BASIC FERTILITY AND REPRODUCTIVE HEALTH

QUESTION

I have been married for 13 months and have been having unprotected sex for the same period. I am 30 yrs old while my husband is 37 next month. I have been trying to get pregant since we got married. My husband has been diagnosed to have low sperm count. The two tests he has done revealed 3.5m and 2.5m respectively. He did the two tests in two differenct laboratories and he did the second one after he had been placed on a drug for a period of two months. I don't have the result of the tests right here but from what I can remember it says poor motility, something percent dead and something per cent sluggish etc. He has stopped alchohol and has gone off cofee and other caffeinated thngs (he used to take it ocassionally). He does not smoke. He would be going for a 3rd test in about one week.

My question goes does:

Is it possible for me to get pregnant while he is still been treated?
How long does it take to treat it?
Can you offer any advice that can aid us?
My temperature rises in the evenings through the nights. Do you think this is related?

We are very depressed and desperate to cuddle our own baby.

I count on your prompt response.

Thanks
Dee

ANSWER
Dear Dee:

Your case is very typical and needs to be treated with a lot of TLC. You both are relatively young and therefore you have time to maneuver and make the right moves in order to have your husband's difficulties treated properly. However, you need to go to it ASAP because you do not know how much time it would take to complete your treatment successfully. Time is of the essence when you come to treating infertility problems. To answer your questions one by one, I have the following:

You definitely can get pregnant while he is being treated unless he's given some sort of medication and his doctor would indicate that it is best that you wait until he goes through his treatment and then attempt to get pregnant.

The duration of treatment is difficult to predict, but if your husband is given either Clomid or other medications to enhance his sperm count and quality, under those conditions it takes up to three months to get noticeable improvements.

You are referring to your temperature as "rising in the evenings through the nights" and that is a bit confusing to me. You need to get more instructions and information from your physician as to how you should get your BBT, and what is a normal biphasic temperature curve. Only under those conditions the temperature becomes a meaningful tool in predicting ovulation and can be used constructively towards the treatment of infertility.

I definitely feel like you need to consider also to be investigated for possible infertility difficulties and that you need to consider seeing an infertility specialist that can guide you and your husband in the right direction.

It seems to me that you are both very determined and highly dedicated in resolving this problem and starting a family. This is a good sign that could yield results. Please don't give up, stay on course, and seek the right doctor that can give you the best treatment and generate positive results. Don't forget that treating infertility and getting positive results is like winning the lottery; YOU MUST HOWEVER BUY A TICKET IN ORDER TO WIN.

Dr. Panayiotis Zavos
Director, Andrology Institute of America
Associate Director, Kentucky Center for Reproductive Medicine & IVF

QUESTION

My husband and I have been trying to conceive for almost two years. We recently had a sperm test done by his urologist.
Volume 1.0
pH 8.1
Motility 2 hour 30%
Count 2.6 million
WBCs 5 (million?)
The urologist felt the high white blood cell count indicated prostate infection. He started a thirty day treatment with Bactrim. Is it possible we can expect significant improvement with treatment of the infection, or should we go to an RE and investigate further? He has lost 75 pounds in the last year and weighs around 290 now. Will further weight loss also improve his results? Many thanks for your time.

ANSWER
Dear Patient:

Your story is very familiar and you need to be patient and understanding. There is no doubt that we see a significant difficulty associated with your husband's semen qualities as they are presented to us. However, the urologist is pointing out a difficulty not only with the semen volume, the sperm count and the quality of the sperm, but also with a slight infection (elevated WBCs in the ejaculate) that should be treated. The infection alone could be contributing to the low volume and also to the low quality of sperm. What is rather confusing to me, however, is how your urologist was able to point out that your husband's infection was associated with a prostate infection unless he was able to "milk" the prostate via rectal palpation and able to isolate and associate the infection with the prostate.

Your husband's dramatic loss of weight can contribute to difficulties with production of sperm and the quality of the sperm that he produces. Although the weight loss can bring about improvements in the seminal characteristics, those improvements can take some time to be established (sometimes 6 months to 1 year), and one needs to be patient and to think positive about the prospects of getting positive results. Don't forget that a man's ability to produce a specimen varies significantly and, as we say around our place, it varies just like "the weather in the Midwest" - that is, one day it's sunny, and the next day is cloudy and rainy. Men can be very strong but also quite fragile when it comes to dealing with their own infertility difficulties.

You definitely need to stay with your urologist and receive proper treatment for his possible prostate infection, but you also need to move on to an infertility facility that provides a much more organized effort in treating male and female infertility and can provide a variety of options for your treatment. Going and seeing a reproductive endocrinology and infertility expert should be your next step. Please stay focused and positive and things will turn out for you. Good luck with your future efforts in solving your difficulties.

Dr. Panayiotis Zavos
Director, Andrology Institute of America
Associate Director, Kentucky Center for Reproductive Medicine & IVF

QUESTION

My question is regarding collection of semen for a test.
Is it absolutely imperitive to collect the entire amount of ejaculate? Is a test done without the whole amount not a test to go by? My hubby got all nervous and was able to get only the last bit in the bottle. The results were low. But the volume seemed okay.
what does that mean? We are doing another test soon.
Really needed to know what affects the test. Thanks.

ANSWER
Dear Patient:

You are asking a very important question that a lot of people undergoing infertility treatment (whether they have male or female difficulties) must understand and comprehend. One must recognize that men are not made to produce a seminal specimen on demand. There are a great deal of feelings, emotions and other tangible parameters that factor in that could enable the male to produce the best specimen that he can produce. That is why the female partner plays a very important role in setting the pace for the male to "do his job." Difficulties such as not having adequate sexual stimulation, interrupting the male during intercourse and ejaculation and not following through with the proper instructions, such as placing the specimen or entire specimen in the collection vessel, could spell significant problems for the male. It is for these reasons why we developed the technology to allow the male to produce at intercourse via the use of a special seminal collection devices. When the special seminal collection device is used, it allows the male to collect a seminal specimen under maximal sexual stimulation being stimulated by his most favorite female partner and also to collect all of the specimen in the collection device. This brings about the production of a superior specimen without any losses during ejaculation.

Now, to answer your question, it is absolutely imperative that in order for the male to be properly assessed we must obtain and evaluate the entire amount of the ejaculate. Normally, the first 4 to 5 drops of semen during ejaculation contain up to 90 percent of the sperm (sperm rich fraction); if the man loses the first portion of his ejaculate, although the volume remains normal, he could be missing a significant portion of the sperm fraction and therefore he could be rendered deficient in sperm numbers although in reality he is not.

Please make sure that "your hubby" remains calm, not nervous, and maximally sexually stimulated in order to do his part. You have a very important role to play and it is obvious that you are needed. For your information, we will soon be offering diagnosis of semen shipped directly from your home (see discussion of such in Section 4 of this e-zine!). This new service will enable couples like you to produce the specimen in the privacy of your home without outside interference and have it evaluated at a reputable facility that can provide your physician with the proper recommendations for the mode of future treatment of the possible problem. This is of utmost importance!

I wish you the best and, if this is your only problem, it should be very easy to correct. You can do it.

Dr. Panayiotis Zavos
Director, Andrology Institute of America
Associate Director, Kentucky Center for Reproductive Medicine & IVF


310 South Limestone Street, Lexington, KY 40503 USA
P.O. Box 23777 " Lexington, KY 40523 USA
Phone: (859) 254-8108, (859) 226-7263, (859) 226-7264

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