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Vasectomy Myths Debunked

A vasectomy is the most reliable form of permanent birth control, so why aren’t more men having them done?

Vasectomy Myths | Denver Urology

One of the most common procedures we conduct at Urology Associates is a vasectomy. A vasectomy is a form of permanent male birth control by permanent sterilization that prevents the release of sperm to mix with semen when a man ejaculates.

Compared with the female sterilization process of having the fallopian tubes “tied,” vasectomies are much more reliable, faster and safer. So why do only 9 percent of sexually active men in the United States get vasectomies, while 27 percent of women get tubal ligations?

Well, there’s a lot of fear involved when men think about vasectomy, because they’ve been buying into myths about the V word.

In an attempt to debunk the various myths surrounding vasectomies and get all the facts out in the open, I’ve compiled a list of typical misunderstandings that patients have regarding vasectomies.

A vasectomy murders your sex drive

No way. A vasectomy will not affect your sexual desire, sex drive or your ability to have erections and ejaculate. Everything, including your orgasms, should remain unchanged. Although it’s important to wait until you feel recovered enough to have sex following the procedure. Some men experience mild aching in their testicles when they are sexually aroused, however most of the enjoyable aspects of intercourse won’t be altered.

A vasectomy hurts like the Dickens

I get it, it’s a sensitive area and you are likely anxious about a surgery around this part of your body. While every patient is unique and some discomfort is always possible with any surgery, a vasectomy generally is not painful. Some patients may experience a slight tugging or pulling while the doctor locates the vas deferens during the procedure, as well as a dull ache and mild pain in the scrotum and groin as the anesthesia wears off. In order to reduce pain and swelling you can take over-the-counter anti-inflammatory medication or apply a bag of ice or frozen vegetables to the affected area. If pain lasts for longer than a week and the symptoms aren’t getting any better, it is important to let your physician know.

I’m going to have a long, painful recovery

Not really. Many patients are pleasantly surprised with how quickly they are able to get back in action. Patients usually recover from a vasectomy in about a week. I recommend they wait a few days before having sex or jumping back into strenuous activity.

One of the most important parts of recovery from a vasectomy is rest. Many men, after my own heart, schedule their procedure during March Madness. It’s a great opportunity to grab a bag of frozen peas and post up on the couch for a couple of days while your body recovers.

A vasectomy procedure takes a good while and feels weird

Weird? Maybe the idea can make you feel weird, but the procedure is very quick, lasting about 20-30 minutes from start to finish. Here’s what to expect:

  • A local anesthetic to numb the scrotum.
  • A small puncture with needle is made on each side of the scrotum.
  • The doctor finds, cuts and seals the vas deferens, the small tubes sperm travel in to mix with semen.
  • The cut tubes are returned to the scrotum and closed with a few small stitches.

Patients who are considering having a vasectomy should be sure about not wanting to have any more children in the future. By blocking the vas deferens during the procedure, the sperm’s pathway is blocked, it can’t combine with the semen that is ejaculated during sexual climax. Without sperm a woman’s egg cannot become fertilized in order to result in a pregnancy.

Vasectomies fail and men end up getting women pregnant

Here’s where old data might be tripping you up. Over the years, urologists have greatly improved vasectomy success rates. Today, if done properly by a well trained and experienced surgeon, failure rates for vasectomies are around 0 percent. It’s considered the most effective form of birth control.

But, just because you’ve had a vasectomy doesn’t mean that it’s immediately effective. It usually takes 10 to 20 ejaculations to clear sperm completely from the semen. Only 1 to 2 women out of 1,000 will have an unplanned pregnancy in the first year after their partners have had a vasectomy – and that’s typically due to failure to wait until sperm has completely cleared from the semen before having intercourse without birth control. After a vasectomy, sperm produced is absorbed into the body.

It’s a good idea to check back in with your doctor for a sperm count before forgoing other birth control methods. Very rarely, the vas deferens will spontaneously reconnect on their own allowing the sperm to mix with semen.

Having a vasectomy will make my semen look funny

For the most part, your ejaculatory fluid will look exactly the same as it did prior to the vasectomy procedure, because less than 3 percent of the volume of ejaculate is made up of sperm. Because the tubes are blocked before the seminal vesicles and the prostate, you will still ejaculate the same amount of fluid, just without the sperm.

If I change my mind and want children, I’m out of luck

Actually, the “permanent” in permanent sterilization can be reversed by reconnecting the vas deferens in vasectomy reversal. But it’s a difficult procedure.

During a vasectomy reversal, the surgeon will make a small incision on either side of the scrotum and check the vas deferens fluid for sperm. If sperm is present, the physician will reconnect the ends of the vas deferens to the epididymis, thereby allowing sperm to pass through again. If there is no sperm, the surgeon will need to perform a more difficult procedure to bypass the blockage in the epididymis to reconnect the vas deferens.

A vasectomy reversal’s efficacy varies depending on how long it’s been since the initial sterilization, how it was done and the patient’s overall health condition. Another consideration is that a vasectomy reversal is a very delicate process that requires an experienced surgeon. The procedure can take, on average, 4 to 5 hours. About 10,000-30,000 men reverse their vasectomies annually.

Active 81-Year-Old Takes Cancer and Kidney Loss in Stride

When diagnosed with cancer, always active and healthy Jean took a step back and relied on her faith to help her through a trying time.

Dr. Bell's patient

Jean Standish is one tough cookie. In fact, she laughs as she remembers receiving the news of her kidney cancer diagnosis early in the summer of 2014 prior to a planned trip to support her grandson who is a professional mountain biker.

Dr. Brad Bell suggested that I try to take it easy on my trip that summer, prior to my surgery, to which my husband humorously responded, Do you have a pill that will make her do that?

He knew that for Jean, taking it easy wouldn’t be easy.

Originally born in Nebraska, Jean and her husband settled in Colorado where they raised two boys. Jean returned to the working world when they were in high school, acting as the business manager for a senior facility for 16 years. She always spent much of her time on-the-go, traveling with her husband, skiing, hiking, camping and she still walks regularly. Taking it easy just isn’t a part of her DNA.

Jean, who lived in Conifer, Colorado, consistently received clean bills of health during her yearly physicals. Which is why she was shocked one May morning in 2014 to discover a large amount of blood in her urine. After receiving a computed tomography (CT) scan from her primary physician, the staff recommended that she see Dr. Bell at Urology Associates in Denver.

With her husband by her side for serious support, Jean visited Dr. Bell.

“He seemed young, but he was extremely knowledgeable and upfront,” recalls Jean. “He told us that it could be cancer, but they’d have to do a bit more checking.”

Jean remembers asking, “How could this be?” After all, she had always been an extremely active and healthy person. Dr. Bell scheduled a biopsy, just in case.

Her faith guided Jean to kidney removal

In June, Jean was informed that her cancer was a renal pelvic cancer (similar to a bladder cancer in which the cancer affects the cells attached to the kidney). Unfortunately, these cells do not respond well to chemotherapy or standard radiation, and surgery remains the gold standard for treatment.

Dr. Bell, Jean and her family reviewed her films and performed a ureteroscopy biopsy of the abnormal cells in the renal pelvis. Upon return of the diagnosis, they discussed her treatment options together. Surgery to remove her entire kidney and ureter (nephroureterectomy) was recommended and monitoring, though not recommended, was also discussed.

It was a tough predicament. At the time Jean was 81-years-old, a risky factor in performing this surgery, because it meant that her health would ultimately depend on the successful function of her remaining kidney.

She thought it over carefully. After relying on the advice and support from her friends, family and acquaintances at her church and on her confidence in the team at Urology Associates, Jean made the decision to schedule the surgery.

“I have a great faith that the Lord is always looking out for us and guides us,” said Jean of her decision.

The kidney removal surgery was performed September 11, 2014. More than a year afterward, her regular check-ins and cystoscopies have shown no problems.

“She came through her surgery with flying colors. No doubt her many years of good health and staying active played a huge part in her successful recovery and ultimate outcome,” said Dr. Bell.

She admits that she experienced her own personal frustration during the recovery and recuperation period. “I suppose I need to realize that I was 81 at the time, not 18,” Jean said with a laugh.

Today, aside from a slightly slower gait and a newly found appreciation for an afternoon nap, Jean still enjoys being active and traveling. In the past few months she has returned to participating in water aerobics and continues to volunteer in the community and at her church.

Through all of the fear and emotions Jean relied strongly on her faith and the belief that she had much more life to enjoy – including five grandchildren ranging in age from 17-25. In fact, every week Jean sends each of her grandchildren in college a care package.

“I like to stay in touch and stay connected since we don’t live near each other,” said Jean. “They may be kind of strange care packages, but I think that they enjoy them and they respond.”

Staying connected and involved, Jean lives her life to the fullest. This woman’s drive and resiliency ensured that cancer was not the end of her story.

Today Jean remains grateful and appreciative of Dr. Bell and his staff for their care and attention throughout the entire process.

“Jean and I, and her family, became a team,” said Dr. Bell. “She is a shining person and I feel fortunate to have been a part of her care.”

He is also personally inspired by Jean’s unwavering dedication and support of her grandson’s biking career. “Jean is an amazing person and exactly who I would want on the sidelines cheering me on,” said Dr. Bell. “Our goal was to get her to her personal finish line so she could get back to cheering for her loved ones at their finish line.”

Why a Second Opinion?

Dr. Edward EignerTalking-About-Mens-Heath was recently featured on Talking About Men’s Health, a national blog focused on the health and well-being of boys, men and their families, discussing why seeking a second opinion is a critical step before deciding on prostate cancer treatment. By asking the right questions and utilizing helpful resources, such as Urology Associates’ free, online second opinion platform, you can have peace of mind that you are making the right decision for your health and future.

Learn More by Reading the Blog

Herbal Viagra Supplements: Safe or Shady?

Lamar Odom’s case shows that taking ED supplements like sildenafil to aid in erections can do more harm than good, so check with your physician before trying them.

Man with ED Considering Herbal Viagra for EDFull disclosure: I don’t follow professional basketball. There is something about the strategic fouling that drives the last two minutes of the game that doesn’t ring true to me. I want to yell “PLAY THE GAME!!!” But, in fact, that is exactly what they are doing, just not in the way I like.

So, up until a few weeks ago, I had never heard of Lamar Odom, former NBA star and husband of a Kardashian. Now I hear his name several times a day from many of my patients. As a urologist who specializes in sexual medicine, I’m asked questions that all focus on the so-called “natural” Viagra he consumed before going into a coma.

From reading news reports, I’ve learned that he used cocaine and consumed numerous tablets of over-the-counter (OTC) nutritional supplement designed to assist erections. I’m not going to focus on the cocaine because the danger there is obvious and well proved. The questions my patients are all focused on surround the use of nutritional supplements.

Can the purchase of a supplement at a corner convenience store cause harm? The short answer is – absolutely!

Let me be clear. I do believe that the reasoned use of high-quality nutritional supplements can enhance erectile response. The problem is that a number of enhancement supplements are tainted with counterfeit Viagra, Cialis or Levitra.

If it works, I’m taking it

Now, at $40-50 per pill for those drugs, a number of my patients have asked why it is so bad that these OTC supplement are “tainted” with prescriptive medications. As one of my patients put it, “If it works, it works. And if it works and is affordable – I’m taking it.”

Here’s the problem. Erectile dysfunction (ED) pharmaceuticals cause immediate and significant physiologic changes. These changes, when occurring in moderation and under the supervision of a physician, are beneficial.

Unfortunately, when purchased at a 7-Eleven and self-administered, they can be dangerous. This is because, (i) we don’t know the dosage of the active medication within the supplement, (ii) we don’t know the quality of the ingredients (remember, these are often counterfeit medications made by unregulated labs from overseas), and (iii) a physician is not monitoring whether there are pre-existing conditions that would place the individual at greater risk from the medication.

So, what should a consumer do? How can someone differentiate between quality nutritional supplements and those that are drug-tainted? Unfortunately, this can be challenging. The FDA keeps a list of known offenders, which they call “tainted products” because they are supplements that contain a pharmaceutical drug. But the market changes so quickly that I question whether the list is completely accurate.

Lamar Odom is reported by the Washington Post to have taken Reload and Libmax Plus. The FDA tagged Reload with a warning that it contained sildenafil, an active ingredient in Viagara. The FDA reported in 2009 that Libmax was removed from the market by the manufacturer because it contained tadalafil, another ingredient in a drug approved for ED. But the (legal) brothel in Nevada where Odom had his problems sold him the product from its store.

Rather than get into trouble assuming that a natural supplement for an erection is safe, I advise my patients to listen to their gut. I explain that pharmaceuticals like Viagra are utilized on an as-needed basis and often taken 1 hour prior to sexual relations. Quality nutritional supplements, on the other hand, work over time and require daily dosing.

With that in mind, I would avoid any supplement that promises fast action, any supplement that is sold in small quantities (1-5 pills taken in a one time dose), and any supplement that makes outrageous claims of success. ED is a condition that often times requires a specialist’s care. I offer the full array of treatment options from medications to injection therapy and, if needed, surgery.

Remember, if the claims are too good to be true then they aren’t true.

The most recent reports on Lamar are ominous. There appears to be significant and permanent brain injury. He has a long road ahead of him. I can only assume that it wasn’t cost that motivated him to utilize the particular nutritional supplements that he consumed. My sense is that he was moved, in part, by the desired results but also, in part, by the pervasive belief that something purchased over-the-counter can’t hurt you. That’s just not the case.

Get help from the experts

Think you might be suffering from erectile dysfunction? Schedule an appointment with our specialists.

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Why Get a Second Opinion? Your Health Deserves It

If you’re facing a major surgery, serious diagnosis or expensive recommended testing, get a second opinion – your physician should welcome that option.

Second Opinion for Cancer | Denver Urology Associates

Healthcare is as much art as it is science. Doctors base their clinical decisions on their education (medical school, publications, etc.) and their personal experiences. If they are unfamiliar with a procedure or the outcome data, they are naturally less likely to present that as an option to their patients. It’s only human nature. When it comes to you or your family’s health, you want to consider all of the options.

When should you get a second opinion on a medical diagnosis or treatment? And how do you go about doing that?

Most people, fortunately, don’t have experience with these questions. We do at Urology Associates, because we give second opinions all the time, and we have our medical opinions second-guessed, so to speak, by other physicians as well. Getting and giving second opinions is practicing good medicine.

Getting a second opinion for a patient could be life saving. It’s your right and often a very smart thing to do. Rule of thumb: if you have doubts about what you are told or if you just feel uncertain, get the second opinion.

No matter what the second opinion turns out to be, you’ll have greater peace of mind knowing you made the right decision for your health. You don’t want to have What If’s? bothering your thoughts as you fight your medical condition.

This is particularly true for cancer diagnoses and treatments. Urology Associates, as well as many other top institutions in the country, offers an online second opinion option. Many cancer patients, particularly prostate cancer patients, seek second opinions. At Urology Associates we offer this service at no charge.

When is a second opinion a good idea?

In general, consider getting a second opinion when your healthcare provider recommends a major surgery (non-emergency), test or treatment. Common reasons include the following.

  • A diagnosis of a life-threatening condition, such as cancer
  • Your insurer requires a second opinion
  • The treatment recommended is risky or potentially harmful
  • You no longer have faith in your physician and what he or she is telling you. This is tricky territory, but if you have confidence in doctor, you’ll know it.
  • You have several medical problems and complications
  • You have a choice of different treatment options or tests with very different costs.

Those are good reasons to get a second opinion. But many patients think, I can’t get a second opinion, I like my doctor and he will think I don’t trust him. Aside from situations in which you actually have lost trust, you shouldn’t worry about this. Most doctors want you to get a second opinion because it will validate their first opinion. And this is what happens most often.

Patients sometimes wonder if they should tell their doctor they are seeking a second opinion. For the reasons above, yes. For the practical reason that you will have to get your doctor’s office to hand over your medical records so you can show them to the second-opinion doctor, you will have to tell your doctor. (Law requires your physician to give you access to your records, though a fee may be involved.)

At the Urology Associates second opinion site, prostate cancer patients can use their most recent laboratory results to help complete a 10-minute questionnaire about their condition. A physician will review the information and provide you with a second opinion in just a couple of days. If you’d like to learn more, an in-office consultation will be needed.

Who to ask, what to ask them

If the second opinion is important – and it is – who gives you that opinion is just as important. You’ll want to go to a different institution because each provider has its own culture, which is often followed by all physicians. Different institutions have different approaches to medicine, which is good for a second opinion.

Seek a physician whose skill level and experience are just as good as, or better, than your current physician’s. Specialized providers, for example a cancer treatment center or cardiac center, are good options.

Okay, you’re all ready to go. So what do you ask?

  • What choices do I have?
  • What is the outcome data for each option?
  • Is the diagnosis/treatment recommendation I have received correct in your opinion? Why or why not?
  • What about my option of doing nothing? What might happen then? And please give me the worst-case and best-case scenarios.
  • What should I do with the opinion you have given me?

Take notes during your second-opinion consultation. You may receive a written recap or it may be sent to your original provider for you.

The questions above are good ones to start with. Your first-opinion physician can also help you formulate a good list of questions. And if the second opinion agrees with the first, you can move forward with the first-opinion doctor.

If two opinions are better than one, are three opinions better than two? Sounds like it might be but most medical experts say two opinions are generally enough. It’s not a good idea to keep seeking opinions until you get the one you want to hear. You will probably never hear it.

However, if the two opinions disagree, you may want to seek a third opinion. Medicare and many insurers will pay for this if they determine it is needed. Your other option would be to go back to your first doctor and talk more about your condition. More discussion may clarify things and give you the peace of mind you need.

Kidney Gone and Cancer Free

Diagnosed with kidney cancer, Don Bosson found both comfort and success at Urology Associates.

Don Bosson’s urine was darker than normal one day after he finished his morning coffee. A little concerned, Don figured he was just a bit dehydrated. Physically, he felt fine and went out for a round of golf, making sure to drink more water throughout the day.  When he returned, his urine was still brown – even darker.

“I knew something had to be wrong,” says Don. “I didn’t want to overreact, but I booked an appointment with my internist that week.”

Don’s internist sent him to Urology Associates where within a week he saw Dr. James Fagelson. Dr. Fagelson ordered an MRI, sent Don home and told him he would call him when he had news. Three days later, Dr. Fagelson called with some less than promising words, “We have a problem, how about you come in and we can talk about it.”

The diagnosis of kidney cancer

Don had kidney cancer and was shocked with the reality of his diagnosis. But he and Dr. Fagelson struck a bond immediately. Not only was Dr. Fagelson’s office wall plastered with specialty degrees from impressive institutions, but it also included dozens of photos of his family, children and grandchildren. Don, who was thinking about his family, children and grandchildren, says he somehow felt at ease during the entire appointment.

Dr. Fagelson showed him the MRI results and exactly where the cancer was. “He couldn’t have explained anything better or been nicer about the whole situation. I related to him immediately and I knew I was in good hands after that day,” says Don.

Many people are born or live with only one kidney instead of two. The kidneys are two small organs that sit below the rib cage and work to filter blood and produce urine – essentially cleansing the urine system. The human body can support all cleansing functions with only 75 percent of one functioning kidney. It’s possible to live with just one kidney and many people do, leading normal, active lives.

Just over 61,000 Americans (mostly over the age of 65) are diagnosed with kidney cancer each year. Twice as many males get kidney cancer as do women. Kidney cancer is normally found before it spreads to other organs, however the tumor masses tend to grow pretty large before they are physically noticed.

Kidney cancer typically can be diagnosed without a biopsy, so there was no need for an invasive surgical biopsy of Don’s kidney tissue. Don left Dr. Fagelson’s office with all his apprehension banished.

“He was probably the most reassuring guy I had ever met or spoken to,” says Don.

From cancer to cured in two weeks

Don had surgery to remove his right kidney in the summer of 2015. The surgery, performed at Sky Ridge, was on a Tuesday and he returned home that Saturday. Don says when he woke up from his surgery, he felt as though he had just been beaten up from the surgery, but it only took a short time to recover.

Dr. Fagelson visited Don in the hospital following the surgery to deliver some good news. The pathology from his removed kidney came back and he was able to determine that every last cancer cell had been removed and Don would not need to undergo chemotherapy. Only two weeks following his diagnosis, Don was cancer free.

“Obviously, this was just about the best news I could have received,” says Don. “That speaks to the thoroughness of Dr. Fagelson and the entire team and staff at Urology Associates.”

Don feels completely fine now and has resumed all of his activities. He regularly plays golf, he’s lost weight and is living a healthier life overall than before his diagnosis.

“I couldn’t be happier with my treatment, with my surgeon and with Urology Associates,” says Don. “Getting a successful outcome has everything to do with your surgeon. I would recommend Dr. Fagelson to anybody on the planet. I can’t sing his praises enough.”

Don says that he plans on spending the rest of his retirement playing as much golf as possible and avoiding any more surgeries.

Do I Really Need a PSA Test?

The PSA test is helpful in detecting prostate cancer, but has its drawbacks.

Denver Urology Associates PSA testIf you’re a man who expects to live past 50, expect to hear a lot about prostate cancer detection, treatment and the prostate specific antigen (PSA). Commonly referred to as the PSA, this is a protein produced in the prostate glands that indicates prostate cancer (as well as other irregularities of the prostate, such as benign prostatic hyperplasia or BPH). The PSA marker has been one of the most revolutionary discoveries in men’s health.

The prostate consists of hundreds of proteins and a group of dedicated research physicians in the 1970s set out to discover the one that indicated prostate cancer. The Food and Drug Administration (FDA) approved the first diagnostic kit in 1986 and in 1994 the kit was approved as a screening aid for diagnosis.

Before early detection of prostate cancer with a PSA test was possible, a prostate cancer diagnosis was often made at a late stage with a 5 percent cure rate. The PSA exam now contributes to 80-90 percent cure rates in modern day prostate cancer diagnoses.

PSA testing is simple. A small blood sample is drawn and sent to a laboratory. Results are reported in a ratio of nanograms of PSA for every mL of blood. PSA levels below 4.0 ng/mL are generally considered normal. The higher the PSA level, the more likely a man has prostate cancer. If a PSA exam comes back high, a biopsy ultimately can confirm whether or not the patient has prostate cancer.

In 2011, the United States Preventive Service Task Force (USPSTF) recommended reducing PSA screenings for men. This task force was comprised of 16 volunteer clinicians including family physicians, general internal medicine physicians, nurses, obstetrician-gynecologists, occupational medicine physicians and pediatricians – there were no urologists directly involved in the recommendation. The task force went so far as to recommend PSA screening only when symptoms are present. The problem is that prostate cancer is slow growing and it is usually in its later stages when men start experiencing symptoms. Urology Associates believes that this recommendation is a disservice to all men.

If your PSA is high, consult a urologist

When changing the PSA screening guidelines, the USPSTF should have clarified and recommended that all men, no matter their risk of prostate cancer, be under the treatment of a urologist, not a primary care provider when it comes to prostate health. The American Urologic Association and Urology Associates recommend an annual prostate exam and PSA test in low-risk individuals every other year for men ages 55-69.

One in 6 men will at some time be diagnosed with prostate cancer, but only 1 in 35 will die from it, thanks to advancements like the PSA. Men with a family history of prostate cancer should consult with their primary care provider or urologist to decide when to start screening. Most men should get PSA screening once they turn 55 if they do not have a family history of prostate cancer.

For undetermined reasons, men of African and Caribbean descent are more prone to prostate cancer, while Asian men are not. Other risk factors of prostate cancer include being obese, aging and certain inherited genetic mutations. Diet may also play a role in susceptibility to prostate cancer. Men who eat higher levels of red meat or dairy products and fewer levels of vegetables have a slightly higher chance of prostate cancer.

The best step men can take toward proactive prostate health is to have an active and engaged relationship with their primary physician or urologist so they can understand all the implications of the PSA – and what to do with the results once they have them.

While the PSA is not perfect, it remains an important indicator for potential prostate issues. Men should talk to their primary care provider today to determine if they should get a PSA this year.

Can Supplements Legitimately Improve Fertility or Are They Just a Farce?

Nutritional supplements not a Holy Grail solution for male infertility, but worth considering

fertility Supplements| Fact or Farce | Urology Associates | Denver

A variety of nutritional supplements are available on the market touted to reverse male infertility by improving sperm count, health and morphology. But do they really?

Physicians and patients alike want to use therapies proven both effective and safe to use. Many studies have been conducted on several supplements to evaluate whether they are, in fact, safe and effective.

The problem with some of these studies is that there is no standard dose for many of the supplements, and few of the studies attempted to assess whether there was any deficiency in patients before initiating therapy. Also, keep in mind that a well-balanced diet will already include many of these supplements.

So how do we interpret such mixed results? When there are contrary results from different, well–designed, randomized studies, it raises questions such as:

  • Was there a different patient population being studied?
  • How long was the population studied?
  • Was there a deficiency in this substance prior to enrolling in the study?
  • Are there are other variables that are not being adequately controlled?

When in doubt, ask the expert urologist

Urologists specializing in male infertility can help the male and his partner achieve a pregnancy in many ways. Most studies on nutritional supplements include patients with idiopathic issues (i.e. without any identifiable cause). It is therefore imperative to work closely with a physician with this expertise to look for and correct any other underlying issues before self-treating with a supplement.

Regardless of what supplement you choose to take, it is important to limit the amount ingested. Even if the supplement is beneficial, consuming excessive amounts of over-the-counter supplements may be detrimental to sperm production and can have serious adverse effects, ranging from gastrointestinal upset to effects on the central nervous system (fatigue, irritability, headache, vision changes). It is important to work closely with your infertility specialist to identify which supplements are appropriate at what dosages.

Physicians Ko and Sanbanegh and Zini and Al-Hathal recently reviewed the medical literature to see if supplements are helpful or not. The following represents a partial list of supplements that have been purported to be helpful.

Supplements: some work, some don’t

Selenium supplementation has been studied mostly in combination with other vitamins. The results in these studies have largely been positive, once again suggesting that selenium supplementation may be beneficial, particularly in those who had low selenium levels.

Carnitine is an energy source for cells in general, and in particular for sperm. Some studies have shown it to be effective in improving sperm count, motility (ability to properly move through the female reproductive tract) and pregnancy rates. While in other studies, no significant benefit was observed. Given the demonstrated benefit in at least some of the studies, it is possible that carnitine supplements will be beneficial with those patients who have an abnormal semen analysis.

Coenzyme Q-10 protects cells from oxidative stress, so in theory it would seem beneficial for damaged sperm. Unfortunately, the data supporting its use are contradictory, with some studies showing improvement in sperm quality and other studies showing no improvement whatsoever. Given this fact, the conclusion that can best be drawn is that coenzyme Q-10 may be beneficial.

Vitamins A, C and E, generally regarded as the main antioxidant vitamins, have been studied largely in combination to assess for any benefit in male fertility. Once again, the data are confusing, with some studies showing some benefit and others showing no benefit at all.

N-acetylcysteine decreases free radical levels, and thus may decrease oxidative injury to cells. Several studies have demonstrated improvement in semen analysis parameters. However, due to high risk of significant side effects and the difficulty of absorbing adequate amounts into the bloodstream from oral supplementation, this supplement is seldom used.

Zinc supplements, taken in the presence of zinc deficiency, have shown to be beneficial. However, with a well-balanced diet, zinc deficiency is quite rare. Given the low incidence of zinc deficiency and the potential side effects of zinc supplementation, it is seldom recommended.

Arginine has an important role in preventing oxidative injury in cells. So in theory, this would be a useful supplement to improve sperm quality. No randomized clinical trials have demonstrated efficacy, so the use of arginine cannot be recommended.

Remember, there is no magic bottle or potion that will ensure a pregnancy. But taking steps, such as working with a urologist to identify possibly beneficial fertility supplements, will put you in the best possible position to conceive.

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