GP Talks About Male Fertility

I Love Children: GP Talks About Male Fertility

What are the common male fertility conditions treated at a GP?

Most male fertility conditions can be treated by your primary healthcare provider because the vast majority of male fertility problems is really optimising the sperm parameters rather than fixing a more serious issue. I think the real value of you seeing your GP really is to get a diagnosis. Because if you do fall into a small category of one in a thousand people with a serious problem, for example, a blockage of your tubes or a severe hormonal aberration or some kind of chromosomal disorder, then you really want to find out early. Then, your GP can point in the right direction and refer you to the appropriate specialist to see.

What are the treatments available for male fertility conditions at a GP?

When your doctor talks about treatment, obviously we're going to try to optimize the health of the sperm. So, this would include things like dietary supplements and controlling chronic disease, and, giving lifestyle advice, including getting back to healthy weight, stopping smoking, and also keeping your testes nice and cool.

But do not forget, healthy sperm does not automatically lead to conception. You still need the act of intercourse and depositing healthy sperm within the vagina, near the cervix at the correct time. So, the doctor can also talk to you about things like the use of ovulation predictors. Surprisingly, many of my patients do not know of this. So, I teach my patients how to use it.

The other thing is also certain tips and tricks. For example, after ejaculating intravaginally, some couples like to put a pillow under the buttocks of the female partner to lift it up. It is free, it is comfortable, it is painless, and you never know – it might help. So, I give all these advice to my patients. I make sure that their care is holistic. It is not just about improving sperm parameters.

Are nutrients from food sufficient to enhance male fertility?

In Singapore, food scarcity or nutrient scarcity really is not on the minds of most people; and most of us get very healthy and sometimes excessive diets. But the thing is there are certain micronutrients like selenium and carnitine and zinc, which you really cannot get in sufficient quantities in the foods that we eat.

So, it is more convenient and more efficacious for you to take a clinically proven dietary supplement to aid in your fertility. Certain micronutrients that you really need to help your sperm become healthier include iron or zinc. If you want to take it from natural foods like spinach, you're going to need to eat a huge volume of spinach. I think something like 4 kilos of spinach a day just get a sufficient amount. So obviously this is not very practical. So really a more convenient way is to take medical supplements.

How different are male fertility medications from female fertility medications?

You will be surprised that the medications used to treat male fertility is really identical to those to treat female fertility. Because if you think about it, the hormonal axis between the men and woman is really quite identical. Our brains produce the same hormones that goes down to the ovaries in women, or in the case of men, the testes, to produce the eggs in women and the sperm in men – the so-called gametes. So, the medication really is to improve this hormonal control axis, such that we produce more healthy sperm or women produce more healthy eggs. That's it guys. Please don't go rummage through your wife's medical cabinet and then grab a pills and start taking it, okay? Because the dosages are really different from men and women. So, you still need to see a doctor. You still need to get proper medical advice.

How does weight loss/ gain affect male fertility?

Both excessive weight loss and excessive weight gain have negative effects on fertility. So, people who are excessively skinny, as in clinically underweight, their bodies may not have enough nutrients to produce healthy sperm. Alternatively, for people who are obese, or fall into the obesity range, there are certain changes in the body. For example, there is a lot of inflammatory hormones produced, and then there even be aberrations in the hormones itself. In other words, people who are obese sometimes produce excessive female hormones, and this can affect the sperm health.

Excessive weight loss and excessive weight gain can also be symptoms of indications of the more serious illness. For example, a thyroid problem. So, if you do experience excessive weight loss, or gain, maybe you should be seeing a doctor. See if there's underlying problem. And if there isn't, then getting a doctor's advice on how you can get back to more healthy weight will really help your fertility.

To know if you're within a healthy weight range or not, the indicator that most doctors use is actually the BMI. You get your weight in kilograms, divided by your height meter squared. You want to be between a BMI of 18.5 to 23. If your BMI is less than 18.5, you are clinically underweight. If your BMI is more than 23, you are overweight. If your BMI is more than 27, you are obese.

Now, how fast do you want to drop from a BMI 27 back down to 23? Actually, a lot of data has shown that quick weight loss leads to a more sustainable weight loss. So, see a doctor, get onto a good exercise and diet program and really expect to lose 2kg – 4kg a month and that should be very healthy.

How does hormone level affect male fertility?

There are two major hormones in the body. The major male hormone is testosterone. Guys should have a lot of that. The major female hormone is oestrogen. Guys should have a little bit of that, but obviously not too much. How the male body mixes oestrogen is, it takes the testosterone and breaks it down into oestrogen.

A lot of this enzyme that does breaking down is actually found in the fat cells in our bellies. So, guys who are more obese tend to then break down more testosterone into oestrogen. Oestrogen has this effect of then making men put on more weight around the central region, that this is also explains why women are always fighting weight around the central region.

So, when this happens in guys, we put on more adipocytes or fat cells in this area. Which that makes even more oestrogen. So, you go down this positive feedback cycle. So, getting back to the healthy weight and really losing the central obesity is very important.

I have seen couple of patients… Because we know that certain food products, like soy products contain a lot of oestrogen. That's why females who are going into menopause, we advise them to take a lot more soy product because it contains more oestrogen. I've seen very few patients who take so much soy product… there is this patient who drinks at least two cups of soybean milk every single day to a point that his oestrogen level actually started to rise. So, all we needed to do is get him to make some simple lifestyle changes, basically cut away the soybean milk and he got back to very good health.

Do all GPs treat men’s fertility health? What are the limitations?

The field of medicine these days is huge. So, every doctor be it a GP or specialist will have a niche area of interest. That said, if you have a concern regarding your fertility, the first person to see will obviously be your GP, who can then order some basic tests and whatever is within his realm of familiarity or specialty, he will be able to manage for you.

As with all doctors, anything that is outside of their realm of expertise, we will that point the right direction and refer you to an appropriate colleague to then take over your management.

Can GPs refer their male patients for a Semen Analysis (SA)

Any doctor can easily fill up a form and send you to a lab for semen analysis. That said, there are few things to take note when you do go for a semen analysis. Number one, you have to refrain from ejaculating for 3 to 10 days prior to the test. Number two, the semen has to be analysed within an hour of collection. So, logistics is usually an issue. What most doctors would do is to actually send you to the lab to collect the specimen there so that you're well within the one-hour window. That said, different labs have different collection facilities, so you might want to check with your doctor what facilities the lab has, and if you're comfortable with that.

So once the semen analysis report comes back, your doctor will definitely sit you down and go through the numbers with you. What most labs use these days is the World Health Organization 2010 reference range. You'll notice in your report, there'll be a lot of numbers. Everything from your sperm count, that means number of sperm in this semen sample to the motility, how fast your function to the morphology, that means are they the correct size and shape.

There will be other numbers such as the acidity, the pH level, and the number of white cells. So, your doctor will be able to look at all these and give you an idea of your fertility status as it is now, and whether or not there's a more sinister underlying problem. And then recommend treatment or then refer you to a colleague to get treatment.

Do you often see men who face stress/ depression while trying to conceive?

Trying to conceive itself can be a very stressful endeavour, especially if they have failed a few times. I've had patients who come to me because they are unable to perform because of such stress. So, you can imagine, I have patients who in the middle of the work day, their partner texted them saying, “I've done my ovulatory test. Today is the day.” And then they start getting stress building up because they know they are going to have to try again, and what if they fail again, right? It is really quite emotionally traumatizing. To the point where some men cannot even get a proper erection and complete the intercourse.

Now this is obviously a big problem because that has to happen for conception to happen. So, when men come to see me with these problems, usually what we do is we try to get them to take a different perspective from the issue. I actually tell my patients to take a holiday if, you know the three days that you need to try to conceive in the next month. Get a staycation and go away for a few days, you'd be surprised how much that helps. Also it takes a lot of stress off the woman and then the more relaxed she is, I find that it really helps with the fertility.

Are there any treatments/ medications that can help with the stress of trying to conceive?

For some men, the stress can build to a level that they cannot even get or sustain erection enough to complete intercourse, which we all know is essential for conception. So, for such patients, sometimes we actually have to prescribe a class of medications called PDE5 inhibitors, the most famous of which is a little blue pill, but obviously there are many other brands available out there.

There's a lot of concerns about side effects of these medications and whether or not men will become dependent on them. These are prescription medications. Obviously, see your doctor, get proper advice on the amount you need to take and when you need to take and how you need to take it. These medicines may have short term side effects, but rest assured that they're very safe and they do not have long side effects and you certainly will be dependent on them.

Are there any other side effects from these medications?

When using these medications or PDE5 inhibitors, one uncommon side effect is actually delayed ejaculation. Sometimes these medications can delay ejaculation to a point where a patient cannot even ejaculate within the vagina, which then becomes a problem. Fortunately, we have solutions for this. The most popular being was known as the Turkey Baster method. I know it's a horrible sounding name, but the techniques actually rather simple. What we get our patients to do is to ejaculate into a clean container. These days, there are commercially available kits for this. But we just need our patients to ejaculate to a clean container and then use a syringe. Just a syringe without the needle. You do not want to cause any trouble. And then extricate the semen out of the container and then introduce it into the vagina.

What is the success rate of the “Turkey Baster Method” with your patients?

When I mentioned this to my patients, nobody has ever heard of it before. So, I educate my patients on this and honestly some of them have taken it to task and used it very successfully to conceive. I'm very happy to report that many of my patients have used this method and they have all come back to give me very good news that they have conceived and given birth to healthy children, which is really satisfying as a doctor.

Is drinking enough water important for sperm health?

Adequate hydration is obviously important for overall good health. That is this concept of making the sperm more watery and less sticky. Now, that is actually called liquefaction time. If you look at semen when it's first ejaculated, it's usually very gel-like, and then if you notice over time, it liquefies. This is physiological. It's initially gel-like so that it can stick to and be close to the cervix, then it liquifies so that it releases the sperm so it can swim up the cervix. Now, if there's a prolonged liquefaction time, if the sperm takes a lot longer to become watery, that might indicate a problem like some inflammation or even some infection within the tubes leading up from the testes all the way into the penis.

Dr Tan’s word of advice to men

Guys, when a couple is facing fertility problems, let's face it, half of the time the problem lies with us. Fortunately for us, the testing and treatment are usually a lot simpler compared to your partner. So really, there's no excuse. If you're trying to conceive for six months and you're not successful, please don't feel shy.

Go see your GP, get some simple tests done, and I'm sure your doctor will be able to give you some sound advice on how to improve your fertility, and hopefully you'll be able to start your family very, very soon.