Male Infertility: New Treatments, More Pregnancies

The ultimate goal of male infertility treatment is to produce a pregnancy. Ideally, the cause of the infertility is reversible and then conception can result from natural sex. Here are a few common male infertility treatments that will be considered if you go to Metropolitan Urological Services in St. Louis, MO.

•   Varicoceles are fixed with surgery to shut off the abnormal veins. This seems to lead to a significant improvement in fertility, although some studies disagree.
•   Hormonal abnormalities can sometimes be addressed with medicine or surgery.
•   Obstructions in the sperm transport plumbing can often be surgically corrected.

In the past, if the above methods didn’t work, it often meant lifelong male infertility. Today, assisted reproductive techniques (ARTs) offer powerful new options.

These high-tech male infertility treatments give sperm an artificial boost to get into an egg. ARTs have made conception possible even for men with very low or abnormal sperm. If you live in Crestwood, Chesterfield, Washington, St. Louis, Missouri, or the surrounding areas, you need to consider these options.

First, sperm are collected either from ejaculated semen or by a needle from the testicle. They're then processed and introduced to eggs by different methods.

•   Intrauterine insemination (IUI.) At the time of ovulation, sperm are injected straight into the uterus. Medicines are usually given to the woman first to boost the number of eggs she releases.
•   In-vitro fertilization (IVF.) Sperm are mixed with multiple eggs collected from the woman in  a plastic dish. Fertilized eggs are then put into the uterus. IVF requires at least some viable sperm.
•   Intracytoplasmic sperm injection (ICSI.) A single sperm is injected through a tiny needle into an egg. The fertilized egg is then implanted in the uterus. ICSI can be performed when sperm counts are really low or abnormal.

By utilizing some combination of ARTs for several months, most couples can expect a pregnancy around 40 to 50% of the time.

Male Infertility Treatments To Try At Home

But are there any things you could do on your own to maximize your fertility? Yes. For one, don’t do things to hurt your chances to have viable sperm — marijuana, cocaine, tobacco, and more than two alcoholic drinks a day harm sperm production. Men should avoid hot baths and whirlpools since the high temperatures impede your sperm factory.

Taking testosterone, or any over-the-counter androgen like DHEA (for weight training), can harm fertility. People have had unnecessary surgeries because they forgot to say they were on these medicines.

Of course, living right helps. Anything that improves quality of health, such as adequate sleep and nutrition should improve fertility. If you have any questions about male infertility, Metropolitan Urological Services is the place to go. They help couples all over Crestwood, Chesterfield, Washington, and St. Louis, Missouri.

Causes of Male Infertility

Infertility has historically been thought of as a woman's problem. But the fact is, men do not get off that easily. About one out of every three cases of infertility is because of the man alone, and the man is somehow involved in infertility fifty percent of the time. Here is some important info from Metropolitan Urological Specialists in St. Louis, MO.

A diagnosis of male infertility may be one of the hardest challenges a man can face. For some, it may be devastating. Not being able to father a child can easily make a guy feel like he’s failing at one of his most cardinal responsibilities. Sadly, some men need to cope with the fact that absolutely nothing can be done about their infertility. But for many other men, advances in male infertility treatment offer real help.

Understanding Male Infertility: Sex Ed 101

To better understand infertility, here is a refresher course on the birds and the bees:

Sperm are produced within the testicles. They're then stored inside yards of “plumbing” known as epididymis, which lies on top of each testicle. Sperm are nourished by semen, which is made by glands along the way. Upon ejaculation, about a hundred and fifty million sperm are ejaculated in a half-teaspoon of semen through the penis. This entire process depends on there being proper levels of testosterone and other hormones in addition to correct signaling from the nervous system.

Women ovulate — send an egg into the uterus — every month. This happens approximately 2 weeks after menstruation. Sex any time in the five days prior to ovulation can make a pregnancy. Sex any other time, even the next day after ovulation, will not result in conception.

It is usually a smart idea to seek fertility evaluation if your partner and you are unable to conceive after one year of unprotected sex. About 85% of couples will have had a pregnancy by that time. If you're over 30, you should seek evaluation after six months. Metropolitan Urological Specialists offers evaluations for couples everywhere in St. Louis, Creve Coeur, Florissant, and Kirkwood, MO.

Common Causes of Male Infertility

The “male factor” plays a role in infertility around half the time, and about one third of the time, it's the main cause of infertility. Most often, the problem lies in the process of either making or moving the sperm.

Any of the following can cause a man to have a low sperm count or abnormal sperm:

•   Varicocele — an abnormal collection of bulging veins above the testicle; they’re the most common cause of reversible male infertility, accounting for 38% of cases
•   Undescended testicle
•   Infections within the testicle (orchitis), the prostate (prostatitis), or somewhere else in the body that causes a fever
•   Chemotherapy for cancer
•   Medications such as anabolic steroids or anti-seizure medications
•   Genetic abnormalities
•   Hormone problems

In many cases, these issues may be reversed, but other times they cannot. An evaluation by a physician is the only way to sort it out.

Sometimes, making sperm just isn't the issue. The problem is getting the sperm where they need to go. Men with this type of male infertility have normal sperm in the testicles. But the sperm in the semen are either abnormal, very low in number, or not there at all. Causes of this kind of infertility include:

•   Retrogradeejaculation. In this condition, semen ejaculates backwards into the bladder instead of out the penis. Usually previous surgery is the cause.
•   Absence of the main sperm pipeline known as the vas deferens. This condition is a genetic problem.
•   Obstruction. An obstruction can occur anywhere in the plumbing between the testicles and the penis.
•   Anti-sperm antibodies. Antibodies can abnormally attack a man's own sperm on their way to the egg.

If you feel that you or your partner might be infertile, go to Metropolitan Urological Specialists in Washington, MO to get the help that you need.

Vasectomy Recovery Guidelines

Immediately after your vasectomy, everything you do or don’t do can mean the difference between a simple, painless recovery and a sore, miserable experience that lasts for days, weeks, or even longer. Here are six easy-to-follow suggestions to give you the best probability for a quick recovery.

1. Most importantly, stay off your feet for several days. The delicate tissues will swell up and hurt if you spend time standing for the first days of recovery. This means you cannot go out to dinner somewhere in St. Louis, a movie, or any activity where you're standing a lot. It's best if you sit around for several days, taking it easy.

2. Avoid lifting of heavy items or straining for around a week or two. If it’s heavier than a gallon of milk, then don’t pick it up. Needless to say, everyone knows you can move that fridge or pick up that keg but immediately after a vasectomy is not necessarily the time to prove it.  And this means if you work out, no squats, crunches, or leg presses for a couple weeks. Your core and muscles will be just fine without the heavy lifting and exercises.

3. You should ice up down there (20 to 30 minutes on, 10 off) for a couple of days following the vasectomy.  You can use frozen peas. This will reduce inflammation and swelling, and give you a more comfortable recovery. And be sure to put the ice outside of your underwear, never right against the skin.

4. Wear an athletic supporter or bike compression shorts, outside your underwear, to offer support during the first week or two following the vasectomy. Gravity and movement aren't best for recently traumatized tissues within your scrotum.

5. Take anti-inflammatory medications like naproxen or ibuprofen, as directed by your physician, for the first few days to minimize swelling, inflammation, and discomfort. Of course, don’t take these if you have had issues with upset stomach or stomach ulcers.

6. No sex (all definitions) for one week to let the area heal. And then, after one week, just with birth control until you are told it's safe to go without. The vasectomy doesn't immediately sterilize you! It only blocks the resupply of fresh sperm into the pipes, so it will take two months or more to flush out the sperm in your system. That's why you have to check and make sure you are cleared out with a sperm check at eight weeks. Don't ever assume you're sterile, as sometimes it takes a lot longer and so you could still be fertile.

The good thing is that for most men, recovery following a vasectomy is relatively easy and painless, especially when you follow these simple guidelines. If you think that you might want to get a vasectomy or want to know more about the procedure, visit Metropolitan Urological Specialists. They help men all around St. Louis, Creve Coeur, Florissant, and Kirkwood, MO with these procedures.

Vasectomy Reversal (Vasovasostomy)

A vasectomy is recognized as a permanent approach to birth control. Vasectomy reversal (vasovasostomy) reconnects the tubes (vas deferens) that were cut in a vasectomy. If you are considering a vasovasostomy, you'll want to read this information given by Metropolitan Urological Specialists in St. Louis, MO.

Vasectomy reversal is usually an outpatient procedure (without an overnight stay in the hospital). Spinal or general anesthesia is typically utilized to ensure that you stay entirely still throughout the surgery.

The odds of vasectomy reversal success depend on just how much time has passed between your vasectomy and the reversal. With time, additional blockages can develop, and some men create antibodies to their own sperm.

The surgery is much more complicated and takes more time when blockage between the vas deferens and the epididymis requires correction (vasoepididymostomy).

What To Expect After Surgery

Vasectomy reversal normally takes from two to four hours, followed by a few more hours for recovery from the anesthetic. You will probably go home the same day.

Pain can be mild to moderate. You should be able to resume normal activities, like sex, within three weeks.

Why It Is Done

Vasectomy reversal is done when you've  had a vasectomy and would now like to be fertile.

How Well It Works

Probability of a successful vasectomy reversal decline over time. Reversals are more successful in the first decade after vasectomy.

Generally, vasectomy reversal:
•   Brings about overall pregnancy rates of higher than 50%.
•   Has the greatest chance of success within three years of the vasectomy.
•   Causes pregnancy only about 30% of the time if the reversal is done ten years following vasectomy.

Risks

Risks of vasectomy reversal include:
•   Infection at the site of surgery.
•   Fluid buildup in the scrotum (hydrocele) that might require draining.
•   Injury to the arteries or nerves within the scrotum.

What To Consider

Before a vasectomy reversal is carried out, your doctor will want to make sure you were fertile before your vasectomy.

You can have tests to find whether you have sperm antibodies in your semen before and after vasectomy reversal. If there are sperm antibodies inside your semen after surgery, your partner is unlikely to become pregnant. In this case, you may decide to try in vitro fertilization with intracytoplasmic sperm injection.

If you have any questions concerning reverse vasectomy or any of the other services provided by Metropolitan Urological Specialists, set up a meeting with them and they’ll give you the answers you need. Metropolitan Urological Specialists is a good place to go for urological knowledge in St. Louis, Creve Coeur, Florissant, and Kirkwood, Missouri.

Kidney Stones And What Causes Them

Kidney stones many times have no particular, single trigger, although a number of factors might increase your chances. Here’s some information from Metropolitan Urological Specialists in St. Louis, MO about some of those factors.

Kidney stones form whenever your urine contains more crystal-forming substances -- such as calcium, oxalate, and uric acid -- than the fluid in your urine can dilute. At the same time, your urine might lack substances that prevent crystals from sticking together, creating a perfect environment for kidney stones to form.

Knowing the kind of kidney stone helps identify the cause and may also give clues on exactly how to lower your risk of getting more kidney stones. Varieties of kidney stones include:

•   Calcium stones. Most kidney stones are calcium stones, normally as calcium oxalate. Oxalate is a natural substance found in food. Some fruits and veggies, and nuts and chocolate, have high oxalate levels. Your liver also generates oxalate. Dietary factors, high doses of vitamin D, intestinal bypass surgery, and numerous metabolic disorders can increase the concentration of calcium or oxalate in urine. Calcium stones might also show up in the form of calcium phosphate.
•   Struvite stones. Struvite stones form in response to an infection, like a urinary tract infection. These stones can grow quickly and get quite large, sometimes with very few symptoms or little warning.
•   Uric acid stones. Uric acid stones can develop in individuals who don't drink enough fluids or who lose too much fluid, those who have a high-protein diet, and those who have gout. Certain genetic factors can also boost your risk of uric acid stones.
•   Cystine stones. These stones form in individuals with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (cystinuria).
•   Other stones. Other, rarer types of kidney stones also can occur.

Factors which increase kidney stone risk for people in St. Louis, Creve Coeur, Florissant, and Kirkwood, MO include:

•   Family or personal history. If somebody in your family has kidney stones, you're more likely to develop stones, as well. And if you have already had one or more kidney stones, you are at increased risk of developing another.
•   Dehydration. Not drinking enough water each day increases your chance of kidney stones. People who live in warm environments and those who sweat a good deal might be at greater risk than other people.
•   Certain diets. Eating a diet that is loaded with protein, sodium, and sugar may raise your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much sodium in what you eat raises the amount of calcium your kidneys must filter and substantially increases your risk of kidney stones.
•   Obesity. High body mass index (BMI), large waist size, and gaining weight have been connected to a greater risk of kidney stones.
•   Digestive diseases and surgery. Gastric bypass surgery, inflammatory bowel disease, or chronic diarrhea can cause changes in the digestive process which affect your absorption of calcium and water, increasing the levels of stone-forming substances within urine.
•   Other medical conditions. Diseases and conditions that may increase your risk of kidney stones include renal tubular acidosis, cystinuria, hyperparathyroidism, specific medications, and some urinary tract infections.

If you think that you might have a kidney stone, the best thing you can do is see a doctor. The experts at Metropolitan Urological Specialists have many years of combined experience helping patients with kidney stones and a number of other urological health problems.

Tips for Talking to Your Doctor about OAB

If you've got urinary symptoms, make bladder worries the main target of your next doctor appointment.

Overactive bladder is a common problem. Generally, people wait seven years prior to seeking treatment for urinary control problems, according to a recently available survey by the National Association For Continence. If you've got OAB, these basic steps from Metropolitan Urological Specialists in St. Louis, Missouri will help you get the best results from your next doctor's appointment.

1. See an expert. Your primary care physician could be a good place to start. Nevertheless, not all doctors are well-trained in diagnosing and treating incontinence. If your family doctor or gynecologist isn't, consider going to Metropolitan Urological Specialists if you live in St. Louis, Creve Coeur, Florissant, Kirkwood, Crestwood, Chesterfield, or Washington, Missouri.

2. Take note. One of the most important things to do is log your bathroom habits. This gives your physician an extensive picture of the symptoms you're experiencing and can help her get right to the source of the problem. Keep a bladder diary for two or three days prior to your visit. In it, note:

•   when you urinate,
•   whether you urinate a lot or a little every time,
•   what you eat and drink throughout each day,
•   the number of accidents you experience,
•   activities that seem to lead to leakages, and
•   whether each leak is small, moderate, or large.
In addition to a bladder diary, give your doctor a list of all medications you take, including over-the-counter and herbal products. Also, list medical procedures you have had (including vaginal births).

3. Know yourself. Create a list of the 3 to 5 most annoying problems related to your bladder problems and share it during your appointment. Maybe you do not leave home without knowing the precise location of every toilet along your route or you no longer get involved in activities that you enjoy, like tennis or golf.

4. Set goals. Come into your appointment with a couple of very clear goals in mind. Maybe you want to be taken seriously or you want to leave the office with a game plan, or you have a very personal goal, like being able to wear white pants without fear of leakage. Remember, you and your doctor are a team, so be open with her about your wishes.

5. Train your bladder with an expert. If you've had little success with the pelvic floor exercises known as Kegels, tell the doctor. Many times, women who are self-taught have been doing them incorrectly. Your physician can make it easier to find out how to do them properly and can teach you proper technique and how to hone in on the right muscle groups.

If you've got overactive bladder, take the first step and visit a doctor. Metropolitan Urological Specialists in St. Louis, MO is a group of dedicated and experienced doctors ready to help you stop thinking about your overactive bladder and get back to thinking about living your life.

Overactive Bladder Diagnosis

Diagnosis of overactive bladder is step one to finding the right treatment for it. Here are some of the tests that will be considered if you visit Metropolitan Urological Specialists. They serve patients in St. Louis, Creve Coeur, Florissant, and Kirkwood, Missouri.

A complete health history, including a voiding diary; a physical assessment; and one or more diagnostic procedures can help your health care provider diagnose any underlying condition and devise a suitable treatment plan for overactive bladder.

Medical History

The medical history includes information regarding bowel habits, patterns of urination and leakage (when, how often, how severe), and whether there is pain, discomfort, or straining when voiding. A history of health complications, pelvic surgeries, pregnancies, and list of medications (prescription and over-the-counter) also can supply information relevant to creating a diagnosis. In seniors, a mental status evaluation and evaluation of social and environmental factors also may be performed.

Physical Examination

A physical examination includes a neurologic status evaluation and examination of the abdomen, rectum, genitals, and pelvic area. The cough stress test, where the patient coughs forcefully while the physician observes the urethra, enables observation of urine loss. Immediate leakage with coughing indicates a diagnosis of stress incontinence. Leakage which is delayed or persistent after the cough indicates urge incontinence.

The physical examination also helps the physician identify health problems which can be the cause of overactive bladder. For example, poor reflexes or sensory responses may suggest a neurological disorder.

Urinalysis

Examination of the urine might identify health problems connected with overactive bladder, including the following:

•   Bacteriuria-presence of bacteria in urine; indicates infection
•   Glycosuria-excess glucose within urine; may indicate diabetes
•   Hematuria-blood in urine; may indicate kidney disease
•   Proteinuria-excess protein within urine; might point to kidney disease, cardiac disease, blood disease
•   Pyuria-presence of pus in urine; suggests infection

Specialized Testing

If overactive bladder continues on after diagnosis and treatment, further testing may be required. Urologists perform urodynamic, endoscopic, and imaging tests to obtain a more extensive evaluation of the lower urinary tract to figure out a new treatment plan.

Postvoid Residual Volume (PRV)

This procedure requires catheterization or pelvic ultrasound. The patient voids right before the PRV is measured. This initial void is observed for hesitancy, straining, or interrupted flow. A PRV lower than 50 mL indicates adequate bladder emptying. Recurring measurements of 100 to 200 mL or higher represent inadequate bladder emptying. The clinical setting and the individual's readiness to void might affect the test result; therefore, repeated measurements may be necessary.

Urodynamic Testing

Cystometry might be used to appraise the anatomic and functional status of the bladder and urethra. The cystometer is an instrument that measures the pressure and capacity of the bladder; thus evaluating the function of the detrusor muscle. Simple cystometry detects unusual detrusor compliance, but abdominal pressure isn't included and the results need to be evaluated with caution.

The multichannel, or subtracted, cystometrogram concurrently measures intra-abdominal, total bladder, and true detrusor pressures. This allows involuntary detrusor contractions to be differentiated from increased intra-abdominal pressure. The voiding cystometrogram registers outlet obstruction in patients who are able to void.

Uroflowmetry identifies unusual voiding patterns. Urethral pressure profilometry measures the resting and dynamic pressures within the urethra.

Endoscopic Tests

Cystoscopy may be carried out when urodynamic testing fails to duplicate symptoms, when the patient encounters new symptoms (e.g., cystitis, pain), or whenever urinalysis reveals a disease process (e.g., henaturia, pyuria). Cystoscopy identifies the presence of bladder lesions (e.g., cysts) and foreign bodies (e.g., stones).

Imaging Tests

X-rays and ultrasound can be used to evaluate anatomic conditions connected with overactive bladder. Imaging of the lower urinary tract before, during, and after voiding is useful in examining the anatomy of the urinary bladder and urethra.

If you think that you may have overactive bladder and want answers, visit Metropolitan Urological Specialists in St. Louis, MO and schedule an appointment.