Boxers are good for fertility; briefs are bad
“This myth arose from the theory that the temperature of a man’s testicles was higher when he wore tight-fitting underwear, and that this adversely affected his sperm count, decreasing his fertility,” says Dr. Boyle. But most studies show no relationship between the type of underwear a man wears and his sperm count.
Still, “it’s true that the testicles are happiest when slightly cooled, like fine wine,” says Dr. Morgentaler. Sources of heat other than snug undergarments are the likely culprits when there are fertility problems. “Laptops on the lap, hot tubs, saunas, steam rooms, and long-distance bike rides play a bigger role than underwear,” says Dr. Perloe.
Fertility is a sign of virility
“Many men feel that fertility problems threaten their manliness,” says Dr. Perloe. “In fact, some men go so far as to refuse a simple semen analysis.” Still, once men learn why the test is so important for diagnosing their fertility problem, they usually agree to take it.
By the way, fertility and sexual function are not always related, Dr. Perloe adds, although it’s not uncommon for men with impotence or decreased libido to have fertility problems. In rare cases—when there are severe hormone deficiencies, physical damage, deformity, illness, or drug usage—sexual dysfunction may be the reason why pregnancy hasn’t occurred.
A man's age and weight have no bearing on his ability to conceive
Sure, Charlie Chaplin fathered a child in his seventies, and Picasso became a father (again) in his sixties. But like women, men also have a biological clock, says Harry Fisch, M.D., professor of clinical urology at Columbia University in New York City and adjunct professor of urology at the Medical University of South Carolina in Charleston. Studies show that men older than 35 are twice as likely to be infertile as men younger than 30. “After 30, there’s a drop in testosterone of about 1 percent a year,” says Dr. Fisch, who adds, “Testosterone is the hormone you need to make good-quality sperm.”
What’s more, as men age, sperm morphology (shape) and motility (movement) tend to decline. The genetic quality of sperm also dips with age, raising the risk of genetic problems in older men’s children. “For men over 40, there’s almost a sixfold increase in autism disorders,” Dr. Fisch says. “And the older the man, the higher the risk of schizophrenia.”
Likewise, being overweight or obese can lower a man’s fertility, just as it does with women. “Men with a body mass index [BMI, a measure of body fat] of over 25 have a 20 percent higher chance of infertility,” says Dr. Fisch. And according to a new study from the University of Utah School of Medicine, obese men are more than three times as likely to have low sperm counts when compared with their normal-weight peers.
Men with no sperm in their ejaculate have no hope for fertility
Called azoospermia, this condition can certainly sound like a death knell for fatherhood. But according to Dr. Boyle, these men may still make sperm in low quantity, which can be found by surgically taking tissue from the testicle and examining it. If sperm are found, they can be removed with a specialized procedure called microdissection testicular sperm extraction and then used with IVF and ICSI to achieve conception. Says Dr. Boyle, “Performed at the time of the female partner’s egg retrieval, the procedure has increased the ability to find sperm in about 60 percent of azoospermic men.”
Nothing can be done about a low sperm count
Not so. Men may have a blockage that affects the sperm count, a hormonal problem, a genetic problem, or a sperm production problem. Occasionally cancer (prostate, testicular) is responsible. Says Dr. Boyle, “A complete evaluation with a history and physical examination is necessary to evaluate if there are correctable causes, such as a varicocele.”In fact, nearly 40 percent of men with fertility problems have a varicocele—an enlargement of the veins of the scrotum that may interfere with sperm production, likely by raising temperature in the testicles. Surgery to seal off the affected vein and redirect the blood flow to normal veins can often restore fertility.
Measures like quitting smoking, losing weight, stopping a fertility-foiling medication, or undergoing other types of
corrective surgery can also sometimes help improve sperm counts. Seeing a specialist can improve the chances of identifying—and correcting—the fertility problem. When problems can’t be medically treated, IVF or ICSI (in which individual sperm are injected directly into an egg to facilitate fertilization) may help a couple conceive.
Taking Hormone supplements or Viagra will improve a man’s sperm count
“Testosterone, often used to treat men with low sex drive and erectile dysfunction, and the same drug used to enhance athletic performance [anabolic steroids], should never be given to men who desire fertility,” Dr. Boyle says. Giving testosterone to a man shuts down his own ability to make the hormone, as well as his ability to make sperm, by affecting the pituitary gland. “It lowers sperm counts precipitously, and may make an otherwise fertile man have little to no sperm in his ejaculate,” she says. Stopping the medication usually causes sperm counts to return to normal after six to nine months, but men often require additional treatment to help their bodies recover.
Viagra and other erectile dysfunction drugs, such as Cialis, also don’t help sperm count. “Viagra can restore the ability to achieve an ejaculation during intercourse, but it doesn’t affect sperm counts or quality,” says Dr. Perloe.
Other Male Fertility Factors
Many factors can stand between men and father-hood. A few to keep in mind:
Smoking impairs sperm motility and may cause genetic changes that affect the offspring. Studies show that men—and women—who smoke have lower success rates with assisted reproductive technologies, including IVF and ICSI (intracytoplasmic sperm injection). And other research indicates that men who smoke also have lower sex drives and less frequent sex.
Use of Alcohol and Drugs
Excessive alcohol and some recreational drugs can affect testicular function, which could lead to abnormally shaped sperm, decreased sperm production, or reduced sperm motility (movement). “Cannabinoids, the active compound in marijuana, can cause DNA damage in the sperm,” says Dr. Perloe. “And it can interfere with tubal motility and implantation as well.”
Diabetes or hypertension, erectile dysfunction, hormone deficiencies, liver or kidney failure, a family history of infertility, or having had an undescended testicle can each affect a man’s fertility and warrant investigation.
Some medications can affect male fertility, including cimetidine (Tagamet), sulfasalazine (Azulfidine), salazopyrine, colchicine, methadone, methotrexate, phenytoin (Dilantin), spironolactone (Aldactone), thioridazine (Mellaril), and calcium channel blockers.
Deficiencies in certain nutrients, such as vitamin E, vitamin C, selenium, zinc, and folate, may be risk factors for infertility. Men should ask their doctors if taking a multivitamin or other supplement could help their chances of conceiving.
A version of this story was originally published in the Winter 2009 issue of Conceive Magazine.
Related Topics: Male Factor Infertility, Male Fertility
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