Fertility and the Infamous Semen Analysis

After last week's blog on male infertility, I thought this topic would make for a great follow-up. We are honored to have our advisory board member, Karen Reynolds, L.Ac., M.S., R.N., of Balanced Restored Center, write a guest blog on this topic for us. Thank you, Karen!

WHAT'S BEHIND THE SEMEN ANALYSIS by Karen Reynolds
A semen analysis, often colloquially called a “sperm count”, is not used only to count sperm.

It also evaluates sperm production (quantity) by the testis, assesses how the sperm are moving (quality), and examines secretions of the genital tract.  A semen analysis does not singularly determine a man’s fertility. Many additional factors must be reviewed and considered. From the standpoint of processing of semen samples: not all labs are the same. In my fertility acupuncture practice, I have stopped sending my patients to larger, unspecialized laboratories, such as those in community hospitals or large corporate labs. This article reviews pros and cons about the types of options available and important considerations for collection for the most accurate results. At the end of this post, I have additionally listed some definitions and terminology.

Semen samples are best processed in an “andrology” lab. Such labs are generally associated with Urology or Reproductive Endocrinology offices.  This is important as a semen analysis is a time-sensitive procedure that requires a certain level of technical expertise to perform accurately. Processing by an andrologist is inherently superior for multiple reasons.  Firstly, an andrologist has advanced training and skills in assessing semen samples and extensive experience in proper handling. Secondly, dedicated andrology labs typically have state of the art equipment with more accurate counting chambers and more formal analytical methodologies. In unspecialized lab settings, semen specimens frequently are relegated to the least senior technician on site, or to the technician available at that moment. For that reason the specimen may be handled and processed by less experienced individuals.

A study published in The Journal of Human Reproduction in 2000 showed marked variability in the same semen samples analyzed at different facilities. Results for the same semen specimen ranged from a count of 3 million sperm/ml to 492 million sperm/ml. Erroneous results can be emotionally devastating, can cause unnecessary stress, can change the course of medical care, and are wasteful.

In other words: your semen analysis results from an unspecialized lab might tell you that
Elvis is in the building but it won’t go into detail about how many cheeseburgers he’s eaten or how well his hips are swiveling. Yes, this is a campy analogy, but I’m sure you understand my point. If you are going to the trouble of spending time and money to produce a sample, you want it to accurately reflect what is going on with your sperm production.

Additionally I strongly encourage men to schedule the semen analysis in conjunction with a
complete medical history and examination by an experienced Urologist. Beyond the natural drive to father a child, each man needs to be evaluated for a disease processes that may cause an abnormal semen analysis, or for mechanical issues or genetic pre-disposition which might affect not only semen quality but his health in the future. Currently it is accepted that infertile men can have higher rates of testis and prostate cancer after the diagnosis of infertility is made.  Unfortunately, the male infertility evaluation is sadly lacking in current conventional practice as the focus has tended toward the women and Assisted Reproductive Technologies (ART). Please remember: a semen analysis alone is insufficient to inform a couple whether male infertility is a) curable, b) caused by an important health condition, or c) a risk factor for late disease development. .

Another vital consideration is your comfort level and how you are treated. At a Urology office such as The Turek Clinic in San Francisco, CA. you will find professional staff, a quiet, private setting and a seamless process for appointments. You can literally show up at 8AM and be completely done well before noon. In those few short hours the semen analysis is collected and processed. The results are interpreted for you the same day by Dr. Paul Turek, and a comprehensive history and physical exam is completed during a consultation hour. It is commonplace to need to meet on-site with Dr. Turek only once and follow ups can be scheduled per telephone, in the comfort of your home or office. Your time will not be wasted and you’ll come away having had a hassle-free, thorough, reliable exam and testing process.

I hope this article is helpful for your journey to fatherhood and having a family.
In my acupuncture clinic, I specialize in male and female fertility, women’s health, and functional endocrinology. Drawing from my 20 years of experience as an ICU nurse, I make extensive use of lab testing. I also utilize acupuncture, dietary changes and nutritional supplementation to optimize health, wellness and vitality for the amazing men and women who I have the great honor treat.

Below are important considerations for obtaining your semen sample as well as some additional information regarding terms you may see on your results.

If you have questions, please feel free to contact me at kreynolds@balancerestored.com or at Balanced Restored Center for Integrative Medicine, 415.381.8500 Ext. 4. Also see my blog for additional information: http://karen-reynolds.com.

Semen samples require specific steps in collection and transport. Here are some important directions to assure accurate results.

•Due to religious or personal beliefs, masturbation for sample collection may not be an option for all men.  In this case, inquire with your MD regarding use of a Milex sheath or a Silastic Sperm Collection device. These specialized condoms are non-toxic to sperm, yet allow for effective collection.

•Abstain from ejaculation for 2-4 days prior to semen collection. Longer or shorter periods of abstinence will impact your results.

•Consult with your MD regarding appropriate lubricants for use during collection.
Most lubricants are toxic to sperm or otherwise impact the specimen.

•Collect in a sterile container-obtain this from your MD.

•Make sure the entire ejaculate volume is collected. All is necessary for an accurate test.

•Samples must be kept at body temperature. Place the sample in a shirt pocket to maintain the temperature.

•Deliver the sample within 1 hour to your testing lab.

•Always check with your lab facility to be certain other requirements are not necessary.

World Health Organization Limits of Adequacy for Semen Samples (1999)
Volume             >1.5 ml
Concentration         >20 million/ml
Motility             >50%
Morphology         >30%
Forward progression     2 on a scale of 0-4

Semen Analysis Terms and Definitions
Density=            how many million sperm per milliliter of semen fluid.
Motility=            the percentage of sperm with any movement
Morphology=            pertains to sperm shape and physical characteristics
Forward progression=    quality of sperm movement rated on a 0-4 scale

Photo by: http://www.livescience.com/strangenews/090709-sperm-competition.html

The Turek Clinic and a Fascinating Look into the Male’s Experience with Infertility

A couple of months ago I spoke at the annual dinner of a Bay Area REI (Reproductive Endocrinology and Infertility) Nurses organization sponsored by Flora Koch of MDR Pharmaceuticals. One of the other speakers was nurse Paula Chavez, LVN, of the Turek Clinic and her talk gave us a fascinating glimpse into the male’s experience and emotions with infertility.

She talked about how the woman drives the process and men try to support and go along (no surprise there), how the men feel helpless in the process, like failures. Unlike women, men don’t share what they’re going through with their buddies; for them infertility is a very isolating experience. Men want to have babies too, they want their DNA to live on.

After her talk, I was hungry to hear more. I felt that if we women better understood what our male partners go through and how they handle and cope with fertility issues—which is very different than how we ladies cope—then we could find ways to lessen the tension that exists between couples struggling with fertility issues. We could create new pathways of communication, and we could learn ways to better support our male partners who, yes!, need our support too.

So, I made arrangements with Paula to speak to her and Paul Turek, MD and Medical Director of The Turek Clinic in San Francisco, which specializes exclusively in men's reproductive health care. As a distinguished and internationally recognized urologist and reproductive microsurgeon, Dr. Turek is very familiar with the unique needs of his male patients and how best to treat them.

Just walking into his clinic you can see even visually that Dr. Turek gets it. The lobby has a high-end, clean modern look, with a surfboard and a stunning, modern painting of a racing car which stretches throughout the room, giving the illusion of speed. It’s a place men can come and feel safe.

WHY A MALE ONLY FERTILITY CENTER?
“Because there’s a sore need for it,” Dr. Turek responded. “Young men with reproductive health issues is the largest underserved population in America today.”

Dr. Turek and Paula explain that the natural path for an infertile couple is to go to a gynecologist and then to an IVF (In-Vitro Fertilization) center, and from there, straight to IVF, without an evaluation.

“When a couple is infertile each partner should be evaluated, and that’s not what’s happening. …In Massachusetts IVF is covered [by insurance]. They get six cycles: bam-bam-bam-bam, and after six cycles have failed the guy is finally evaluated,” Dr. Turek said.

Dr. Turek is concerned. “I’m publishing papers…that say these [infertile] men are getting higher rates of prostate cancer, testicular cancer… something is going on to show that infertility is a marker of a later disease.”

“I had a guy come in with low sperm count. They had gone for an IUI (Intrauterine Insemination) and it failed. It turns out he had prolactinoma, a benign brain tumor… and now his testosterone is low, and he’s feeling crappy. You don’t know what direction he’ll go in; he could go blind, get suicidal, depressed. So we scooped him up and got him going again. Happens regularly.

“My worry is that infertile men get terrible care because of IVF… Because [the clinics] just go right by them, ‘oh you have sperm, go to IVF’ and the guy never gets the exam.”

WHAT'S DIFFERENT ABOUT THE MALE'S PERSPECTIVE?
“There is none,” Dr. Turek said. “They don’t know how to deal with it. So that’s the secret to this practice. [We say] that it’s OK, you’re still a guy, nothing’s changed. Because this is something they assumed they’d have no trouble with, and a lot of it is genetics so this it isn’t something they’ve done. There’s a lot of guilt.”

What is the male’s experience and attitude as he goes through the infertility process?

“Here it is," Dr. Turek said. “Men are encouraged to work hard, shut up, be culturally invisible, get the work done, not complain and deal with it.

"So in the man’s world you see several reactions to infertility: deep depression, self blame and guilt – lots of guilt. Or you see men brush it under the rug with no idea of how to deal with it, and it comes back in a destructive way such as divorce.”

Paula added, “The wife is driving [the process] and [the men] just go along with the program to get things done… It’s kind of a denial issue, but they go through the emotions.”

“And then there’s the guy who takes the reins: I’ll go on a diet, lose 30 pounds, and we enable that,” Dr. Turek said.

“But there’s nothing in society that helps these guys. There’s no place to go. Paula is best friends with these guys, because she’s private, outside the house, one person they can confide in. She learns a lot about these guys that no one else knows. When they call, they want a person. They ask for Paula. …She’s better than anesthesia.”

WHY IS THIS CLINIC DIFFERENT?
“They get a serious amount of care here. They’re #1 and they know it. You get an hour with me, a super specialist and have total access to me.”

Dr. Turek also makes a point of treating men the way they’re built.

“Men are not women, they don’t follow up. This is a little of an insult to their manhood, so it’s something they want to go away. …I see them once and teach them everything on that one visit… how to examine themselves.”

“Men are supposed to be busy and working. Treat men in the environment in which they live. Don’t pull them out of their environment and expectant them to do miracles.”

WHAT KIND OF CONFLICTS DO YOU SEE?
“There are always conflicts! How about the patient who doesn’t tell his wife for a year that he’s had a vasectomy and she’s going through IVF?” Dr. Turek said.

Paula told a story of a guy who was doing a semen analysis and then heating it up, so the sample was bad. “He finally said that he really didn’t want to go through this process but didn’t have the balls to tell her.”

There are a lot of secrets, they explain to me. “Men aren’t as in touch. It’s hard for them to express themselves. We handle it by being open and forward about it.”

Paula shares the story of a guy going through IVF who can’t produce ejaculate at the critical moment. His wife was freaked out, screaming at him, which of course didn’t help.

Paula said, “I took him in the room, took his cell phone away… and said she can’t talk to him until he’s done. After talking to him for 20 minutes and letting him vent and catch up on gossip, I said OK I’m going to leave you alone.” Five minutes later, he emerged with cup in hand.

“This is a typical story,” Dr. Turek said.

There have been so many dramatic stories that a well-received play, Sperm Warfare, written by a former patient of Dr. Turek’s, was based on this clinic’s collection room.

Dr. Turek uses his experience and knowledge to solve problems. “A good urologist understands getting the kid is not the same as fixing the man.” He gave an example of a guy with low sperm count. “We could increase his sperm count, but with the time it takes to do that, her eggs get old, so we have to look at other solutions.”

Dr. Turek admits that in the end what he wants is the Christmas Card. The one with the baby in it.

HOW DO MEN HANDLE FERTILITY ISSUES? ...AND CULTURAL, RELIGIOUS CONSIDERATIONS...
"Quietly, secretly."

You also have to look at cultural and religious differences, Paula said. “There are some cultures in which it’s so intense that they have a baby that they don’t even tell their families they’re going through this because they’re afraid of the response. And some cultures don’t believe in IVF or any assisted reproduction, so they keep the secret between them because they don’t want the families to find out or else they’ll be disowned.”

Dr. Turek added, “There’s a measurable suicide rate among infertile Hispanic men. Divorce rates are definitely appreciable and suicide rates are measurable. …Same thing with the Middle-Eastern community.”

Dr. Turek relayed this story: “I’m treating this guy from the Middle East, and for 10 years he could not accept no. People took advantage of him and did a lot of IVF procedures.” When he came to Dr. Turek, he had to tell him he simply had no sperm.

“[Infertile men represent] a very quiet 15% of the population, much quieter than diabetics, which is about the same,” said Dr. Turek.

SUPPORT FOR HOLISTIC APPROACHES
In his practice, Dr. Turek supports natural methods of optimizing fertility and health, recommending acupuncturists and others. His handout on a holistic approach includes maintaining a well-balanced diet low in fat and sugar, emphasizing whole grains, fruits and vegetables; antioxidants (vitamins A, C, E); stress reduction (massage, yoga, acupuncture, with biking being OK), and more.

Visit his website, and library of resources, to learn more! http://www.theturekclinic.com/ and his blog http://turekonmenshealth.com/

Should Men Follow a Fertility Diet Too?

The short answer is yes, absolutely. Men should go on the fertility diet right along with their female partners, even if they don’t appear to have fertility issues themselves, and especially if they do.

Here’s why: not only can diet affect such factors as sperm count, motility and morphology, but there is also the fact that 10 to 15 percent of couples have unexplained infertility, meaning the cause is unknown. Since you can never be absolutely sure of all the factors that are causing your infertility, you should do the diet together.

Conception ultimately is a mystery, which is why I also believe in a “third” fertility factor (in addition to female and the male fertility), and that is the combined fertility of the couple as a unit. Who knows what that is, but I have many stories to show it exists. Here’s one:

A friend wanted to get pregnant for a couple of years, but it just wasn’t happening. She and her boyfriend checked out fine. For reasons that had nothing to do with fertility, the couple split up. She then fell in love with another man, decided to marry him and got pregnant almost immediately. She had her baby and is now pregnant with a second one. What happened the second time around? Who knows? But I believe it’s the “third” fertility factor at work.

Another story involves a friend who conceived at 43 after years of trying after her new husband did acupuncture and herbs – and there was nothing “wrong” with either of them aside from the mother’s age.

There is also another good reason for male partners to do the diet too, and that’s to provide the added support of working as a couple toward parenthood. Battling fertility issues is hard work, and harder still if you’re doing it alone. Having your partner on board with you, even if he’s not following the diet as closely, is really helpful.

In the meantime, make sure he gets plenty of vitamin C (drink that orange juice!) and zinc (found in nuts and whole grains). Both are helpful to male fertility.