seminal tract (obstructive azoospermia). In addition, it is possible to retrieve and use sperm when sperm production is so low that there is not enough to make it to the outside world (non-obstructive azoospermia or NOA).There are a number of different sperm retrieval procedures, each with potential benefits and drawbacks. Therefore, the one chosen has to be tailored to the couple’s specific needs.
The procedures MESA, PESA and TESE are either performed through the skin (percutaneous) or through a small opening in the skin about 1/2 inch in size. Applying microsurgical techniques in a process known as Microscopic Epididymal Sperm Aspiration (MESA), sperm can be gathered from the epididymis, a sperm rich tube at the back of the testis. Percutaneous Epididymal Sperm Aspiration (PESA) uses a needle to penetrate the scrotal skin and draw a small amount of sperm from the epididymis. Testicular Sperm Extraction (TESE) involves removing small samples of testis tissue for processing and eventual extraction of sperm. Microscopic micro-dissection TESE (MicroTESE) is a very exacting search for sperm under high magnification in cases of extremely low sperm production.
Up until 1992, couples faced with these hurdles would have been given no hope of making babies involving both of their genes. With the advent of a particular type of In Vitro Fertilization (IVF) called Intra Cytoplasmic Sperm Injection (ICSI), a single sperm is injected into each ripe female egg. This allows even a few retrieved sperm to be adequate for fertilization and has led to countless "miracle babies". The minute quantities of sperm obtained at retrieval are not enough to be useful for Intra Uterine Insemination (IUI) or any procedure other than ICSI. MESA, the most popular retrieval technique with ICSI, is performed in advance of the IVF cycle. It is frozen to reduce stress on the couple since the sperm is "safe in the bank" and can be used at any time. This approach allows each partner to be supportive to the needs of the other at the time of their procedure. In general, frozen sperm is just fine for IVF/ICSI but each program has its own requirements to optimize pregnancy results. Dr. Bastuba and his staff work closely together with the IVF lab during the couple’s infertility treatment. Sometimes sperm quality or quantity requires use of "fresh" sperm. The chosen sperm retrieval method would then be timed to coincide with the female egg retrieval and IVF/ICSI cycle. The percutaneous TESE and Micro TESE methods are always done fresh since sperm quantity and quality are not sufficient to allow freezing.
For more information about sperm retrieval techniques go to our website.
Excellent Source of Information for Cancer Patients
With over 10 million cancer survivors living in the U.S., infertility is a top concern of many cancer patients. According to Fertile Hope, 120,000 men and women in their reproductive age are faced with the risk of permanent infertility from cancer treatments like chemotherapy, radiation and surgery. The non-profit organization Fertile Hope was founded four years ago to raise awareness about cancer patients’ fertility issues and to provide information and support to cancer patients. Since not every oncologist informs their patients about fertility risks, it is their mission to educate the public about cancer patients’ reproductive options. Dr. Bastuba is offering his services to men facing this life-altering challenge in their life. Fertile Hope publishes an extensive resource guide, which includes a complete directory of physicians providing services for men undergoing cancer treatment such as sperm banking, sperm retrieval services and testicular tissue freezing. The organization, which is also an affiliation of the Lance Armstrong Foundation, offers a financial assistance program and a monthly newsletter. Go to www.fertilehope.org for more information.
Molecular Explanation for Male Fertility
Cancer research in UK recently discovered a key function of a molecule in male reproductive health. Scientists found that the molecule called JAM-C plays a critical role in the sperm development cycle. Sperm development, called spermatogenesis, takes place in the seminiferous tubules (ducts) of the testes. Each spermatogenesis cycle consists of six stages and takes about 16 days to complete. Approximately five cycles, or 2 ½ months, are needed to produce one mature sperm. The cancer test results suggested that genetic defects interfering with the normal function of the molecule could lead to defects during those stages and ultimately prevent sperm from reaching maturity. JAM-C was mostly found in the heads of elongated, normally shaped sperm, which leads to believe that the molecule helps development of the head of the sperm. With more studies about this molecule in the future, the recent findings may lead scientists to future cancer treatment and cures for male infertility.
Male Fertility at Risk With Frequent Laptop Use
As part of a healthy lifestyle with a man’s fertility in mind, Dr. Bastuba recommends stopping habits like hot tub use and high alcohol intake. Hot tub use may lead to overheating in men’s scrotal area, which may cause a low sperm count. Using a laptop placed on your lap for over 15 minutes has a similar effect, according to a recent study. Researchers found that laptops reach “sperm unfriendly” temperatures on the surface of the device within just a short time, causing scrotal hyperthermia. An abnormally high body temperature in the scrotal area will be enough to impair healthy sperm production. It has been theorized that frequent usage of laptops several times a day over many years may even cause irreversible infertility.
There is little reason to be concerned when exposure doesn’t happen over long periods of time. Short-term exposure is reversible within three months – the time is takes to produce new, healthy sperm. Dr. Bastuba recommends avoiding long-term use of laptops on men’s laps and legs until more studies confirm the safety of the devices.
Why Male Fertility Work-up is SOO .. Important
Often male fertility work-up is limited to a simple semen analysis. This sometimes leaves treatable male fertility factors missed. It also may leave a testicular cancer undiagnosed. A study confirms that all patients with diagnosed male factor should undergo a sonographic screening the diagnosis phase. Approximately 2% of male infertility cases in the U.S. are diagnosed with testicular cancer, which can be detected in early stages through ultrasound screening as part of the fertility work-up. Very small lesions can be detected with this technique, which otherwise would stay undetected during a traditional manual exam. The procedure of trans-scrotal sonography is painless and is performed in an office setting.
Research showed that patients with a history of undescended testis or diagnosed azoospermia (no sperm in the ejaculate) have a higher risk for testicular cancer. Dr. Bastuba comments, “The earlier we detect a problem like testicular cancer, the better our chances to save testicular tissue and the couple's dream of having children.”
Obesity in Men May Cause Male Infertility
The latest research confirms that overweight men are more likely to have poor sperm quality than normal weight men. A study compared semen analysis parameters of 1,558 men in correlation to their body mass index (BMI). Overweight men had a lower sperm count of 21.6% and 23.9% lower sperm concentration than men with recorded healthy BMI. Research cannot determine the biological mechanism for this observation. A possible explanation are abnormal estrogen levels causing hormonal imbalances in obese men. “Fortunately, I only have to advise a small number of my patients to lose weight for fertility treatment,” adds Dr. Bastuba to these findings, ”Californians are very health conscious and aware of weight-related health risks.” It has been previously proven that fertility in women with high BMI may be adversely effected by their unhealthy weight. With these latest findings about male obesity, there is now a reason for both partners to watch their diet, to join a health club and to exercise together.
Marijuana Dangerous for Male Fertility
A recently published study confirms that smoking marijuana may impair fertility in men. In a study conduced by the University of Buffalo, 22 confirmed marijuana smokers participated. Fertility parameters such as volume, sperm-count-per-unit of seminal fluid, total sperm count, velocity, motility and sperm shape were analyzed and compared to a control group of 59 fertile men who produced a pregnancy prior to the study.
Results showed that both the volume of seminal fluid and the total number of sperm from marijuana smokers were significantly less than in non-smoking, healthy men. In addition, it was found that the sperm displayed abnormal swimming patterns, swimming too fast too early and the inability to attach to the egg for fertilization. Marijuana is known to contain among other canabinoid drugs tetrahydrocannabinol (THC), which is the primary psychoactive chemical in the substance. When further examined, the THC exposed sperm showed abnormal changes in the sperm acrosome (enzyme cap). The study was unable to determine how exactly THC changes sperm function.
“It is interesting that this is the first study of its kind,” comments Dr. Bastuba, “I strongly advise all of my patients not to smoke marijuana when trying to conceive.” It is uncertain if sperm health can be reestablished when smokers stop using marijuana. THC is stored in fat for a long period of time. This means that even in case of discontinued drug use, the process to establish fertility might be slow.
Sperm Storage Techniques in the Future
With the introduction of intracytoplasmic sperm injection (ICSI), patients with severe cases of male factor can father children today. For cases of azoospermia (no sperm in the ejaculate), Dr. Bastuba extract sperm surgically from the epididymus or from tissue removed from the testis. In order to avoid additional tissue-damaging sperm extractions in the future, the goal is to retrieve as much sperm as possible during the procedure and to store obtained sperm as save as possible. Since the retrieved sperm in a case of azoospermia is very valuable, research is looking at techniques to aid recovery of sperm after undergoing cryopreservation.
A successful method was found in freezing sperm in small numbers using the membranes of egg cells (zona pellucida). However, the usage of egg cells is very expensive and increases the risk of an acrosome reaction. These disadvantages are not present when sperm is injected in small colonies of algae called volvox globator for cryopreservation. Research showed that sperm stored in volvox has an excellent survival rate.
Dr. Bastuba agrees that once approved by the FDA, this might be an excellent sperm storage tool when only small quantities of sperm are recovered for fertility treatment.
Healthy Lifestyle Improves Male Fertility
When trying to conceive, Dr. Bastuba recommends for the male partner to take a close look at his current lifestyle. Sometimes a simple adjustment in habits contributes to overall health and to improved semen quality within a 3 to 6 month period.
The man should make sure he avoids gonadotoxins such as excessive alcohol consumption, illicit drugs, smoking, and anabolic steroids. Research showed that extra doses of antioxidants might improve sperm parameters. Fortunately, antioxidants like vitamin C, L-carnitine, zinc, vitamin E and selenium are available in pill form and make a self-administered therapy simple and easy.
Recently, another antioxidant known for its important role in healthy cell formation, has been added to the list. A daily supplement of coenzyme Q10 can significantly improve sperm motility (movement). However, positive effects can only be seen after 1—2 spermatogenic cycles of taking a daily supplement of 200mg of Q10. One spermatogenic cycle is defined by the time period of 3 months it takes to produce new sperm. More on healthy lifestyle...
Sexually Transmitted Disease Dangerous for Male Fertility
A recent study conducted in Sweden found that the sexually transmitted disease chlamydia may cause male infertility.
Chlamydia, which has been known to cause infertility in women, is one of the most common sexually transmitted diseases with little or no symptoms. It is estimated that there are 3 million new cases of chlamydia infections in the U.S. each year.
In the study the physicians first conducted a chlamydia test on 244 couples who also were treated for infertility. The test is a simple blood test looking for IgG antibodies indicating the chlamydia infection. Results showed that 20% of the males were infected with chlamydia. In the next step of the study, the couple’s success of infertility treatment was observed over a period of three years, which determined that the success rate to father a child was 33% lower in males with chlamydia than in the healthy men. It is unclear, how chlamyida affects male health. It has been known that if treated early in women, it causes no lasting health issues. However, in case of a re-infection or diagnosed in an advanced stage, it may cause infertility, ectopic pregnancies and other health problems for a woman and her fetus.
“For years, it has been a recommendation for women to be tested for chlamydia before trying to conceive” , comments Dr. Bastuba, “ We have to start extending this advice to their partner, especially if the couple copes with infertility issues.”
More studies have to be done to explain how this STD affects sperm to overcome male infertility and to avoid birth defects in the unborn child.
The Male Partner's Role During Fertility Treatment
When a couple undergoes IVF treatment, the male partner needs to provide much more than his specimen. While the female partner has to endure fertility tests and stressful hormone injections, he needs to give her all the encouragement and support she needs. Here are some recommendations for men on how to act: Communicate. Men and women have different communication styles. Agree on a way to communicate with each other to lessen stress and frustration.
In addition, tell her that you are proud of her and that she is doing a great job. Occasional praise and appreciation can make a big difference. Hormone treatment sends her on a permanent, unpredictable emotional roller coaster. Verbal encouragements such as compliments will help her to defeat feelings of helplessness and frustration.
Listen to what she has to say. Women do not expect men to solve their problems. In fact, most issues on her mind can be erased by simply her telling you about it. Also, offer your help by asking what she wants. Support her in any way you can. If you have an idea what she needs, just do it. Some women do not admit that they need help and will not ask for it. With open communication channels and a little understanding, you as a
couple will have less stress during fertility treatment and a higher chance of success realizing your dream of parenthood.
Hot Topic: Is Vasectomy Reversal Right for Me?
Per year, over half a million men choose vasectomy as a way to prevent conception. At some point later on, five percent of those men decide to have a vasectomy reversal.
If your goal is to make babies the old-fashioned way, this might be the best choice. Vasectomy reversals performed by a trained microsurgeon have a success rate up to 95 percent. Recent research showed that the chance of success doesn’t decline until 15 years after the initial vasectomy. The procedure does not require an overnight hospital stay and lasts only 3 to 5 hours at an outpatient surgery center.
However, there are other circumstances under which a couple might consider advanced treatment options. For example, a blocked sperm passage closer to the testicle where sperm are produced requires the advanced procedure of vasoepididymostomy to bypass the blockage. Only 1-2% of urologists know to perform this type of advanced surgery. Fortunately, this is a routine procedure for Dr. Bastuba. If in addition, the couple also faces female infertility factors, Dr. Bastuba recommends considering assisted reproductive techniques such as in-vitro fertilization (IVF). Sperm retrieval techniques such as MESA and TESE are a specialty for Dr. Bastuba’s team.
Previous Children no Indication for a Man’s Fertility
When looking for causes of infertility, a couple should go through all recommended tests including a semen analysis. Too often, couples and physicians jump to the wrong conclusion that if the male partner recently fathered a pregnancy he must still be fertile. A new study found that a male partner’s previous children are no indication for his fertility. Researchers looked at the data of current semen analyses of 174 men, who also had records of a previously taken semen analysis. The outcome was compared to a control group of men who had unproven fertility what showed no statistical difference between the two groups. The results of the study were not effected by the period of time since the last pregnancy nor the male’s age.
Dr. Bastuba’s advice is to perform a semen analysis even if you think you are healthy and fertile.
Look for High Standards When Choosing an Andrology Lab
When it comes to laboratories performing semen analyses, not all are created equal. Due to the lack of standardization of labs, it is important for patients to know if the lab the physician is using has certain certifications. The lab should be CLIA (Clinical Laboratory Improvement Amendments) approved and follow the guidelines of the WHO (World Health rganization).
Dr. Bastuba recommends using a high quality center such as the Fertility Center of California (www.fertilityctr.com) or any of the labs associated with in-vitro fertilization centers.
These highly specialized labs stand head and shoulders above hospital-based labs, which often times have technicians that aren’t interested in
performing this highly specialized and fairly unusual test. Many hospital-based laboratories literally draw straws to see who is stuck with doing semen analysis. The technicians in more specialized “fertility labs” are interested in performing this specialized testing. They simply would not work in these laboratories since they do many of them every day. For this reason, often times hospital-based lab semen analyses are difficult to interpret and their results often times vary with reality.
Another important aspect is to have more than one data point for the patient. Often times, a single semen analysis can be misleading.
Overall, Dr. Bastuba feels that it is difficult to fake a “good semen analysis”, but often times with improper lab handling various aspects of the
semen analysis may test out poor. Such things as low motility can happen if the specimen is let set too long before the testing is undertaking since the sperm literally ran out of gas. Also changes in the shape of sperm can occur due to improper handling leading to inaccurate morphology
readings.
It is best to have at least two semen analyses and often times three semen analyses so that an average of the patient’s true sperm parameters can be assessed. Since males just like females cycle in their sperm production not on a set monthly schedule as in females.
Acupuncture Boosts Male Fertility
While many women complement their infertility treatment with acupuncture to increase their chances to conceive, men might want to join their partners in the future.
A study showed that acupuncture treatment for men increased sperm count and motility in 67% of men in the study. Acupuncture, part of traditional Chinese medicine, has been offering infertility treatment for centuries.
During a consultation with a licensed acupuncturist, symptom patterns, deficiencies and system imbalances are identified. The acupuncturist then selects pressure points used for the needle application, which is a painless procedure. Patients describe the experience as relaxing and rejuvenating.
“Many of my patients have strong ethical concerns of moving forward with advanced infertility treatment such as IVF”, comments Dr. Bastuba, “such treatment interferes with their religious and ethical beliefs.”
When trying to conceive naturally or just looking for complementary beneficial treatment, this might be the right choice for some couples to
fulfill the dream of having children.
If you missed Dr. Bastuba's interviews in the local news, you can read it here or watch the video in our collection.
MALE IMPLANTS IMPROVE INTIMACY (02-14-2002)
NEW TREATMENTS FOR ED (02-13-2002)
MALE IMPLANTS IMPROVE INTIMACY (02-14-2002)
Although there are two new and experimental pills that may help men with erectile dysfunction, some of those types of drugs won't fix the problem. Here's another solution that is available now and has benefits for both partners in a relationship.
Gene, 62, has spent his life building up a successful autobody shop in El Cajon. But four years ago, he noticed the intimate part of his relationship wasn't running as smoothly as his business. "It's a devstating thing. It might not mean a lot when you're younger, but when you get older and you can't have a sexual relationship 'cause you have a problem, both people suffer from it," says Gene.
On the advice of his doctor, he decided to try a penile implant. "It kind of fixes the problem instead of taking a pill and doing things every time to try and bring about an event. Basically, spontanaiety is returned. You're able to just have the event happen in a very natural way, whenever you want it to for as long as you want it to," explains Dr. Martin Bastuba.
The implant is now considered the gold standard. It's made up of two cylinders, a pump, and a reservoir with saline fluid. Each part has its own hidden place in the body and looks and feels completely natural. "The way that the device is initiated is by gently squeezing down on the scrotal skin where it's completely contained within. Nothing is seen from the outside and it allows fluid to be transferred from one component to another, which is what changes it from flacid to erect state and recreates nature," describes Dr. Bastuba. Gene says it was very easy to adapt to and it was "much easier than I thought and you don't even know it's there. It's very easy to use and it's very easy to have a relationship with it." "Orgasm still happens the same way. Ejaculation still happens the same way. Urine flow still happens the same way. It basically just affects that one portion of the body."
Young men have also benefitted from the implants. "And on the other end of the spectrum, I've put devices in people in their 80s who are true lovers and have not responded to other things, but they still respond to their partner and they want to not lose that part of their relationship," says Dr. Bastuba.
Dr. Bastuba says there are very few complications with this device. We'd like to thank Gene for being so open with us. As you can imagine, this is a topic that is difficult to talk about for some men. Gene says he's happy to help because the surgery saved his marriage. And based on his experience, he would highly recommend the procedure.
NEW TREATMENTS FOR ED (02-13-2002)
This Valentine's Day, there are many couples that will approach intimacy with some difficulty. For many, Viagra has helped men regain the confidence they need. But for others, the drug hasn't been the miracle they were hoping for. Here's a look at the new drugs in development that may provide help and hope for couples in need.
These days, everyone's heard of Viagra, but not everyone has had the same results with it. "They go home, they give it a try on a full stomach, which is the worst condition for the drug. Their body never even saw the medication and it didn't work and they think they're a failure, even the Viagra didn't work," explains Dr. Martin Bastuba.
More than half of all American men over 40 will have difficulty with erectile dysfunction or ED. Many think the little blue pill, Viagra, will be their cure. "If the Viagra was a failure, it doesn't mean that you're a failure as a patient. It means that we need to go onto other things and there are a lot of other options out there," encourages Dr. Bastuba.
Two of those options are waiting for approval right now. One is a pill called Vardenafil. It's in the same family as Viagra, but has been shown to help up to 85-percent of patients. By comparison, Viagra only works for 60 to 70-percent of users. The other drug is called Cialis. "They all work similarly and basically by improving and maintaining blood flow to the area of interest. What is different about Cialis is that it has a longer half-life. So, it remains in your bloodstream longer," describes Dr. Bastuba. Feasibly, one pill could last the entire weekend. It may also work faster and on a wider group of men. Dr. Bastuba says both new options may be available by the end of the year.
"They've changed a countless number of people's lives and given them new hope. also new spontaneity, new ability to get on with life, get on with love, and get past a lot of the really important quality of life issues that are affected significantly by the loss of that part of a relationship," says Dr. Bastuba. Both Vardenafil and Cialis are still in the approval process by the FDA. There is a chance that they won't make it to the market, although there is a lot of confidence by professionals that they will. Vardenafil could be sold under the trade name, Nuviva, but that still has to be approved as well.
Male Fertility Specialists
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