|
 Portugues  Español |
|
|
|
Portugues Español |
|
To view previous forum questions and the responses of Dr. Russel Williams, please click on the topics listed below:
Question:
[November 8, 2000, Time: 6:22 p.m.]
I have boyfriend in Southeast Asia who was kicked quite hard in the groin playing soccer 3 years ago. Immediately after the accident, his testicles became swollen, and slowly over time, he started to ejaculate less and less. Although he performs sex and climaxes absolutely normally, there is now no ejaculate except for the occasional small amount of clear, salty emission (this is normally present on the tip of his penis before sex also). His testicles are still a big larger than average. Because of the healthcare conditions where he lives and his economic situation, he has not been able to get medical help. We are both very concerned, and want to have children very much, and am trying to get any information I can until he is able to emigrate to a western country. I am wondering if this condition is reversible, if he is still producing sperm, and if he is, is there a way it can come out? Any help would be greatly appreciated!
Response:
The soccer accident most likely caused your boyfriend to have a scrotal hematoma (blood Clot) and could have caused injury to the urethra. Usually blunt trauma to the scrotum does not cause vas deferens (the tubes that drain the testicle) obstruction. This could be definitely evaluated with a semen analysis. A low ejaculate volume makes me think that he could have develop an urethral injury and possibly a urethral stricture (scar tissue inside the urethra).The low ejaculate volume needs to be evaluated first. I recommend two semen analyses in his local country. If his sperm volume continues to be low then he should see an urologist. He would need a cystoscopy (a scope view of the urethra) to evaluate for a stricture. A urethral stricture can be dilated to a normal size and therefore is reversible. His sperm production is still most likely fine.
Sincerely,
Russel Williams, M.D.
Question:
[November 8, 2000, Time: 2:28 p.m.]
My husband was diagnosed with crystorchidism (undescended testicles) he had a bilateral orchidopexy at the age of 5, He is now 32 and I am 30. We have 1 child age 3 which was conceived with the help of ICSI. We just went through it again and it failed. The first time we went through ICSI, his sperm count was 5 million with a 30% mobility. In the most recent attempt it was 500,000 with a 20% mobility. Three years ago, he went through injections of hormones to increase the count but the Dr. didn't think it had a significant impact on his production. I guess what I am wondering is if there is anything new out there that can be done or if there is any type of corrective surgery that can be performed. It seems because he was diagnosed so long ago that we were just expected to go with the ICSI again and 4 years is a long time and there are always new methods.
Response:
I would recommend that prior to proceeding with a second round of IVF that your husband have a genetic analysis. Cryptorchidism may be associated with a chromosome or a gene abnormality. We have genetic tests that look at the main chromosome number and the integrity of the genes on the Y chromosome (the male chromosome). This information might explain the drop in his sperm count and give you information about any genetic defects that may be passed along to an offspring.In addition to a genetic evaluation, I recommend a repeat hormonal evaluation and a complete physical exam. If there is a low testosterone or an elevated estradiol it should be treated. Reversing any hormonal abnormalities can be helpful. If a large varicocele is encountered and no genetic abnormality is detected then it should be treated.
Sincerely,
Russel Williams, M.D.
Sperm Agglutination and IUI Success Rates
Question:
[November 8, 2000, Time: 12:39 a.m.]
I have been told that I have "sticky semen" and that they cannot do a sperm count on either of the two samples I have given because the sperm have "clumped together". Further research on my part leads me to believe that they are referring to sperm agglutination. They suggest sperm washing and IUI. Assuming that there is no female infertility factor, what are the likely IUI success rates?
Response:
Sperm agglutination does effect the fertility and can be treated with sperm wash and IUI. Sperm agglutination occurs due to antisperm antibodies (the body's own immune system acting against the sperm). The success of sperm wash and IUI will be dependent on the sperm count and motility after the wash. Also the success from IUI can depend on the percent of sperm affected by antibodies and the location of the antibodies. In general, success rates for antibody bound sperm treated by IUI were reported to be as high as 64% following three cycles of IUI. A 27% conception rate was reported for the first cycle (Ombelet et al 1997).Sincerely,
Russel Williams, M.D.
Question:
[November 1, 2000, Time: 8:28 p.m.]
I heard somewhere that STD's can go through the membrane of condoms and cause infertility. Is it true, due to the fact that an STD virus is smaller than a sperm cell and can therefore go through the mebrane?
Response:
A virus such as HIV can go through a condom because the size of the virus is small. Most bacterial viruses (like gonorrhea and Chlamydia) do not penetrate an intact condom. The STD's that can cause infertility are not the viruses but rather STD from gonorrhea and Chlamydia.Sincerely,
Russel Williams, M.D.
Semen Analysis, Low Testosterone Level, Androgel
Question:
[November 1, 2000, Time: 4:18 p.m. ]
At my OB's suggestion, my husband had a semen analysis. (We've been trying to conceive for 8 months, both 30, no children). Results as follows: Volume 7.5 ML Viscosity Low PH 8.5H Motility 14 L % Count 12 L x10-6/ML Morphology 35 H % Abnormal The Abnormal Spermatozoa Consisted Of: 47% Terminal Droplets 29% Large Heads 18% Bent Tails 6% Vacuolated Heads Leucocytes 7/HPF. We have an appointment with RE in 3 weeks. We decided to go ahead and see a urologist. The urologist performed a quick 5 minute examination on my husband and said there was no varicocele, prostate seemed fine, but my husband's testicles were on the "smaller side." They also took some blood from my husband. Blood tests came back with the following results: T Testo DPC 1.5 Prolact ACS 8.0 LH ACS 1.8 FSH ACS 5.8 Basically all came back normal except testosterone level which should be 2.7-10.7 ng/ml. The doctor is prescribing androgel and wants another semen analysis in 4 weeks. We don't know whether my husband should take the androgel. I have read that pg women should not come in contact with it and the only reason we would be using it is to increase sperm count and motility in order to get pregnant. Will or can the androgel do that? The urologist did not seem concerned about the leucocytes, high volume, and high ph in the semen analysis, all of which seem to indicate an infection from what I've read. My husband has no symptoms but can't there still be an infection? Should we insist that a semen culture be done if WBCs present in next analysis? Can you recommend a urologist in the Birmingham (Alabama) area that specializes in male infertility? Although we know there is nothing proven about vitamins, my husband has started taking 1000 mg vit C, 25,000 iu vit A (beta carotene), 70 mcg selenium, 400 iu vit E, 50 mg zinc, and a multivitamin (centrum). We've read B12, carnitine, and arginine can be helpful, but didn't get those b/c my husband is already taking so many vitamins. I apologize for such a lengthy post but any information you could provide regarding the above questions would be greatly appreciated. Thank you!
Response:
I recommend a different approach. I recommend that the testosterone levels be repeated and verified. If it continues to be low then it should be treated. I do not recommend androgel as the form of treatment but rather recommend an antiestrogen like Clomid.I agree that the elevated seminal leucocytes should be evaluated with semen culture and if significantly positive should be treated. I do not know of an infertility physician in Birmingham but you should contact Resolve Infertility who has an extensive list of male infertility physicians.
Sincerely,
Russel Williams, M.D.
Question:
[October 31, 2000, Time: 2:19 p.m.]
Doctor, my husband and I have been trying to conceive our second child for 8 months now. We are in our early thirties and had no problems conceiving our first child. The only difference is that my husband has been running 26 mile marathons. He has been training hard for one over the last 6 months. We live in an area that gets very hot and humid in the summers. My question is, could the running be causing a fertility problem? I have been ovulating regularly each month. Thank you.
Response:
There is some data that suggest that excessive exercise can reduce a man's sperm count. Training for a marathon is definitely a high level of exercise. I recommend a semen analyses. If it shows a low sperm count then this should be addressed.Sincerely,
Russel Williams, M.D.
Question:
[October 30, 2000, Time: 12:56 a.m.]
I have been diagnosed with partial maturation arrest. SAs have shown between 5 and 1.5 million sperm. Hormone levels (FSH, LH and T), physical exam and urinalysis are all normal. My WBC count has been between 1-2.9m/ml (only thing abnormal- besides count of course). I read in your literature that maturation arrest w/normal hormones could be treatable. Could you tell me how? Any advice on the next step(s)/test(s) would be greatly appreciated. Thanks in advance
Response:
I would need some more information from your biopsy that prompted the diagnosis of maturation arrest. What percent of the tubules were effected? Is it an early or late arrest?Also I recommend a genetic evaluation. Your genetic evaluation may demonstrate a genetic cause for your abnormal sperm production. We do not have a method to correct genetic defects. If your hormone levels and physical exam are normal then correcting the arrest may be difficult. Make sure you have as little exposure to harmful substances such as alcohol, smoking, recreational drugs, etc. You might need to proceed to IVF to overcome your low sperm count.
Sincerely,
Russel Williams, M.D.
Question:
[October 27, 2000, Time: 4:15 a.m.]
I have heard that the application of products such as: IcyHot or Bengay to a male's testicular region can cause sterility. Is there any truth in this statement?
Response:
I have not heard that either of those products causes infertility.Sincerely,
Russel Williams, M.D.
Question:
[November 9, 2000, Time: 1:08 a.m.]
I have a problem with Hypogonadism. My brother is 20 years old and a hypogonade so it's
oppressive for him and me too. First I want to know is there any cure for him ? A big and the first in this problem is hair on his face that is abortive . I mean can we have somthing for this at first? And I just want to thank you for all of those informations that you gave me . Best regard
Response:
A low testosterone level (hypogonadism) can be treated in several ways. The form of treatment depends on the cause of the low testosterone level and what his fertility plans are. He should have a very close physical examination and complete hormonal test by an urologist in your area.Sincerely,
Russel Williams, M.D.
Question:
[October 17, 2000, Time: 3:58 a.m.]
I'm 27 years old and i had a sperm count test a while ago and it came up that i have azoospermia. here are the results of my test. I hope they might reveal something. Volume: 3.5 Color: ivory white Consistancy: liquid after one hour PH: 8.00sperm count: Mil/ml 0.00 Leukocytes: 0-1/hpf Red blood cells: 1-2/hpf Precursor Spermatocytes: 1-2/hpf my endocrinology test results were as such: TESTOSTERONE: ng/dl 399 FSH: mlU/ml 6.51 LH: mlU/ml 6.76 PROLACTIN: ng/dl 5.87 usTSH: 1.49 FT3: 2.57 FT4 10.20 I also have a big kystic intra-scrotal lesion pushing my left testicle towards the bottom which has a length of 9 cm and it's echographic aspect is compatible with a spermatocele. i'd like to add that i am overweight and i do have a lot of heat in my testicular regions and i have slight but still consistent pains inside my testicles mostly after ejaculation I am really anxious to know if any of this information might give an answer for my case. Thank you so much
Response:
The most important information from your situation is a zero sperm count, a normal FSH, a normal Testosterone and the findings from the scrotal ultrasound. A 9-cm spermatocele is huge. I think that there must be some misinterpretation. Most spermatoceles are less than a centimeter. You did not mention your testis size�. The missing information now is testis size, cord appearance, and a genetic evaluation for abnormal chromosomes.I suspect a problem in sperm production that would be confirmed with this additional information. If my suspicion is correct then you should start gathering information on IVF/ICSI as a form of treatment.
Sincerely,
Russel Williams, M.D.
Question:
[October 17, 2000, Time: 10:47 p.m.]
my husband had a recent semen analysis it read: 23.1 million/ml 18% motility 14% normal sperm. It was evaluated under the kriegers evaluation method. Is there possibility for pregnancy? prior analysis one yr ago was 6 million/ml motility was 12% normal sperm was 8%. Please answer ASAP! THANK YOU
Response:
Your husband's count is low normal. His percent normal morphology is good. His motility is low especially if the range is that of the WHO that requires that 50% have moderately to good motility. I would retest the sperm motility with a collection at the laboratory. If the repeat semen sample shows good motility then the likelihood of a significant male factor is low. In general, your husband has a relatively good quality semen analysis that can provide for a pregnancy.Sincerely,
Russel Williams, M.D.
Question:
[August 24, 2000, Time: 6:52 p.m.]
The surgeon has diagnosed I have a cyst of the rt. epididymis. Am Married for 4years and no child till date. 1). could this be the cause. (2). Would surgery help my chances of fertility or not (3). could the subcutaneous larva migrans infection ( I picked from my dogs) sometime ago be a contributory factor. (4) what tests / investigations could assist a correct diagnosis. Am afraid regarding the prospects of surgery viz a viz improved chances of fertility. Thank you for being on line
Response:
I think what you have been diagnosed with is a spermatocele (cyst in the top of the epididymis). Spermatoceles are common and seen in fertile men. Spermatoceles are not associated with infertility. Have you had a semen analysis? I would evaluate your four-year infertility first based on a semen analysis then a physical exam. I have not heard that exposure to subcutaneous larva migrans cause any form of infertility. First step is to see a urologist and have a semen analysis.Sincerely,
Russel Williams, M.D.
Question:
[August 27, 2000, Time: 12:26 p.m.]
Dh is battling his second infection with ecoli in the semen. Culture shows few cells. He was treated with one month of Cipro 2x day. What causes this infection to happen. Will it ever totally go away? What is the medical term for this condition?
Response:
Ecoli infection of the prostate is relatively common. The urethra has Ecoli naturally in it and this colonization of bacteria can easily make its way into the prostate. Some men have symptoms and others do not. The ecoli cause a significant inflammatory response that is seen in the semen. Cipro is the appropriate drug and a four to six week course is needed. Most men will clear their infection after antibiotic treatment. This is called prostatitis.Sincerely,
Russel Williams, M.D.
Question:
[August 29, 2000, Time: 3:34 p.m.]
I am a 30-year old male taking Elmiron, a treatment for interstitial cystitis. My wife and I have begun to try and conceive a child. Are you aware of whether Elmiron affects sperm count, fertility, etc. in men.
Response:
I have seen no information to suggest that Elmiron causes infertility.Sincerely,
Russel Williams, M.D.
Question:
[September 2, 2000, Time: 3:24 p.m.]
I am married for last four years but we are not able to conceive. Recently, my testicular biopsy was performed. Two months have passed but pain in my left teste persist. The pain is so much that I cannot walk properly. the doctor says that it is very rare and will take time. I have come to know that normally it takes a person only seven days to recover from biopsy. Please give me reasons for this problem and any treatment is possible.I will be greatful to you as this problem has made my life miserable.
Response:
The amount of pain a person has after surgery can be quite variable. Two months of pain after a testes biopsy is definitely unusual but does not indicate that you have an unrecognized injury. You should be reexamined to make sure there is no blood clot or infection. I recommend a scrotal support, warm towels around the scrotum while at home, and an anti-inflammatory medication.Sincerely,
Russel Williams, M.D.
Question:
[September 13, 2000, Time: 7:50 a.m.]
I recently had my third semen analysis done.All parameters are extremely poor.On one of the test results, I noticed that my level of leukocytes was moderate, yet the reference range states that this is abnormal. My urologist made no mention of it whatsoever. Should I insist upon a semen culture to determine if there is an underlying bacterial infection thatmay e contributing to my infertility?
Response:
The normal standard for leukocytes in the semen analysis is less than one million. If you have any genital pain or prostate pain then you may have an infection. I doubt though that all your parameters being poor are related to a "moderately" elevated leukocyte count. I would look for other causes contributing to a poor semen analysis.Sincerely,
Russel Williams, M.D.
Question:
[September 13, 2000, Time: 11:31 p.m.]
My husband has an extremely high sperm count. Our own internet research has revealed that he has a condition known as polyzoospermia. None of the articles mention any type of treatment for this condition. We have been trying for over a year to get pregnant and have been unsuccessful. Do you have know of any treatment plans that may be recommended? Thank you
Response:
Polyzoospermia does mean an extremely high sperm count but it does not mean a male factor infertility. Too much sperm is not an infertility problem. I would concentrate on a female infertility evaluation.Sincerely,
Russel Williams, M.D.
Question:
[September 19, 2000, Time: 2:04 p.m.]
I am scheduled for varicocele repair at Mayo Clinic...low sperm count 1 million / mL low motility and am wondering if I should go through with it. With such low sperm counts will it really help? No pain involved with varicocele left testicle about 1/2 the size of right. If ICSI is planned therapy anyway, why go through with the repair? I am 35 year old male never fathered children, never smoked don't use alcohol, on no meds. 6'tall 205 pounds. Wife is 31 never been pregnant, otherwise seems to have normal reproductive health.
Response:
A large varicocele that is repaired can lead to very significant improvement in the sperm count. You may see improvement in counts above 5 to 10 million per cc. It is hard to say whether you would need to still rely upon IVF. Intrauterine insemination success rates are very low when the count reaches below 10 million total sperm. Remember that the effects of a varicocele are progressive. With time you can expect to see further decrease in the size and function of you testicle. I would agree that you should have your varicocele corrected, especially because your wife is young and otherwise fertile.Sincerely,
Russel Williams, M.D.
Question:
[September 24, 2000, Time: 2:33 p.m.]
I need information on the availability of treatment for the production of sperm due to the presence of a pituitary adenoma. - Two years post-pituitary adenoma - No Anterior Pituitary function - Synthroid 0.088 replacement Q-Day - Delatestryl 200mg/ml IM Q-14days - Humatrope 0.6 Sub-Q/3X week Is there an easy answer for returning sperm production? Can the LH/FSH be replaced in males as easily as it can be in women with a positive outcome? Please advise me on this as soon as possible. Thanks!
Response:
There are many different protocols for treating hypogonadotrophic hypogonadism and this issue is going to be addressed at our annual infertility meeting. With no pituitary function then a GNRH agonist would not help. You are correct in that you need both FSH and LH initially simultaneously. I have no additional information on this now but anticipate a collection of information in the near future.Sincerely,
Russel Williams, M.D.
Question:
[September 25, 2000, Time: 5:37 p.m.]
Can you help us to understand what is an exact reading "healthy" sperm analysis: concentration, total sperm count, motility, speed, progression, mean linear vel, mean straight, lateral displ. ??????? We have the results but did not get them interpreted. thank you.
Response:
The parameters are count >20 million per cc, motility >60 % fast and slow motion, morphology >30% by WHO criteria. Lateral head displacement and strict criteria morphology are more sensitive test to judge sperm function. This needs to be discussed with the doctors who ordered your tests.Sincerely,
Russel Williams, M.D.
|
Main Office
9190 Old Katy Road, Ste 101 Houston, TX 77055 Tel: 832.358.8600 Fax: 832.358.0376 [ map ] |
Cypress Fairbanks Medical Center
11302 Fallbrook Suite 106 Houston, TX 77076 [ map ] |
Content Copyright © 1999–2008
by Male Reproductive Clinic, P.A.
All rights reserved.
Design and Architecture Copyright © 1999–2008
by Healthcommunities.com, Inc.
All rights reserved.
No part of this website may be reproduced or distributed in
any form or by any means or stored in a database or retrieval
system without the prior written permission of the copyright
owner.