Update on Male Contraception: Do Vasectomies Still Rule?

the male pill
Wondering if there’ll ever be a “little pink pill” for male oral contraception (Courtesy Unsplash)

I know you’re wondering: What’s up with the male pill? Exactly where are we with male contraceptives other than condoms or vasectomy? Well, it’s a good time to ask as it’s now very clear that the desire for alternatives to vasectomy is great and growing. Studies of couples around the globe found that 25-75% of them would use a male hormonal contraceptive. That means that between 44 million and 130 million men in those nine surveyed countries alone would consider a male pill. That’s a need indeed!

A Storied Past

Contraception has been defined by innovations on the male side for almost 5000 years:

3000BCE: Evidence of condom use made from animal bladder or intestine or linen cloth in Crete and Egypt.

1800 BCE: Spermicides made by combining crocodile feces and fermented dough in Egypt

1830: First vasectomy performed in a human by R. Harrison in London. Its popularity rose dramatically after WWII. The first national program for vasectomy was launched in India in 1954

1855: The first rubber condom is made by…wait for it…Charles Goodyear, who later invented the rubber tire.

Over the last century, however female contraceptive innovations surpassed male contraception like it was standing still and female contraceptives are currently the preferred choice for most couples by a wide margin (5:1). What happened here? The most glaring issue is that funding has been sporadic as pharmaceutical companies haven’t been interested in developing male pills due to high development costs and the fear of lawsuits.

The Male Pipeline

Approaches to male contraception involve  stopping sperm production, rendering sperm immotile so they don’t move, or blocking the exit path from the testicle. They can be hormonal, non-hormonal or surgical in nature. There is currently one hormonal male contraceptive in clinical trials: a non-oral testosterone-progesterone gel applied to the skin daily to turn off or turn down sperm production. The goal is to reduce sperm to less than 1 million/mL in the semen. The questions are whether it can do this reliably in all men (remember the gold standard is vasectomy which is 99.99% effective) and whether hormonal side effects are tolerable: acne, moodiness, changes in sex drive or erections. After all, having significant sexual side effects from a pill that aims to take the worry out of sex kind of defeats the purpose, wouldn’t you say?

There is also good research developing on a sperm binding agent called Eppin that renders sperm immotile so they just sit there and can’t reach the egg to fertilize it. It’s being billed as “non-hormonal” and “reversible” but it has only been shown to be effective as an immunocontraceptive in monkeys (i.e., essentially a vaccine). It’s not clear to me how complete the sperm motility block generated with this pill can be, as we all know that sperm love to wiggle. Also, I am not entirely sure how reversible anything is with the human immune system as it literally remembers everything that it has ever seen. To date, this approach has not seen clinical trials. Lastly there is ADAM*, a non-hormonal, non-oral, hydrogel polymer “plug” that blocks the flow of sperm in the vas deferens without interrupting fluid flow. It is essentially a “screen door” for sperm and should be an improvement over the classic 100-year-old vasectomy, especially if it lives up to its promise of being reversible. It’s also in clinical trials right now. So, there’s a lot of window shopping in male contraceptive research right now, but no available product inventory.

Vasectomies Rule

So, it appears that we are left with the good ole’ vasectomy. Tried and true, nonhormonal and compliance-free, nothing on earth beats it in terms of reliability. In fact one of the reasons it’s so well-loved is that you don’t have to think about doing something every time sex is contemplated. All set to go, time after time after time. And, it has new and improved versions including the no-scalpel vasectomy, the Brosectomy® and the Nitrous-powered vasectomy, all developed with the goal of making the procedure as much of a “non-experience” as possible.

*Disclosure: I advise this company.

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Case Report: Disease Causing Low Testosterone: Look and You Shall Find

Male Fertility Specialist Los Angeles, CA
Your empty tank can be refilled but it’s good to ask why it emptied (Courtesy: Unsplash)

He came to my office out of sorts, looking for answers to his medical issues. As a 30-year-old, he had been experiencing fatigue, depression, low sex drive and erectile dysfunction for 8 years! Knowing that the average young male thinks about sex every 10 minutes during waking hours and ever so rarely fails to have an erection, I was very concerned for him and took his symptoms very seriously. He had seen his primary care provider, an endocrinologist and a neurologist before me. He was given antidepressants, psychotherapy and other treatments to no avail. This led to a diagnosis of low testosterone and subsequent treatment with testosterone injections. Like a recharged Energizer® bunny, testosterone replacement revived him entirely, making him feel “absolutely better in every way.” All good. Yet, he sat in front of me wondering whether or not he would have to take testosterone for the rest of his life, maybe 60+ years! He was more worried about how he would stay fertile when he learned that testosterone therapy acts as a contraceptive.

The Bottom of Things

I am a “root-cause” guy. By figuring out why things happen, you have the best chance for cure. The simple question here is: What was causing the testosterone drain on this young man, and could it be reversed? So, I went to work.

His medical history was a blank slate for risk, including no pot or other drug use, no untimely stress, and no sleep apnea or obesity. His physical examination was also unremarkable with normal testicle size and no varicoceles. The finding of normal sized testicles told me that whatever happened to his testosterone occurred after puberty and was not a lifelong problem of testicular failure. His blood work showed no diabetes, anemia, prolactin or thyroid issues, all of which can be associated with low testosterone.

But then I saw it, deep within his bundle of laboratory studies: his blood counts were high. He was polycythemic. But why? Well, just being on testosterone could do this, but he wasn’t taking high enough, anabolic doses of testosterone. Then, I came upon blood tests taken before he started testosterone and, lo and behold, he was polycythemic then too. Bingo! The diagnosis: hemochromatosis.

A Bloody Disease

Hereditary hemochromatosis is caused by a mutation in a gene that controls the amount of iron your body absorbs from food. It occurs in 1 of every 200-300 people and is found far more often in men than women. Because of this gene defect, excess iron is absorbed and then gets stored in body organs like the liver, pancreas and spleen. Over time, the stored iron causes scarring and organ damage that may lead to liver disease, diabetes and heart failure. Infertility, erectile dysfunction and low testosterone are also consequences of hemochromatosis. And, left untreated, it can be fatal.

You’ll never guess how it’s treated: Bloodletting (now known as therapeutic phlebotomy). Bloodletting, or draining of a patient’s blood to prevent or cure disease, was the most common medical procedure performed by surgeons from antiquity until the late 19th century, a span of over 2,000 years. And it still has application today. Does it cure hemochromatosis? No, but it prevents damage to organs by keeping iron from accumulating in them and results in an essentially normal lifespan.

So, this root cause analysis paid off handsomely. I asked this young man to consider donating blood regularly. I also took him off of the testosterone injections and started him on clomiphene citrate pills to push his “lazy” pituitary harder to make more of his own testosterone levels. In this way, we maintained his normal (high) quality of life that he enjoyed while on testosterone without using testosterone; he now also enjoys good sexual health and is fertile, and we added a few more years to his life.  We have done what Hippocrates, the Father of Medicine, ordered us to do: “Declare the past, diagnose the present, foretell the future.” And that, my friends, is the hat trick of great medicine!

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How Soon Should Couples Seek Fertility Treatment?

Snoopy is pretty smart
Charlie Brown had it down. And Snoopy did too. (Courtesy: Unsplash.com)

You’ve been trying to conceive but sparks just aren’t flying. You stopped using birth control pills (or pulled the IUD) and started having unprotected sex. With the help of an app, you figured out your most fertile time of the month and began timing sex to increase the odds. You switched to vegetable oils for lubricants and tried all sorts of positions, from missionary to doggie to cowgirl to kneeling lotus to quarter moon, full moon and even no moon, but still no luck. Maybe it’s time to get some help.

When To Seek Help?

Society guidelines define infertility as the inability to conceive after one year of trying. It’s that simple. How, when and where you have sex is all up to you, but if it doesn’t happen after 12 months, then infertility is present. The basis for this definition becomes apparent when you look at the trigonometry of trying: 30% get pregnant within the first month of trying, 60% get pregnant by 3 months, and 80% are pregnant by 6 months. After that another 5% of couples will conceive by 12 months and 15% will not have conceived.

So, the classic recommendation is to try for one year before seeking help. But, as a fertility specialist who sees infertile couples for a living, I would suggest that couples seek help whenever they get concerned about it. I say this because concern snowballs into stress and anxiety, and all of this can negatively impact the relationship, quality of life and fertility potential. Realizing that women’s fertility is known to decrease with age, I also recommend that couples seek help after 6 months if the female partner is older than 35 years. And, if either partner has a known medical history that might impact fertility, say like cancer treatment or surgery on their reproductive parts, then they should also consider seeking help even sooner than 6 months.

Who Goes First?

Society guidelines are clear on the issue of who gets evaluated once care is sought: Both partners. And at the same time.  However, what usually happens is that women make the first call to their gynecologists and the process begins. That evaluation should include a detailed medical and menstrual history, a physical examination and further blood and imaging studies as indicated. The male partner evaluation should also include a history, a proper physical examination, two semen analyses and blood and imaging studies as indicated. Importantly, since gynecologists do not typically take care of men, the male evaluation should be performed by a urologist with an interest or expertise in male infertility. In my practice, a thorough male infertility evaluation is completed in a single office visit, and one that I promise will not hurt.

Remember, although making babies is the most fun you might ever have without laughing (Woody Allen), behind the scenes there is a virtual symphony of precisely orchestrated biological events that must occur for its success.  The beauty and complexity of human conception is staggering if you really think about it. And getting professional help to tweak the process can mean all the difference in the world. Charlie Brown hit the nail on the head when he said: “Asking for help isn’t weak, it’s a great example of how to take care of yourself.”

Call us today at 1-888-887-3563 or visit our Los Angeles or San Francisco clinics to schedule an appointment.

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Does Producing More Semen Make You More Potent?

Sperm production treatment, Beverly Hills, CA
How to read spilled milk (Courtesy: Unsplash.com)

When it comes to health, love and possibly money, more may be better. But what’s the scoop when it comes to the amount of semen produced with ejaculation? Does more mean more potency or better fertility?

Funny thing is, this issue really runs deep with men. In several religions, semen is precious and can’t be spilled or wasted. Throughout human history, this liquid has some serious gravitas; in fact its importance is…wait for it…seminal.

A Poker Hand

As a male fertility specialist, I have reviewed literally hundreds of thousands of semen samples from tens of thousands of men. From this experience, I have concluded that a semen sample is like a hand of cards. Each measurement, such as semen volume, sperm concentration, motility and shape, is like a poker card with its own value or meaning. But together they also have a larger meaning or “look” that can have clinical significance. For example, if the semen volume and the sperm concentration are both low, then this could reflect something called retrograde ejaculation, in which semen preferentially goes backwards into the bladder instead of forward through the penis into the real world. In essence, the big picture matters most, and as with many things in life, the “look” and not the amount matters more for semen.

Larger Loads

Although one may think that unleashing a bigger load of semen makes you more of a man, outside of pornography, the facts do not bear this out. There is no real correlation of semen volume or force of ejaculation with testosterone levels, virility, erectile capability, sexual competence or fertility. Semen volume has less to do with manhood than simply the size of the seminal vesicles that produce it, as these paired internal organs behind the prostate are the main contributors to semen volume. And since, sperm enters the semen from separate channels leading out of the testicle, their numbers are relatively independent of semen volume. Therefore, high volume ejaculates may in fact have lower sperm concentrations due to dilution issues. However, fertility is typically unaffected either way, so no worries here.

Smaller Spurts

The story is quite different when semen volumes are low (< 2 mL). When this occurs, my interest perks up considerably as there are only a few good reasons for having a low ejaculate volume.

The most common among them is incomplete collection. Sometimes men simply miss the cup and hit the wall instead. This is especially common on the first attempt at procuring a semen sample as men must think about what they’re doing (and collect the sample) while ejaculating. I refer to this as “first sample syndrome” and it typically goes away with more experience and repeat samples.

If the seminal vesicles are missing or blocked, due to genetic or acquired disorders, ejaculate volumes are typically low, and fertility is impaired.

With low testosterone levels, semen volumes can also be reduced as sex gland secretions are Vitamin T-dependent in general.

Medications such as alpha blockers for prostatic enlargement or finasteride for hair loss can also impact semen volume by reducing production in the seminal vesicles.

Finally, medical conditions such as diabetes and multiple sclerosis and procedures involving the back and lower abdominal can redirect ejaculate toward the bladder instead of the outside world, causing reduced semen volume.

So, semen volume is more reflective of a man’s biology than his manhood. This means if you want to increase it, spend time thinking about how to stay healthy: eat well, sleep well, maintain a lean body weight, and eat a balanced diet. Exercise regularly and reduce your stress. These are the forces that matter most for sex and semen.

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Will the Office of Men’s Health Finally Arrive?

The hallowed halls of congress and the healing of men (Courtesy: Unsplash.com)

“You should go and see a doctor.” Who ignores this advice more often: men or women? To help you answer this, look at these U.S. medical facts:

  • Men lead in 9 of the top 10 causes of death.
  • 80% of suicide deaths are men.
  • There is a 5-year difference in life expectancy between men (76.2 yrs) and women (81.2 yrs).
  • The average black male in America barely lives long enough to collect social security.
  • Cancer death rates are 40% higher for men than women.
  • Women are twice as likely as men to seek preventative medical care.
  • The cost to government and society at large for early death and illness in men exceeds $300 billion annually.

It’s pretty obvious that the answer is “men.” The issue at heart is why such an egregious gender health care disparity exists in American medicine today. It starts with “typical” male behavior fed by testosterone and an immortality complex, leading to symptom avoidance and risk-taking behavior that is largely unregulated due to lack of mentors, communication, and poor access to care. Whatever the root causes, the consequence is that men are medically underserved.

A Captain Needed

The solution to this medical epidemic is clearly complex and involves many stakeholders, including family, friends, employers, peers, religious and sports organizations, and local, state, and federal governments working together. How best to pool and organize all these resources to improve men’s health? A federal Office of Men’s Health would be a great start! An Office of Women’s Health was established at the federal level in 1991. With the goal of improving awareness of, access to, and delivery of better health care to women, it succeeded in spades. Witness the fact that 90% of women with breast cancer are now cured of their disease.

The time has come for men to catch up! Bill H.R. 5986 entitled “Men’s Health Awareness and Improvement Act” was introduced into the 117th Congress this past month by Rep. Donald Payne (D-NJ). Hallelujah! It proposes to use the resources of the Department of Health and Human Services to promote, educate and coordinate men’s health activities at all levels in both the public and private sectors, just like the Office of Women’s Health has so successfully done over the past 30 years. It’s the ship captain that we so desperately need to bring men’s health into the 21st century.

A Sailing Ship

What excites me the most about this initiative is it’s potential to improve the health of males at all ages, from boys to men. Remember that after leaving the care of pediatricians as teenagers, men are essentially provider-less, whereas women have gynecologists who care for them throughout adulthood. This Congressional act has the potential to commit to and codify the medical care offered to American men throughout their lives by organizing all resources at hand around this great country, and thereby raising the tide of better medical care and floating all boats along with it. In so doing, we can teach men to invest in themselves, improve their lives and enhance the lives of those around them. In the words of Ernest Hemingway: “There is nothing noble in being superior to your fellow man; true nobility is being superior to your former self.” Please join me in supporting this long-overdue act of compassionate medical care and write your congressperson!

 

 

 

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Things That You Didn’t Know About Your Penis

Mona Lisa
Da Vinci knew a lot more about us than how to paint a great smile (Courtesy: Wikipedia)

Honestly the human penis, that ultimate love muscle, is an architectural and biological marvel. At rest, it serves as a conduit for urine. When rubbed like a genie’s lamp, it takes on a whole other, Jekyll and Hyde-like character. And did you know that pound-for-pound the human penis is the largest in proportion to body size among all mammals? But it’s also unique in other ways. Yep, this little appendage is a full of surprises.

A Boneless Organ

Here is another Snapple-cap fact: pretty much every mammal besides humans has a bone in their penis. The baculum or os penis bone evolved in mammals more than 95 million years ago. For some reason, humans lost that bone about 1.9 million years ago, sometime during our homo erectus phase. Theory has it that the bone was no longer needed as human reproduction drifted from polygamy to monogamy. Apparently, bony penises can stay in the female reproductive tract longer, keeping other penises away, and thereby increasing reproductive fitness.

Amazingly enough, even without a bone, one can still “fracture” a human penis. It’s not easy to do, but it happens when serious weight suddenly comes down on a semi-erect penis, bending it until it makes a snapping sound and then turning it all hues of black and blue. So be careful how and where you direct this little sword.

Sleepless Nights

Another little-known fact is that it takes more energy to keep a penis soft or flaccid than it does to keep it erect. Erections occur when blood flow opens like a spigot after being tightly clamped down. Notably, the blood pressure within the erect penis can be twice as high as your blood pressure; this is necessary to attain the required stiffness essential for a firm erection and proper use.

Along these lines, did you know that your penis “sighs” and relaxes about 3 times every night for 1 hour each while you are asleep? During these sighs, which occur during deep REM sleep, there is a full-blown erection. Since you’re in your deepest, dreamiest state, you might never know that it happened. Your partner might though.

Loading the Gun

The act of ejaculation is actually a reflex that, like a sneeze, has a point of no return. Fundamentally, it consists of two distinct events. The first, termed “emission,” occurs during foreplay and arousal. During this time, the body is busy pumping a glob of sperm from the scrotum up to the prostate through the vas deferens, effectively loading a bullet in the gun’s chamber. It may be felt as a pulsating sensation down there. Then comes the “ejaculation phase,” which is what we know as ejaculation. What happens here is a series of well-orchestrated events: the seminal vesicles contract, the bladder neck closes, and the urinary sphincter opens, all to allow the semen to traverse the penis and enter the free world. This clockwork-like activity is aided by contractions of the pelvic musculature every 0.9 secs to help force fluid from the penis. A magical moment in more ways than one.

Flipping the Switch

To get a good erection, the body must be relaxed. That’s why stress kills erections. Remember, our nervous systems are pretty primitive: Who wants an erection when being chased (stressed) by a woolly mammoth? But, once an erection is achieved and climax is imminent, the dormant “fight or flight” nervous system kicks in again and is responsible for ejaculation. Afterwards, the erection falls and cannot be regained for some time. This is termed the “refractory” period and it is during this post-coital moment when the nervous system switches back to “rest and restore” mode to allow for yet another erection. The marvelous interplay of both halves of our nervous system is present in every moment of the climacteric.

You know who knew a whole lot of these little penis secrets? Leonardo da Vinci, who said: “The penis does not obey the order of its master, who tries to erect or shrink it at will, whereas instead the penis erects freely while its master is asleep. The penis must be said to have its own mind, by any stretch of the imagination.”

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Should You Buy ED drugs Online?

When is a pill just a pill like other pills? (Courtesy Unsplash.com)

It’s simply incredible to see how the way we buy things has changed over the last two decades. In just 20 years, online shopping has gone from being non-existent to becoming a trillion-dollar industry. What with 360-degree product views, videos, consumer ratings, detailed sizing instructions, free shipping, front door delivery and EZ returns, shopping online has become more like shopping in person than ever. And the facts about online shopping are also staggering: In 2021, more than 2.1 billion people are expected to shop online, with e-commerce sales expected to reach $4.9 trillion. As a car guy, I never imagined that anyone would purchase a 6-figure car online without a test drive or kicking the tires, but it happens all the time now. Amidst this e-commerce revolution, one key question is whether it is a good idea to buy prescription drugs online. And more specifically, how about buying “embarrassment drugs” for erectile dysfunction?

Cybermedicine Legality

Just because you can buy a drug online and from the comfort of your home does not mean that it is legal or safe. Remember, prescription drugs in the US must be “prescribed” by a licensed medical provider, and that includes a doctor’s visit with a consultation and examination. Lawsuits to date and statements made by prominent medical societies make it clear that the “physician-patient” relationship still matters for prescribing drugs. Foregoing this time-honored process could prove dangerous for consumers.

Cybermedicine Safety

The online drug commerce market has grown very quickly. So quickly, in fact, that state and federal drug agencies are overwhelmed and understaffed when trying to enforce interstate commerce laws among pharmacies and physicians. Part of “prescribing” a drug is a responsibility to educate the consumer about risks as well as benefits of a medicine. This has huge implications for patient health and safety.

You should never take a prescription drug without a consultation with and prescription from a physician. Moreover, there are some important questions you should ask yourself before taking a prescription drug:

  • What’s actually in the drug? Many drugs sold online do not meet the quality standards of FDA-approved pharmaceuticals. FDA-approved, pharma-grade prescription drugs may cost more but they are quality-guaranteed. Not always true with online medications.
  • Is the drug legal? The lack of enforcement means that access to illegal or unapproved drugs is widespread. And with this comes the issue of fake health claims.
  • Is the drug right for me? The loss of the patient-provider relationship could result in missed warning signs regarding prescription medicines and lead to untoward health consequences.
  • What if I have a drug reaction? If things go wrong with the medication, who are you supposed to contact for problems?

Buying “Embarrassment Drugs”

When it comes to buying “lifestyle drugs” like erection pills, the benefits of going online are clear: cost, confidentiality, convenience, speed, and access to oodles of information not readily available in brick-and-mortar pharmacies. But a study by the grandfather of Viagra®, Dr Irwin Goldstein, found that 77% of pills purchased from 22 different websites were counterfeit and contained only between 30-50% of the active ingredient advertised on their labels. In light of this, here is my advice regarding buying ED drugs online:

  • Be cautious when visiting online drug sites. Understand that the legality and product quality of many online drug stores is questionable. Try to buy from reputable pharmacies.
  • Realize that consultation (and preferably a visit) with a doctor is technically required for buying prescription drugs. Seek a similar interaction when buying drugs online and talk to a professional before buying.
  • Prescription drugs are not sold “over the counter” for good reason: they have known side effects which could have health consequences. Get educated from a provider or pharmacist regarding these issues as it’s your health at stake!

As we wander deeper into cybermedicine, we should heed the words of George Herbert: “The buyer needs a hundred eyes, the seller not one.”

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Recommendation from Males Who Have Overcome a Male Infertility Analysis

Going locations you’ve by no means been earlier than (Courtesy: Unsplash.com)

Males as a species are fairly good at adapting to the brand new or totally different, to judging and taking dangers and to responding to the unknown. I didn’t say good, however fairly good. Certainly, this capacity has allowed them to surf waves the scale of mountains, run the mile in nicely beneath 4 minutes, run firms, increase households, earn a living, and simply merely survive in an ever-changing world. However, inform a person that he’s infertile, and he could resemble a deer in headlights. Being infertile strikes at a person’s very core and is an unknowably devastating blow to id, ego and superego.

A Freudian View

I’ve typically questioned why an infertility prognosis is so disabling for males. I’ve revealed that being infertile impacts males’s intercourse lives, shallowness and social interactions. And now I look to Freud for a deeper rationalization of this response. The Freudian view of people is that of id, ego and superego. Id represents the fully unconscious man, and consists of the instinctive, childish and primitive behaviors which can be pushed by satisfying “pleasures” resembling consuming, sleeping and reproducing. Ego is derived from each the aware and unconscious thoughts, and it ensures that the id is expressed in a socially acceptable method. Freud in contrast the id to a horse and the ego to the horse’s rider. The horse gives the ability and movement, and the rider governs and directs. Overseeing all of this, the superego bears the ethical requirements and beliefs discovered from dad and mom and society. It gives the correct and unsuitable tips for making judgments and tries to good and civilize conduct.

A Freudian Fault

With regards to replica, the id sees it as an instinctive want, as primary as starvation. It’s important and elementary to life. Neither the ego nor the superego questions this precedence, as it’s so primary in nature. As an unchallenged cornerstone of being human, replica fails to seize the eye of the ego and tremendous ego…till there’s a drawback. And when infertility surfaces, there isn’t a actual basis for a coherent response. Therefore, emotional chaos outcomes. Within the phrases of Freud, “Males are robust as long as they symbolize a powerful concept.”

A Freudian Response

During the last quarter century, I’ve seen each response possible when males are knowledgeable that they’re infertile. Infertility impacts shallowness and self-identity like few different mortal challenges. You had been placed on this good earth to breed, and but you’ll be able to’t? This goes deep. And, since emotions about fertility and sexual adequacy are sometimes intertwined, infertility can lead males to query their masculinity and sexual prowess. The id, ego and superego are fully unprepared for this.

I’ve additionally seen the large interior power that males reveal when confronted with infertility. This tends to happen with the next realizations:

  • That some issues are out of your management
  • That some issues are literally in your management
  • That data and information are energy and may help you navigate the unknown
  • That total well being issues
  • That emotional help issues

Freud truly nailed it when he stated: “Being fully trustworthy with oneself is an efficient train.” So true on the subject of coping with the sudden in life. And, reflecting on the non-public development that’s potential in adversity, he additionally stated: “At some point, looking back, the years of battle will strike you as essentially the most stunning.”

 

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Sperm Washing: What to Know

sperm washing
Which one is the perfect? Microfluidics may also help. (Courtesy Unsplash.com)

Why would anybody wash sperm? Are they like garments that get soiled? Not precisely, however sperm washing can clear up the setting wherein sperm discover themselves. And it will probably focus the boys, in order that they pack a extra highly effective punch.

On the draw back, the act of washing sperm, which is actually placing them in tiny, high-speed washing machines that spin at 1000 rpm, also can injury their genetic payloads. That valuable cargo is the stuff of infants and due to this fact jostling it an excessive amount of by washing sperm could result in fewer pregnancies. Fortunately, there are actually methods to “clear up” sperm with out washing them. The miracle of microfluidic know-how.

Turkey Basting – Sperm

The best method to make use of washed sperm is with intrauterine insemination (IUI). With IUI, a washed pattern of ejaculated sperm is put right into a syringe and positioned into the feminine uterus, nicely past the vagina and cervix the place sperm usually discover themselves after intercourse. And, just like intercourse and aligned with Darwin’s creed, the perfect sperm ought to nonetheless win.

Some type of IUI has been round a extremely very long time: vegetation and bugs have been conceiving by mixing their gametes with out intercourse for hundreds of thousands of years.

The primary mammalian IUI was thought to have originated within the 14th century for horse breeding within the Center East. In 1784, Lorenzo Spallanzani was reported to have used it for canine breeding. And as medical lore has it, John Hunter was the primary to attain a human being pregnant with IUI in 1793.

It has develop into a go-to staple for fertility remedy for infertile people and in animal husbandry during the last 200 years; that’s, till in vitro fertilization (IVF) was invented in 1978.

Now, IUI has had a verifiably sturdy, hundred-year run as a fertility remedy for people. It’s used for {couples} with unexplained infertility, in ladies with cervical points, when donor sperm is chosen and for males with spinal wire damage or erection points. It is usually utilized in circumstances of male infertility as a consequence of low semen high quality. In essence, for male infertility, IUI places extra bullets within the gun and shoots these bullets farther. In finest case eventualities, IUI being pregnant charges are very respectable, however they don’t method the upper being pregnant charges achieved with IVF. After all, the price of IUI is barely about 1/10 that of an IVF cycle, so the bang for the buck remains to be fairly affordable. And IUI is definitely a extra “pure” (and I dare say extra romantic) course of to undergo than IVF (take a look at tube child) wherein conception happens in a petri dish.

Sorting Beats Washing

As a result of its success charges are decrease than IVF, IUI has more and more develop into IVF’s ignored older sibling. This will partly be as a consequence of the truth that sperm are solely “washed” and concentrated however not essentially enhanced with IUI. However microfluidic know-how could change all of this. As a substitute of simply “washing” sperm, it’s now potential to place an ejaculate on a chip, wait 20 minutes, siphon it off, and acquire not solely probably the most motile sperm but in addition probably the most genomically competent sperm within the bunch to make use of for IUI or IVF. Consider it as CrossFit for sperm. Certainly, a current, massive examine (n=265 {couples}) confirmed that the continuing being pregnant charges in chip sorted IUI sperm was 15% per cycle in comparison with 9% per cycle utilizing sperm “washing” — a 60% distinction! Does this imply that, on the planet of human infertility remedy, IUI is staging a comeback? Keep tuned as time will inform.

Disclosure: Dr Turek is a medical advisor to ZymotFertility.com

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How you can Overcome Failed Fertility Therapies

Overcoming failed fertility treatments
A brand new daybreak is simply across the nook… (Courtesy: unsplash)

Failed once more. One other month, one other failed infertility therapy. Are you too frightened or drained or broke to maintain going, but unable to simply accept that end-of-the-road feeling? Listed below are some issues to contemplate as the sensation of desperation units in:

  • Why didn’t it work? Discover out extra about what occurred. If there’s a proof, and it is sensible, and one thing could be completed about it, then take into account giving it one other attempt. Are extra diagnostic checks wanted? In that case, how would they make the following expertise or cycle completely different than earlier ones?
  • Contemplate the sperm. For years it’s been thought that infertility is only a feminine challenge. Hi there! It’s not. Sperm matter too. And we now know that sperm matter greater than ever. Possibly it’s him and perhaps he wants a deeper dive to attain success.
  • Respect the chances. Sincere reality: most instances of IVF fail. One UK examine of over 178,000 cycles discovered that the cumulative stay start price after 3 cycles of IVF was 42%. After 8 cycles, it was 82%. Meaning it takes a mean of 7 IVF cycles to conceive. If the success charges of IVF had been utilized to most cancers, we wouldn’t be curing half the cancers we do as we speak. Contemplate weighing the emotional, monetary and bodily toll in opposition to the chances of success when contemplating one other attempt.
  • Dont rush into one other therapy. Many sufferers go complete hog into IVF, cycle after cycle, to dissipate the ache, anger, despair and emotions of urgency to get pregnant as quickly as doable. Notice too that each failed therapy takes an emotional toll, chipping away on the basis of who you’re. Take a break and ask your self: How is your relationship doing? Are you drifting other than associates? Is that this actually price it? Usually, day without work from therapies can assist you recharge and rally your help.
  • Get an trustworthy (probably second) opinion. Drugs is as a lot artwork as science. As with all artwork type, the best way that medical info, signs and well being care is interpreted and delivered varies tremendously amongst docs. What are the chances of success attempting the identical factor once more? What about when attempting one thing completely different? Do the proposed subsequent steps make sense? For years, I’ve supplied a digital Second Opinion that would make an enormous distinction in what you resolve to do.
  • Are you open to Jap therapies? Name me a “swingman,” however Jap medication has quite a bit up its sleeve too. And for good purpose: Western medication likes to separate well being from illness, whereas Jap medication considers well being as a state of steadiness that coexists with illness. Since infertility is a biomarker of total well being, the Jap strategy is manner forward right here. And in addition to, who wouldn’t favor intercourse and candles to pictures and egg retrievals?
  • Are you able to make peace? Don’t be afraid to say that sufficient is sufficient. Saying no is, in some unusual manner, an effective way to realize management. Over love, life and every part in between. And also you in all probability didn’t know this, however there’s a major and measurable at-home, old school being pregnant price after {couples} fail infertility therapies.

There’s life, and there’s infertility, and there’s life after infertility. Is it the identical? No. However there’s nonetheless magnificence in it, as we stay and breathe on this good earth. Simply as we should always by no means let success get to our heads, we must also by no means let failure get to our hearts.

 

The submit How you can Overcome Failed Fertility Therapies appeared first on The Turek Clinic.

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