Search for tag: "male infertility"

Interviewer: At-home male fertility tests that you get over the counter. You go to the drugstore, you get the fertility test, you take it. Does that give you helpful information? Are they accurate? Are they worthwhile? That's what we're going to find out today from urologist Dr. John Smith. What is your take on those over-the-counter, at-home male fertility tests?

Dr. Smith: We see a lot of people for fertility at the University of Utah, and those at-home tests really are very rudimentary. They don't tell you a lot of information. They pretty much tell you if you have an adequate amount of sperm in the ejaculate or not. And that's really all they can tell you.

So if you had a positive test where it said, "Hey, you've got enough," that doesn't tell you if those sperm are alive, if there's any motion in those sperm, the morphology or the shape of those sperm. It doesn't give you really any other information. The only thing it tells you is if there's enough sperm there to hopefully not have fertility issues.

And the way these tests work is similar to a pregnancy test where it looks for a protein that's only on the sperm. And so that's how they quantify. So you've got to have enough of that protein in order to have the test come back positive that you've got a high enough quantity of sperm to have a normal sperm count.

Interviewer: But if partners have been trying to have kids and they have not been successful, and the man goes and gets this and finds out, "Oh, hey, I've got enough sperm according to this test because they detected enough protein," but you're still not having kids. You really haven't solved anything by taking the test, have you?

Dr. Smith: No. You really haven't. And that's the other part of things that go on. There's also two parties when you're trying to have kids. You've got the male side of fertility and the female side of fertility, and we're going to talk about the male side today.

But if you have been trying unsuccessfully, having unprotected intercourse for over . . . usually the definition is one year. Some people will say six months to a year. But all in all, if you've been trying and you haven't been successful and you get that at-home test and it tells you that there's enough sperm there, that still doesn't tell you that there's not necessarily a problem. Because if there's low motility, meaning you don't have any that can move and get where they need to be, the viability of things, so to speak, and then the morphology, the shape, if they're not the normal shape where they're not going to travel in a uniform way . . . there are a lot of things that go into a sperm test.

And so when we do a semen analysis at the University of Utah in our lab, we get the volume of the semen. It tells us the total sperm count, the sperm concentration, or how much there is per milliliter that's in the sample that we received. It tells us the viability, how many of those are alive and moving. It tells us the motility, how many of them are moving in an adequate amount to be beneficial for you. And then the shape and morphology. So it really gives us a lot more information.

However, the biggest thing I find for most patients is fertility may not be covered under their insurance. So they're looking for a quick test that can give them some information. And that test may or may not be helpful for them because if there is another aspect to the semen parameters that's not good, that's not just the number, then they're never going to see that on the test.

And so I think a lot of people are looking for a cost-effective way to just get some answers, but sometimes the most cost-effective way is just to come in and get a full semen analysis done with a fertility specialist.

Interviewer: Yeah. That way you can discover exactly what the issue is, and then go about perhaps solving that issue if there is indeed an issue.

Dr. Smith: Exactly.

Interviewer: So, from a male perspective, when you get this information back, generally then when you start solving the problem, is it going to be an expensive process or sometimes are there some simple changes that can be made that can make all the difference?

Dr. Smith: It's different for every patient. Some guys come in and they have a hormone-related issue that we can solve with some medication. That can really be an inexpensive fix. Oftentimes a lot of medications are still covered by insurance, which can be helpful.

And then in some men, if there is an issue where there is a low sperm count or no sperm count, some of the procedures to check and see if the testicles have viable sperm in them can be a little bit more expensive.

However, the real expense comes if you had to have IUI or IVF, which are insemination techniques. Most of the male stuff tends to be less expensive than that.

Now, again, when you're looking at things, fertility is not cheap by any stretch of the imagination. A lot of the procedures that are done to check for viable sperm within the testis can run anywhere from $2,000 to $5,000, but then a round of IVF can cost greater than $10,000 upwards, even much more than that.

So, when I talk about cost, it's very interesting because the male side of things generally is a skosh less expensive than the total amount that it takes to get the fertility solved in some cases.

Interviewer: So it is possible that you go and you get the test, you get some solid results, and it might be an inexpensive fix. That is not unheard of.

Dr. Smith: No, not at all, and we do a lot of that. And sometimes if the sperm count looks maybe borderline, we can also try some medication to try to bolster that sperm count for a few months and then do a retest type of thing.

And so a lot of times, we usually don't run right to the higher dollar surgical procedures, things like that, unless they're absolutely needed because we do understand that a lot of times this stuff isn't covered by insurance and we want to try to make it as best we can and most cost-effective for these folks.

It's a tough road. Fertility is tough. I see quite a few folks who we have success with, and it's great to see that, but any of those couples that are having trouble, I would say just get in and see if there's something that can be done to really help you because sometimes it is a simple solution.

Fertility can be one of the toughest portions of a relationship, but also one of the most rewarding. So I would say don't delay. Just get in and see if there is something that can be done to make things easier for you.

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Interviewer: If you watch any TV at all you can't escape the ads, ads for you need testosterone therapy. It looks like it's pretty easy to get, but should you get it? That's the question. Right now I've got with Dr. Tom Miller, University of Utah health care.

Dr. Tom, for a guy that's over 30 years old, it's been scientifically proven that testosterone levels start dropping at that point. Should I be ordering some of this testosterone online? I mean after all, I want to look like that guy.

Dr. Tom: I think the question, Scot, is why do you think you need it? What's different?

Scot: So, the ads tell me my energy levels have dropped, which they have, that I start putting on more body weight, that my mood is affected, and my sex drive is decreased. Testosterone is going to cure it. It's kind of cure-all is what they're telling me.

Dr. Tom: That's a great concern. That's a concern of many men, and women, throughout the country, but the real question is are there different causes for those things you mentioned? There are many causes for people being a little overweight, feeling a little fatigued. It isn't just testosterone; it's a whole basket full of causes.

Scot: So, if I came into your office, and I gave you those symptoms, and I said that I want testosterone what would you say to me? Where would you start looking?

Dr. Tom: I would ask a few questions. One I'd ask, "What's your sex drive like? Has it dropped off? Are you interested in sex? Do you have the same drive that you had five years ago?" And if the answer to that is no and that you were concerned about it, I'd then go ahead and measure your testosterone level.

Scot: Okay.

Dr. Tom: But I'd also ask you a number of other questions. If the testosterone levels came back low, then we might do a trial of testosterone replacement, and we would then monitor how you felt. Did it make you feel better over the course of time that we try the medicine? If not, it might be wise to stop it.

Scot: So, let's back up for a second, these ads that I'm seeing on TV, I can just order without a doctor's prescription?

Dr. Tom: No, you have to have a doctor's prescription. There's a doctor on the other end that's asking a set of questions.

Scot: So, when I make that call, there is a doctor?

Dr. Tom: There's somebody that has to write the prescription.

Scot: Got you. How do they know how much I need, because it sounds like you would do tests to find out what the actual level is? It sounds like they're just asking me some questions and if I pass they're going to write me the prescription.

Dr. Tom: That's probably true. I can't attest what other things that they do, I'm not sure that's the best way to get health care. Basically you're telling them that you need testosterone, and they're saying, "Fine. Answer these questions. Here's your prescription." I'm not sure that's the best way to try to define what your problem is. As I mentioned before, the causes of fatigue and weight gain there are multiple issues related to that not just testosterone.

Scot: So, let's pretend that I come into you because I want to be a little smarter about it. You ask me some questions; you decide to run some tests. You find I'm in the normal range, on the low end of the normal range. Would you do anything at that point?

Dr. Tom: I probably would counsel you about your lack of sexual drive. Well, I'd seek more information about that, and it might me that there are other reasons for that aside from the fact that the testosterone is in the borderline range. I suppose if you really wanted to try it we could do a trial.

Scot: Sure.

Dr. Tom: I'm not opposed to that if the patient thinks that's right, but I try to give them a realistic expectation. Also tell them that, "Look, it's not a wise thing to take medicine if we do this for several months and you find there's no difference, and you're honest with yourself about it." Just as with any medicine, in my mind, it doesn't make sense to take it if you really aren't getting a benefit from it.

Scot: So, let's take a look at these ads; they promise me so many things. Let's talk about the benefits of testosterone therapy, just from a strict benefit. Why would I, as a man, even come to you and talk to you about it?

Dr. Tom: Certainly, if you had low levels, it might be affecting your sexual drive, you might have some fatigue, you might have less muscle mass then you were used to. In that instance, if you were replacing testosterone, it might help you quite a bit; you might have a great improvement. The problem though, long term, is we don't really know if the side effect . . . we don't know what the side effects are of testosterone replacement over the long haul greater than five years. We just don't know that yet.

Scot: So, this is kind of the risks part right now, is we don't know what the risk are.

Dr. Tom: We don't really know what long-term risks of testosterone use might be, replacement. There are a number of men that I know who have low testosterone and they don't notice any difference. So, do you replace testosterone by testing for it in men who are low? The answer is I don't think we really know. We don't have enough information. We do know that testosterone helps maintain bone integrity and strength but we're not at the point where we say screening for testosterone is a thing to do.

Scot: So, it falls off as I turn 30, and as I get older. When you're testing, are you testing for the normal range for, say, a 55-year-old man, if I'm 55, or were you...?

Dr. Tom: I want to back you up a little bit; testosterone may decrease variably in men so it's not the same as menopause in women.

Scot: Okay.

Dr. Tom: So, when women enter menopause their levels of estrogen drop precipitously. The same is not uniformly true in men. Some men have lower levels of testosterone over time, but not all. So, it's unclear which men would have low testosterone and others have normal testosterone; we just don't know yet. There's not a recommendation to screen all men for testosterone levels.

Scot: So, you really can't say how much should a 50 year old man have?

Dr. Tom: Well that's correct, I mean because we don't screen.

Scot: Got you.

Dr. Tom: We don't test for testosterone as part of an annual exam in the same way that we test blood pressure or test cholesterol or test blood sugar.

Scot: So, your advice is don't order the stuff on TV because you're playing with something that...?

Dr. Tom: My advice is that if you have questions about the way you feel, whether you have fatigue or decrease in energy level or a decrease in your sexual drive, then you should probably talk to your physician about that and decide if testing your testosterone level is right for you. Nothing wrong with that.

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