FAQ's - Questions and Answers Regarding Male Fertility and Health.

Dr. Emanuel Friedman of MetroWest Urology offers practical advice and answers your most pressing sexual health related issues.
What are the differences between male infertility, impotence, erectile dysfunction, and premature ejaculation?
Infertility is defined as the inability to establish a pregnancy after trying to conceive for 1 year. Impotence or erectile dysfunction is the inability of a man to achieve or maintain an erection. Premature ejaculation is more difficult to define but is generally described as recurrent ejaculation with minimal stimulation before the person wishes. These conditions may be related in some patients or may occur independent of each other. Men experiencing fertility problems may be potent and men with erectile dysfunction may be fertile.
Which doctors specialize in treating male infertility?

Urologists are physicians and surgeons who treat genitourinary tract disorders. Most general urologists have only basic knowledge and training in treating male infertility. There is a subspecialty within Urology known as Andrology which deals specifically with male fertility, reproductive tract disorders and microsurgery. This requires an intensive 1-2 year period of fellowship training after Urology residency. There are only a handful of urologists who have completed this type of training and are truly “experts” in this area. The reason that this extra training is necessary is that the field of Andrology is evolving rapidly and much of the surgery performed to treat infertility needs to be done using an operating microscope for best results. Microsurgery is a skill which takes time and constant practice to perfect and maintain. A male infertility specialist should dedicate more than half of his/her practice to only infertility problems to remain current with information and skills. It is the responsibility of YOU the patient to make sure the doctor you choose is really a male infertility expert and avoid wasting precious time, unnecessary lab tests, surgical procedures, misinformation, and ensure the best possible results. Ask your doctor if he or she has had microsurgery training, and how much experience does he or she have in treating infertility. If possible, ask to speak with patients who have had a reversal vasectomy by him or her.

Is it possible to reverse a vasectomy?
Vasectomy reversal is not only possible but is highly successful when performed by an experienced infertility micro-surgeon. Unfortunately other doctors without these special skills will perform the surgery themselves rather then referring the patient to an infertility specialist. Once again it is incumbent upon the patient to make sure that his doctor performs the procedure regularly and successfully. A good idea is to ask to speak with some of his patients that have already undergone the procedure. Studies have shown that the outcome of surgery is so dependent on the surgical technique and the surgeon that performs it that it is well worth making the extra effort in going to a specialized center. Although failed vasectomy reversals can be repaired, the first attempt at reversal is the easiest and best opportunity for success.
With ICSI only a handful of sperm are needed, why should I have a vasectomy reversal?
Both vasectomy reversal and ICSI/sperm aspiration are good alternatives to father a child after vasectomy. They each have advantages and drawbacks. In most situations vasectomy reversal offers the greatest chance for pregnancy. It requires one procedure be performed only on the man and couples can then try to get pregnant every month the old fashioned way using “IBF” or what we call “in-bed fertilization”. ICSI on the other hand requires that both partners undergo a procedure and the woman is stimulated with fertility drugs to treat a “male problem”. The costs of establishing a pregnancy are three times greater with ICSI than with vasectomy reversal. It is even less expensive to have a vasectomy reversal and a repeat vasectomy (if desired) then to have ICSI. The advantage of ICSI is the possibility for some couples to establish a pregnancy quicker than with vasectomy reversal. We recommend ICSI/sperm harvesting in those situations where vasectomy reversal would be difficult or impossible, the female partner is of advanced reproductive age, or when there is also a female factor contributing to the infertility. Each couples’ circumstances are unique and need to be addressed on an individual basis. Our goal is to assist couples in having a child of their own, regardless of the path they choose.
Does using a hot tub affect my fertility?
Excess heat applied to the testicles of animals does indeed cause a decrease in sperm production. A study in California showed that men who used hot tubs experienced q drop in sperm production. However, when the heat is avoided for several months, sperm production should return to normal. The production of sperm is a process requiring approximately three months. Consequently, when any condition or factor injurious to production of sperm is removed, a change in sperm quantity or quality should not be expected for a minimum of three months.
Does it matter what kind of underwear I wear?
The old wives’ tale that tight underwear causes decreased fertility has, perhaps, some basis in the truth. The truth is that excess heat applied to the testicles can decrease sperm production. This has been shown in men using hot tubs. However, the type of increased heat produced by tight clothing and/or underclothing has not been shown to elevate scrotal temperature. Hence, tight underwear has not been shown scientifically to cause any increase in testicular heat and is not thought to have any effect on sperm production. Nevertheless, if you would like to try a change in clothing to see what happens, there is really no reason not to try it.
Does masturbation affect fertility?
Masturbation is not different from normal intercourse in that an orgasm causes ejaculation whether it is the result of masturbation or sexual relations. When fertility is a concern, masturbation should not be practiced around the time of the wife’s fertile period. Theoretically, this can decrease the sperm reserve in an individual with a low or low-normal count and thus reduce semen quality at the time that the highest quality is needed – when the wife is ovulating. However, masturbation will not have a long-term injurious effect on the testes.
Should I be concerned about fertility if I have a venereal disease?

In the male, most sexual transmitted diseases cause irritating symptoms at the time the disease is active. Following the acute stage of the disease, long-term problems with fertility is not common. However, untreated venereal disease can cause infection of some of the accessory sexual structures, such as the epididymis (the gland that collects the sperm) or the vas deferens (the tube that transmits the sperm). If these become infected by gonorrhea or chlamydia (common sexually transmitted organisms) the result can be scarring which affects fertility by blocking the transport system. Sperm production should not be affected unless the disease process spreads to the testes.

May I use lubricant with intercourse?
Most lubricants used with sexual intercourse have a toxic effect on the sperm. This can be a problem if the woman lubricates poorly during sexual arousal and finds intercourse without use of lubricants to be irritating and uncomfortable. If lubricants are used, they should be used sparingly.
How often should I have intercourse?
The frequency of intercourse generally should be that which the couple considers most enjoyable. However, during the time of the month when ovulation takes place, the most advantageous frequency of intercourse is every other day (i.e., every 48 hours). The reason for this interval is that sperm should survive for 48 hours within the woman’s reproductive tract and the egg should be subject to impregnate for 12 to 24 hours. Intercourse every other day keeps sperm along the course of the fallopian tube ready for contact with the egg as it makes its descent from the ovary towards the uterus.
Does the use of drugs such as marijuana affect fertility?
A group of drugs or substances either ingested or present in the environment that hurt sperm production are known as gonadoloxins. Drugs which can adversely effect sperm production include alcohol, marijuana, steroids used to induce weight gain in athletes, and certain preparations, such as Azulfidine, taken for irritative bowel disease. However, when these substances are discontinued, sperm production should return to normal within three to six months. The problem with substances such as alcohol and marijuana is that no one is certain of the level at which they can be ingested without affecting sperm production. Consequently, the use of these substances should be minimized during the time that a couple is attempting to establish a pregnancy.
What is the effect on fertility of working outside in the heat?
Heat is bad for sperm production according to data gathered by applying heat directly to the testicles. However, environmental heat, such as that experienced by workers in the sunshine should not affect sperm production.
Why is it that my semen analysis is different here than in my first doctor's office?
Semen quality changes day to day, week to week and month to month. There are also certain minor variations in laboratory techniques that will result in differences in evaluation of the semen quality from one office to another. However, the differences should not be sufficient enough to make an abnormal semen normal or visa versa. Usually, when the sperm production has once been adversely and seriously affected, one’s sperm count stays in the low range, no matter where it is tested. A change of two or three million is not a significant variation. However, in order to establish a good base line for future therapy, at least three semen analyses should be collected. They should all be collected with a minimum amount of variation, i.e., always after a 48-hour abstinence, and delivered to a doctor’s office within two hours of collection.
Why do I frequently have pain during my first urination after ejaculation?
It is not unusual for the male to experience some burning (dysuria) during urination following ejaculation. This is the result of friction developed along the urethra (the lining of the penis) during the act of sexual intercourse or masturbation. Urine moving along the urethra creates a burning sensation. It should not be considered a sign of any active disease or indicative of injury to the penis but rather a natural event. However, if burning persists in the absence of ejaculation or sexual contact, some type of infection may be present.

The visible ejaculate is a combination of material from the testes, prostate, and seminal Vesicles. The latter two are known as the sex accessory glands in the male. At the time of ejaculation, the seminal fluid is a gel. It will normally liquefy within 5 to 30 minutes. During the process of liquidation, the ejaculate may appear lumpy. This is not abnormal and should not be considered a pathological situation.

Does it matter what position we use during intercourse?
Positions during intercourse should not adversely affect fertility and subsequent pregnancy. The loss of some semen from the vagina is experienced by most women following intercourse and does not indicate that enough semen is leaking out to prevent pregnancy. However it is a good idea, if fertility has been a problem, to minimize semen loss and maximize contact of the cervix with the seminal pool within the vagina. This is achieved most conveniently if the woman lies on her side with her knees brought up towards her chest following sexual relations. This forces the cervix down into the vaginal pool of semen which has been created. It is also helpful for the female to minimize trips to the bathroom following intercourse by voiding prior to sexual activity. The sensation of having to void following intercourse usually is caused by irritation of the urethra, is normal in nature, and should pass if the female merely waits.

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