WHAT ARE THE GENERAL GUIDELINES FOR TREATING MALE INFERTILITY?

Many men diagnosed as sterile in past years would be considered treatable now, even some men with spinal cord injuries. Unless a man produces no sperm at all, recent developments in treatment have made fertility possible for many men willing to undergo treatment and bear the expense. Before undergoing more advanced procedures, some simple lifestyle changes should be attempted.

Timing Sexual Activity for Best Results

Both male and female hormone levels fluctuate according to the time of day and they also vary from day to day and month to month. Some timing tips might be helpful.

Male Hormone Levels and Sexual Activity. Male hormone levels are highest in the morning. (Sexual interest also tends to be higher in the morning.) In one study of men, their sexual activity was highest in October, when conception rates were also high.

Fertility and Seasonal Changes. Different studies have reported higher sperm counts in the winter than in the summer. For women, fertility rates as measured by treatment success are highest in months when days are longest.

Female Menstrual Cycle and Peak Fertility Times. A woman's sexual peak is usually around the second week of her menstrual cycle. (A menstrual cycle is counted starting from the first day of a woman's period.) This sexual peak coincides with ovulation. Studies indicate conception is most likely when intercourse occurs during the two days before or on the day of ovulation. (A woman can use a special thermometer to measure her body, or basal, temperature, which also surges at ovulation.)

Frequency of Intercourse. The question of how often a couple should have intercourse is in debate. Some experts say that having sex more than two days a week adds no benefits. And, in fact, frequent sexual activity lowers sperm count per ejaculation. Some studies have indicated, however, that having intercourse every day or even several times a day, before and during ovulation improves pregnancy rates. Although sperm count per ejaculation is low, a constantly replenished semen supply is more likely to result in a fertilized egg.

Other Lifestyle Changes

A man who wants to increase his sperm count should also improve his lifestyle:

• Avoid cigarettes and any drugs that may affect sperm count or reduce sexual function.
• Eat healthy foods low in fat and rich in whole grains, fruits, and vegetables. Be sure the diet has sufficient minerals (zinc and selenium).
• One study suggested that fish oil supplements might have some benefits on sperm. Such supplements contain fatty acids that are found in certain oily fish (eg, salmon, tuna, mackerel, sardines). Choosing fish in any case is always a healthy choice.
• Overweight men should try to reduce their weight.
• Get sufficient rest, and exercise moderately but regularly. (Those who exercise excessively might cut back, but not stop altogether.)
• Stress may contribute to reduced sperm quality. It is not known if stress reduction techniques can improve fertility but they may help couples endure the difficult processes involved in fertility.
• Although studies now indicate that tight underwear and pants pose no threat to fertility, there is no harm in wearing looser clothing.
• To prevent overheating of the testes men should avoid hot baths, showers, and steam rooms.
• Because oxidant particles may play a harmful role in infertility, some research has focused on antioxidant supplements. They include vitamins C and E, glutathione, selenium, and coenzyme Q10. Vitamin C may help the body absorb trace elements of zinc, copper, magnesium, potassium, and calcium, which improve the vitality and longevity of the sperm. In one study, vitamin E improved fertility in men who had normal sperm count but evidence of excess free-oxygen radicals. (One 1999 study reported, however, that taking high doses of vitamin C, E, or a combination of the two had no effect on fertility in men with defective sperm.)

Choosing a Fertility Clinic

Choosing a good fertility clinic is important. The government does not always regulate centers offering assisted reproductive techniques, and abuses have been reported, including lack of informed consent, unauthorized use of embryos, and failure to routinely screen donors for disease.

The clinic should always provide the following information:

• The live-birth rate (not just pregnancy success rate) for other couples with similar infertility problems. (Multiple births, such as twins or triplets, are counted as one live birth.)
• Such statistics should include high-risk women, such as those who are older or fail to produce eggs. (Some disreputable clinics give success percentages that exclude high-risk women from their total, thereby making the percentage of success much higher.)

Advanced fertility procedures and medications are extremely expensive and often not covered by insurance. Warning: Couples should be cautious about offers of rebates in the event of failure; the clinics offering them are often significantly more expensive than those that don't. [For more information see the Well-Connected Report #22, Infertility in Women .]

Planning for Stress and Depression

The fertility process is a roller coaster of emotions that are present throughout and in both failure and success. There are almost no sure ways to predict which couples will eventually conceive. Some couples with multiple problems will overcome great odds, while other, seemingly fertile couples fail to conceive. Many of the new treatments are remarkable, but a live birth is never guaranteed. The emotional burden on the couple is considerable and some planning is helpful.

Planning for Emotional Turmoil

• Decide in advance how many and what kind of procedures will be emotionally and financially acceptable and attempt to determine a final limit. Fertility treatments are expensive and often not covered by health insurance, and a successful pregnancy often depends on repeated attempts. (Some couples become addicted to treatment, and continue with fertility procedures until they are emotionally and financially drained.)
• Determine alternatives (adoption, donor sperm or egg, or having no children) as early as possible in the fertility process. This can reduce anxiety during treatments and feelings of hopelessness in case conception does not occur.
• Locate support groups or counseling services for help before and after treatment to help endure the process and ease the grief should treatment fail.

Managing Emotional Stress during the Process. Managing negative emotions can be viewed as important as medical treatment. Talking to one's spouse, family, and friends is very beneficial. The best support comes from the spouse. It should be noted, however, that men and women may cope differently with the stress, and each should understand the other's different needs. Women tend to want greater personal space and also to want to share the burden with their husbands. Men tend to cope by seeking to improve themselves (for example being strong, or being the "best").

Managing the Emotional Effects of the Outcome. After enduring the process, the couple must face the outcome, and even a positive outcome has emotional repercussions.

Effects of Failure. Needless to say, the emotional stress of failure can be devastating even on the most loving and affectionate relationships and even in those who have prepared for the possibility of failure. Neither the male or female partner should hesitate to seek professional help if the emotional burdens are too heavy.

Effects of Successful Treatments. Some studies have indicated that even if successful, women experience increased stress and fear of failure during pregnancy.

Effects of Multiple Births. A successful pregnancy that results in a multiple birth introduces new complexities and emotional problems. One study reported a very high rate of depression in women with triplets, particularly if they had little help from others, and especially if their husbands weren't involved.

Effect on Parenting. Once the fertility treatment-assisted child arrives, parents (both men and women) are more likely to have less self esteem, to be anxious, and less confident.