Category Archives for "Reproductive Health"

May 12

3 Methods of male contraception

By Alanne | Reproductive Health

Blocking sperm production or delivery

With the ever growing world population, contraception is an important health issue for the 21st century. About 50% of couples who are of reproductive age either do not have access to or choose not to use modern contraceptives methods. Currently there are multiple methods available for the woman, including oral contraceptive pills (“birth control pills”), the “day after” pill, implants, intrauterine devices, cervical caps, diaphragm, female condom and tubal ligation. For the man, contraceptive choices are limited.

AVAILABLE MALE METHODS

All forms of male contraception work by interfering with sperm production or delivery. The goal of male contraception in to achieve azoospermia, the absence of sperm in the ejaculate.

STANDARD AND ACCEPTED MALE METHODS

  1. Coitus interruptus involves withdrawing the penis at the time of ejaculation. This is a technique that not widely accepted and not perfected by most men. The failure rate is high.
  2. Periodic abstinence, or the rhythm method, is when the couple does not have intercourse at the time the woman is considered fertile. This requires knowledge and participation of the woman who must understand when the fertile period is. Failure rates with this technique are very high also.
  3. Condoms. These are used by approximately 40-50 million men with a failure rate of about 15%. The advantage of latex condoms is that they protect against sexually transmitted diseases. The non-latex condoms may be more sexually pleasing, but are more expensive and do not protect against disease.
  4. Vasectomy is a simple office surgical procedure usually performed by a urologist. The vas deferens (the tubes that carry sperm out of the testicles) are cut, thus preventing sperm from coming out in the semen. Vasectomy offers permanent (though reversible) contraception with extremely low risk of complications. The success rate with this is probably the best compared to any permanent or temporary sterilization procedure available to men or women.

vasectomy_diagram

EXPERIMENTAL METHODS OF BIRTH CONTROL FOR MENHORMONAL METHODS OF MALE CONTRACEPTION

Hormonal methods act by decreasing testosterone production of the testes which in turn lowers sperm production. The production of sperm and the production of male hormones (one of the male hormones is testosterone) are closely related so it is difficult to suppress sperm production without also suppressing the production of male hormones (androgens).

Androgens are responsible for libido, sexual performance, secondary sexual characteristics, muscle mass and strength. The goal of hormonal methods of contraception is to provide a safe, effective and reversible contraception to couples. Presently, there are several hormonal methods being tested in clinical trials. Current clinical trials, however, reveal that azoospermia cannot be achieved in all men.

  1. Androgens. The classical androgen used to suppress sperm production has been testosterone enanthate given intramuscularly in a weekly dose. There are newer androgen preparations that are applied directly to the skin. This may cause sterility but will not affect libido and sexual performance. However, it is not always reversible.
  2. Androgens and progestogens. Combining progestogens (another hormone) with androgens appears to provide greater contraceptive effect. This combination allows lowering the dosage of the androgens.
  3. Anti-androgens. Although these can suppress sperm production, they are accompanied by a marked decrease in sexual function, thus requiring testosterone to also be used.
  4. Gonadotropin releasing hormone agonists (GnRH) suppress testicular function. These drugs have been used in the last decade to cause “medical castration” and eliminate the need for either orchiectomy (surgical removal of the testicle) or estrogen treatment in males with prostate cancer.
May 12

Male infertility you should to know

By Alanne | Reproductive Health

In 1988, a poignant advertisement for an article to appear in the Ladies’ Home Journal filled a full page in the Wall Street Journal. Above a drawing of an infant was the following headline: “Will this be the status symbol of the 90s?” Below the drawing the text said:”In the 80s, it was anything that was expensive. In the 90s, however, will having a baby be infinitely more impressive than any hood ornament or designer name?”Now in the new millennium, and looking back at the last decade of the 20th century, we can ask whether this question was answered affirmatively.

We see in data accumulated by the American Society for Reproductive Medicine (ASRM) in 1998 that one million women made new visits to their gynecologists to address the subject of infertility. Despite this apparent desire for babies, however, only 250,000, or roughly 20%, of the male partners of these women were ever seen for an evaluation. Why is there this disparity?One could theorize that since women do have gynecologists whom they see regularly, a couple’s first means of addressing the subject of infertility would be by the wife’s mentioning this at her yearly examination. However, this does not explain why more husbands were not seen.

Lack of male factor evaluation in infertile couples can be blamed, it would seem, on two problems:(1) The perception held by gynecologists that urologists are not interested in infertility.(2) The beliefs of the public that little can be done to treat the male factor and that the initial step should be confrontation of the female factor.Both of these perceptions are inaccurate. Most urologists today are interested in and trained to varying degrees in addressing the subject of male infertility. We now know that much can be done in solving the problem of male infertility once an accurate diagnosis is made. The key is having the patient see an interested urologist who can initiate a cost-effective, goal-oriented evaluation that results in the most accurate diagnosis possible and offers the best possible options for cure.

The fact that the males are not being seen is indeed a problem. Roughly 30% of the time, the male accounts solely for a couple’s infertility, and another 20% of the time the male factor is a contributing factor. Consequently, in approximately 50% of couples, the male requires treatment of some form if the couple’s fertility potential is to be optimized.The evaluation of the male patient is much like the evaluation of any patient with a health complaint. That is, a visit with the physician and a detailed history are required. A physical examination is needed with, in this instance, a focus on the male reproductive organs. And finally, appropriate testing is performed, in this case a semen analysis.

male_infertility

However, fertility is best achieved when a man and his partner openly communicate their questions regarding each other’s health issues, both between themselves and with their respective treating physicians. Individual blame should not become part of the infertility workup, since infertility itself is a couple-related phenomenon and can only be solved when the couple is treated as a reproductive unit. It is hoped that this brochure will promote dialogue and encourage couples to seek out a knowledgeable and caring urologist to make the best possible initial diagnosis for the male and to discuss treatment options not only for the male but also for the couple in an effort to allow them to achieve a natural pregnancy.

May 09

Male Infertility Treatment Options

By Alanne | Reproductive Health

Male Infertility Treatment: There are many potential causes for male infertility. Many of these causes have treatment options and some do not. Below is a discussion of common treatments Varicocele: Varicoceles are big veins around the testicles that may cause the testicles to have a higher temperature. This may affect the quality of sperm. Varicoceles are treated surgically by a urologist in a procedure called a varicocelectomy or by a radiologist in a procedure called an embolization. Surgery has lower risks and a greater chance of success; embolization has a quicker recovery.

A semen analysis and follow-up physical examination are recommended 4 months after the procedure. Improvement in the quality of sperm occurs in about 70% of treated men and pregnancy occurs in 30-35% of couples. Hormones: Two hormones, testosterone and follicle stimulating hormone (FSH) are necessary for the production and maintenance of sperm. Other hormones such as luteinizing hormone (LH), prolactin, and thyroid hormones, also play a role in sperm production. Each of these hormones can be checked by a blood test. Additional testing may be necessary if the hormone levels suggest involvement of the pituitary gland (located in the brain).

There are some injectable medications available that will often increase sperm production. These medications primarily work by increasing the testosterone level within the testicle (warning: do not take testosterone shots, patches, or use topical gel as this will increase testosterone in the bloodstream, but will decrease testosterone within the testicle which will decrease sperm production). Other hormones are available that can be used in specific situations to correct hormone deficiencies. It should be noted that women may also use the medications discussed above in their treatment. Antisperm Antibodies: Antisperm antibodies are antibodies that attack one’s own sperm. Treatment is aimed to reduce these antibodies with steroid medications and is often done along with intrauterine inseminations.

Infertility_causes

There are risks associated with the use of steroids that you should discuss with your physician prior to the start of treatment. Another option for someone with antisperm antibodies is in vitro fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI).Blockages: Any obstruction in the sperm’s path can prohibit the sperm from getting from the testicle to the ejaculate. Blockages can be found in the vas deferens, epididymis, or ejaculatory duct. A complete evaluation with an expert will determine if and where there is a blockage. Once a blockage has been confirmed, outpatient surgery may be required to repair it. If it is in the vas deferens a vasovastomy will be performed. A vasovastomy is a microscopic procedure in which the vas deferens will be reconnected after the obstruction has been removed. If the blockage is in the epididymis a vasoepididymostomy will be performed.

A vasoepididymostomy is a microscopic procedure in which the vas deferens will be connected to the epididymis above the area of obstruction, thus bypassing the blockage. If the blockage is in the ejaculatory duct, a transurethral resection of the prostate may be advised to cut out the blockage. This is done with a telescope, not through an open incision.Infection: Since infections and white blood cells can be harmful to sperm, antibiotics may be prescribed to cure the infection.Problems with Ejaculation or Impotence: Approximately 5% of male infertility cases are due to problems with erections or ejaculation.

May 09

Male Infertility Causes

By Alanne | Reproductive Health

As nearly 50% of fertility problems in couples involve the male partner, the evaluation and treatment of the man is extremely important. Many of the causes of male infertility are treatable, and a careful history and physical exam will identify most of these causes. The most common cause of male infertility is the varicocele, the enlargement of the veins that normally surround the testicle. This problem may be identified in up to 40% of men presenting for male factor infertility evaluation. Other identifiable factors include blockages, hypogonadism (low hormones), problems with ejaculation, and gonadotoxins (exposure to substances harmful to the testes).

Treatment of these conditions often result in increased fertility, as evidenced by improved sperm counts and/or pregnancy.A patient’s medical history is an extremely crucial part of the fertility evaluation. Duration of infertility, previous pregnancies, and previous evaluation and/or treatment are key points. Sexual history, particularly with respect to potency and ejaculatory function, should be reviewed. Past medical history, including childhood and development, should be gathered. Specifically, any history of torsion (testicular twisting), cryptorchidism (undescended testes), or trauma in childhood may play a role in the cause.

Previous hernia repair may also cause blockages.Infections can affect fertility in several ways. Running a fever may periodically decrease sperm production, although this is usually short-lived. Mumps in adolescence may also cause problems with sperm production later in life. Sexually transmitted diseases, specifically Chlamydia and gonorrhea, may cause obstruction, as can any inflammatory condition within the testes or epididymides.

Gonadotoxins in the form of chemicals, medications (both prescription and over the counter), tobacco, alcohol, and illicit drugs, all affect sperm production to some degree. Finally, both family history and a physical examination may suggest a reason for the infertility. Other family members with fertility problems, or disorders such as cystic fibrosis or androgen receptor deficiency, all may suggest a genetic cause. Impaired visual fields, discharge from nipples, frequent respiratory infections, or problems with smell may also help identify both congenital (since birth) or acquired causes of infertility. Approximately 1% of men with subfertility have an underlying serious medical condition, such as a testis cancer or brain tumor which may contribute to the problem. Laboratory tests may also be used to make a diagnosis. All patients should have at least 2 semen samples analyzed.

Male_anatomy

There should be 2-5 days of ejaculatory abstinence before each sample is collected, and the samples should be collected 1-2 weeks apart. Because there is normal variation of sperm counts within an individual, if the 2 semen analyses are not similar, a third should be obtained. Although there are many characteristics that may be examined, the most important are the sperm density, motility (percent of moving sperm), volume and pH of ejaculate, quality of sperm movement, and the total number of motile sperm in the ejaculate. The treatment of male factor infertility is directed towards treating reversible causes, halting damaging factors, and assisting in advanced reproductive techniques. Varicoceles, dilated veins around the testicles, are the most common cause of male subfertility.

The success rate following treatment results in improvement in semen production in up to 70% of men, with 35-50% of the men being able to impregnate their partner.Obstruction of the ductal system is another treatable cause. This may be due to vasectomy, epididymal blockage from previous trauma or infection, congenital bilateral absence of the vas deferens, or previous surgery such as a hernia repair. Correction of obstruction, whether from vasectomy or other factors, results in return of sperm to the ejaculate in 50-95% of men. Pregnancy rates as high as 65-70% have been obtained, although a more realistic value is probably closer to 50%. It is possible to obtain sperm for freezing at the time of surgical correction; thus, if the procedure is not technically successful, the couple has frozen sperm that may be used in conjunction with in vitro fertilization.

Treatment of very low hormone levels (hypogonadism) typically results in moderate pregnancy rates, even when sperm counts do not improve dramatically. In the era of assisted reproductive technology, it is tempting to bypass evaluation of the male partner and proceed to more aggressive treatments, such as in vitro fertilization. However, this is a disservice to many couples, as identification and treatment of the male partner often results in pregnancy without other intervention, as well as correction of any underlying disorders.

May 09

Andropause, androgen testosterone deficiency, male menopause

By Alanne | Reproductive Health

Introduction:  Among the many features characterizing the aging process is the progressive alteration in the hormonal environment. In women, this ovarian failure is known as menopause. It is predictable and clinically obvious and leads to a number of clinical and biochemical changes. In men, on the other hand, these changes are not universal and their manifestations are subtle. Male menopause has been termed andropause, but perhaps a better term is “androgen deficiency, or altered hormones in the aging male”. It is not only the sex hormones that are altered in the aging male as other hormones are also affected. While the manifestations of their deficiencies are difficult to separate, androgen deficiency is readily diagnosed and treated.

Epidemiology

Although this is a matter of concern for governmental planners, the most important and worrisome issue is the increased mean age of the population. In 1950 less than 5% of the population was over the age of 65, but by 2025, this figure will increase to over 15%. Thus, illnesses and infirmities affecting the aged will increase dramatically through the first quarter of the new century. Clinical ManifestationsAndropause is characterized by

1) the well recognized alterations in libido and erectile function,

2) diminution in muscle mass and strength,

3) fatigue,

4) depression, irritability and diminution of mental acuity,

5) alterations in skin and hair distribution,

6) alterations in body fat distribution,

7) decrease in bone mineral density resulting in osteoporosis, and

8) hot flashes.

Not all symptoms will appear either simultaneously or in all men and those that do appear will vary in intensity. True andropause is often seen in men undergoing treatment for prostate cancer that involves suppression of the male hormones, either chemically or surgically.Laboratory StudiesOne of the best places to start is diagnosing male andropause is with a blood test to detect serum total testosterone (measuring the amount of testosterone).

Although there are additional blood tests that can be performed, the serum testosterone is the best place to start. Other hormonesOther hormones may be affected by aging including those involved with the endocrine system including the adrenal gland, melatonin (a product of the pineal gland) which plays a critical role in the regulation of bio-rhythms including sleep, growth hormone which declines over time and whose decline is linked to a decrease in muscle mass and strength, and possibly also leptin, a hormone which may share responsibility with androgens in maintaining a lean body mass. It is not believed that the corticosteriods change with age.

Menopause

Treatment

Testosterone replacement can be given via intramuscular injection, orally or transdermally (skin patch). Intramuscular injections are effective, safe and inexpensive but need to be repeated every 2 – 3 weeks and tend to have a roller-coaster effect (high levels during the first week after administration followed by a rapid decline). Some oral preparations have erratic absorption rates and the potential for liver toxicity, others are not available in the US; others are expensive and must be taken with certain types of foods. Testosterone patches are safe and effective but expensive.

Their main drawback is the potential to develop dermatitis at the site of the application. Recently a testosterone gel was introduced in the US; while it may avoid dermatitis, it has the ability to be passed to others.

Monitoring

This is the most important aspect of androgen therapy. When a patient is started on testosterone supplementation, it is generally for life. Special attention must be paid to the prostate, both monitoring its size and any increases in prostate specific antigen (PSA). Contraindications to testosterone supplementation include patients with significant obstructive symptoms or suspected or documented prostate or breast cancer. Monitoring of other lab values including lipid profiles and liver studies is also very important. Sleep apnea can be exacerbated with testosterone supplementation, as can polycythemia (increase in the number of red blood cells) which can carry significant health risks in elderly men.