Why Both Partners Should Be Diagnosed for InfertilityWhen it comes to treating infertility in the United States, it’s often the female partner who receives diagnosis and treatment. Yet, according to male fertility specialist Kelli Gross, MD, as…
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May 05, 2022
Family Health and Wellness
Womens Health
Mens Health Interviewer: When it comes to issues of infertility, it's important that both members of the couple are involved in the diagnosis and treatment of the issue. To find out why that is, we're joined by Dr. Kelli Gross, a men's health specialist and assistant professor in urology at University of Utah Health. Now, Dr. Gross, why is it so important that both partners are involved when we're trying to, say, diagnose why a couple can't get pregnant? Dr. Gross: It's incredibly common that men come to see me and they've never been considered at all in their fertility workup. We find that up to about 40% of the time, there is what we call male-factor infertility or an abnormality in fertility in the male partner. So it can be greatly underdiagnosed. With all of the technology that we have in fertility, things like in vitro fertilization can make it so that optimizing the male partner is not as essential as it once was. But it can be a lot more expensive and have its own set of downsides. Interviewer: So when you say that it's 40% of the time, does that mean that it is often misdiagnosed, or do we often deal with the female issues more often? Dr. Gross: It wouldn't necessarily be that it's misdiagnosed, more that it's ignored. With couples, they may be experiencing infertility without having any major health issues or causes. It can be both sides things are a little bit abnormal. So having things that are less than optimal in one partner can still lead to issues, but sometimes we just get around these by other sorts of things. Interviewer: And what kind of things are those? Dr. Gross: So it would be things like intrauterine insemination or in vitro fertilization. So what that is, for intrauterine insemination, is we put the sperm directly into the uterus. So it bypasses some abnormalities if there are low counts in the sperm or if there are issues on the female side. We can also do things like in vitro fertilization, which is where the egg and the sperm are joined outside of the body. And that can, likewise, overcome a lot of issues on both sides, such as having very low sperm counts or issues from a female partner side. Interviewer: So if a couple is trying to identify what is causing their infertility, why is it more economical to have both partners involved from the start? Dr. Gross: So there are things that we can improve from a male side that can make it easier to get pregnant either naturally or with help. So, for example, there are certain procedures that we do that can improve sperm counts in certain men. So if we have somebody who has very low sperm counts, then doing something like that where they previously would not be a candidate for something like intrauterine insemination, which takes a certain amount of sperm, by raising those counts, we then make them a candidate for that, or they are able to get pregnant naturally because the sperm counts are higher. So they can save a lot of money from the cost of, for example, in vitro fertilization. Interviewer: We spoke about why it's so important to have both partners involved in diagnosing and treating infertility. How long should a couple be trying before they technically are dealing with infertility issues, or when should they start to see a specialist? Dr. Gross: So we usually define infertility as trying for one year. And that's kind of just because 90% of couples will get pregnant within one year. It's kind of arbitrary. So, for example, if you've been in a long-distance relationship and you haven't been having intercourse, of course, a year may not mean that there's anything wrong biologically. And at the same time, if there's any sort of history or medical concerns that make you seek treatment earlier, there's nothing wrong with that at all. We don't say, "Keep trying," necessarily. We would typically evaluate to see if there was anything that we can improve, no matter what time it is.
When it comes to treating infertility in the United States, it’s often the female partner who receives diagnosis and treatment. Yet, according to some specialists as many as 40% of causes of infertility lie with the male partner. Learn why it’s more successful and economical to approach infertility as a couple. |
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Three Common Causes for Infertility in MenCould something as simple as spending time in a hot tub or taking a supplement be impacting your fertility? Male infertility specialist Kelli Gross, MD, explains the top three most common things she…
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April 28, 2022 Interviewer: For a couple that is having difficulty getting pregnant, as often as 40% of the time, it's actually an issue with the male partner. Why is that, and what are some of the more common things that can be causing infertility in men? We're joined by Dr. Kelli Gross, a men's health specialist and Assistant Professor in urology at University of Utah Health. Now, Dr. Gross, if we were to pick out the top three reasons why men might be infertile, what are they and how can they be treated? Dr. Gross: So, number one, one of the top modifiable reasons that I see is exposure of the testicles to heat. What that commonly is, is a hot tub, bathtub, sauna. And the reason why is because sperm really likes the cooler temperature of the testicles. The testicles are outside of the body. They're about four degrees cooler than the rest of the body. And things like hot tubs, that increases the heat and the sperm just doesn't work as well, isn't produced as well. People are surprised that those effects last about three months. Seventy-four days is the lifecycle of the sperm, so going in the hot tub once is going to potentially affect your fertility for the next three months. Interviewer: Wow. Dr. Gross: Yeah. People are always shocked by that number. Now, we found that things like showers don't necessarily make a big difference, the kind of underwear that you wear, those sorts of things. But a lot of direct heat from the testicle you do want to avoid. Interviewer: I guess how big of a temperature change are we talking before we see that 74-day impact on the sperm count or functional sperm count? Dr. Gross: I don't know if we necessarily know an exact number, but I usually advise patients the testicles are four degrees cooler than the rest of the body, so kind of keep it under that point. Another common thing that we see is fevers. So after fevers, it's incredibly common to see abnormalities on a semen analysis. Interviewer: Wow. Okay. So that's number one. That's pretty common. It's not something that's at the forefront of your mind. What about number two? Dr. Gross: So number two would be something called a varicocele. Those are dilated veins to the testicle. So if you think about varicose veins in your legs, it's the same kind of thing. And they happen in about 15% to 20% of men overall, but we find it in up to about 50% of men who see a urologist for fertility issues. They are repairable surgically. We think the reason why they have such an effect is potentially because it does trap heat. So the blood pools in those dilated veins, so it traps more heat in the testicles, which sperm doesn't like. Interviewer: And what causes these veins? Is it just genetics? Is it just maybe lifestyle stuff? Dr. Gross: It's mostly just genetics, kind of the way that you were born. They're incredibly common. So it's in part just the way that we're constructed, the way the veins have to travel such a long distance. Interviewer: And so is this an outpatient procedure type of surgery? What kind of . . . what is involved in treating the varicocele? Dr. Gross: Yes, it's an outpatient surgery. It takes about an hour more or less, depending on if we have to do both sides or what. We make an incision that's about an inch, inch and a half long, and then just divide all the veins. It's fairly straightforward as far as surgeries go. Not everyone needs it, but a fertility specialist can help determine if it's something that needs to be repaired. Interviewer: Okay. So we have heat. We have an outpatient procedure if there are some extra veins or some varicoceles that have been formed. What about number three? What is the third most common thing? Dr. Gross: So number three that I see very frequently is people who are on supplements that can potentially harm fertility or other medications. Testosterone, for example, is one of the biggest culprits that I see. Most other medications that are prescribed aren't going to have a big effect. But there are certain other ones like Propecia or Finasteride, which is used for hair loss, that can potentially affect fertility. Cancer medications, unsurprisingly, can affect fertility. But the one that people don't really expect is supplements. They've done studies on supplements, and I've been absolutely shocked with what's actually in a lot of the supplements that we take. For example, there are steroid hormones. There are things like testosterone, including testosterone, that are in some of these supplements, even ones that aren't labeled, or that you would necessarily worry about. There's even oral testosterone, which is actually pretty bad for your liver. It's just not well regulated. I see patients all the time who I look at their hormone panels and I'm like, "You may not be on testosterone, but there's something that you're taking that has testosterone in it." And we usually can pick something out and stop it and then those effects go away. Interviewer: Wow. And so are these just over-the-counter type? Are we looking at like a daily multivitamin supplement? Are we looking at, say, muscle building, those things that you get in the big jugs at the supplement store? Dr. Gross: Not usually the multivitamin, the Centrum or anything like that. Those are usually pretty safe. But it's like pre-workouts, even ones that aren't "boost your testosterone pre-workout," just regular pre-workouts, anything that's kind of marketed towards the erectile dysfunction, men's health kind of thing. I've seen potentially having issues with that. Interviewer: And how long does it usually take for someone to see the effects go away after they stop taking it? Dr. Gross: It can really vary. For example, with people who've been on testosterone for years, it can take up to about 18 months for that to come back. So in 90% of men it'll come back in about 18 months, but 3 months is usually a minimum. And some people won't come back in at all. Interviewer: Okay. So those are three common things that can be causing male infertility. Now, Dr. Gross, how long should a couple be trying before they come and see a specialist like yourself? Dr. Gross: So it's different for every couple. We generally say if after a year, definitely come in. But we won't question if it's sooner. It's easy to check to see if things are normal or not.
Could something as simple as spending time in a hot tub or taking a supplement be impacting your fertility? Learn about the top three most common causes of infertility in men and simple changes that can increase a man’s fertility. |