A Man’s #1 Reason to Stop Smoking

ManSmokingAccording to the CDC1, Smoking causes more deaths each year than all of the following things combined:

  • Human immunodeficiency virus (HIV)
  • Illegal drug use
  • Alcohol use
  • Motor vehicle injuries
  • Firearm-related incidents

Smoking is a hard habit to break. But if the health hazards haven’t persuaded you to go cold turkey, this one fact just might: Smoking can hit you below the belt.

Erectile Dysfunction

When it comes to the bedroom, lightning up might not be so hot. Numerous studies2 have linked smoking to erectile dysfunction. Smoking restricts blood flow in your veins and arteries, and proper blood flow is essential for erectile function. If you smoke, you are at greater risk of developing this condition.

Reproductive Issues

If you are considering having a family, smoking might keep you from that goal. One study3 compared semen from smokers to semen of non-smokers and found that smokers suffered from the following complications:

  • low testosterone
  • low sperm motility
  • impaired sperm fertilizing capacity

Testicular Cancer

According to one study done in Canada4, smoking was shown to increase the risk of testicular cancer. The researchers stated that “smoking to any degree was suggestive of an increased risk.” They additionally noted that there was “no association with age of initiation and no reduction of risk with smoking cessation.” So what does that mean for you? If you have ever smoked, at any age, for any length of time, you have increased your risk of testicular cancer. Even if you have stopped smoking, you have permanently elevated your risk. And the longer you smoke (the higher your pack-year ratio), the more you increase your risk.

So the next time you consider taking a smoking break, think instead of taking a break from smoking. If you won’t do it for your lungs, do it for the family jewels.

References

1. Centers for Disease Control and Prevention (2014). Health effects of cigarette smoking. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/

2. Gades, N. M., Nehra, A., Jacobson, D. J., McGree, M. E., Girman, C. J., Rhodes, T. . . . & Jacobsen, S. J. (2005). Association between Smoking and Erectile Dysfunction: A Population-based Study. Americal Journal of Epidemiology, 161(4), 346–351. doi: 10.1093/aje/kwi052

3. Sofikitis, N., Miyagawa, I., Dimitriadis, D., Zavos, P., Sikka, S., & Hellstrom, W. (1995). Effects of smoking on testicular function, semen quality and sperm fertilizing capacity. Journal of Urology, 154(3), 1030–4. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7637048

4. Srivastava, A & Kreiger, N. (2004). Cigarette smoking and testicular cancer. Cancer Epidemiology, Biomarkers, and Prevention, 13; 49–54. doi: 10.1158/1055-9965.EPI-03-0133

You Are What You Eat … And Your Children May Be Too

AbdObeseMaleLeaf through any magazine dedicated to health and wellness, whether its intended audience is the general consumer or a medical professional, and you will invariably come across an article whose focus is some obesity related health condition.  The CDC considers obesity an epidemic responsible for a host of chronic diseases affecting every major organ system of the body, and the male reproductive system is not immune. Over the last couple of years, researchers have linked obesity to several factors causing male infertility.

Obesity is an endocrine disrupter resulting in lower levels of reproductive hormones that are critical to spermatogenesis, the development of sperm cells. Spermatogenesis requires sufficient testosterone and properly functioning Sertoli cells, which provide physical and nutritional support to developing sperm cells. Luteinizing hormone (LH) stimulates testosterone production, which in turn stimulates sperm cell maturation under the “care and protection” of Sertoli cells. Follicle stimulating hormone (FSH) and Inhibin B regulate the function of Sertoli cells. Sub-optimal levels of any of these four hormones will lead to fewer mature sperm cells and a lower sperm count, and researchers have linked obesity to lower levels of all four. They are exploring the possibility that elevated insulin levels, a hallmark of metabolic syndrome, is a factor in the dysregulation of these reproductive hormones. (Metabolic syndrome is a group of risk factors, brought on by obesity, that increase an individual’s risk for cardiovascular disease and type-2 diabetes. These risk factors are high blood pressure, abnormal cholesterol levels, high blood sugar, elevated insulin levels, and excessive abdominal fat.)

Obesity has been linked to a higher level of sperm oxidative stress.  Oxidative stress is the damage caused by free radicals reacting with molecules in an organism. This happens when physical and environmental changes occur that prevent antioxidants from reacting with, and thus eliminating, these free radicals. Oxidative stress damages the molecular composition of sperm. It compromises DNA integrity and decreases the acrosome reaction. The acrosome reaction occurs in the head of sperm and involves the release of enzymes that enable sperm to penetrate an egg. Oxidative stress is also implicated in decreased motility and disrupted cell signaling (communication).  All these factors impair the ability of sperm to fertilize an egg.

The development and maturation of sperm is highly sensitive to heat. The presence of excessive fat around the testes elevates the temperature in the testes to damaging levels, reducing the amount of mature sperm produced. Higher gonadal temperatures also contribute to sperm oxidative stress.

Some of the most recent and quite possibly most disturbing research findings involve obesity and epigenetic inheritance. Epigenetic inheritance involves changes in gene expression, as opposed to physical changes to the genes themselves. Scientists are studying the link between obesity in fathers and reproductive and metabolic disturbances in their children.  Studies are being conducted on rats and mice that show a strong correlation between paternal obesity at the time of conception, and fertility and metabolism disorders in offspring. Altered methylation of sperm DNA and damage to sperm RNA from oxidative stress are being explored as possible culprits.

If you are an overweight male who is having trouble achieving a pregnancy with your partner, all is not lost.  Each of the outcomes described above can be improved with weight loss, proper nutrition, and exercise. Considering the devastating impact obesity has on all major organ systems, weight loss will not only be an investment in your future fertility, but also an investment in your future health and well-being.

 References:

Palmer NO, Hassan WB, Fullston T, Lane M. Impact of obesity on male fertility, sperm function and molecular composition. Spermatogenesis. 2012; 2(4): 253-263.

McPherson NO, Fullston T, Hassan WB, Setchell BP, Lane M. Obese father’s metabolic state, adiposity, and reproductive capacity indicate son’s reproductive health. Fertil Steril. 2014; 101(3): 865-873.

Hammoud AO, Wilde N, et al. Male obesity and alteration in sperm parameters. Fertil Steril. 2008; 90(6): 2222-2225.

Putting Off Having a Family? What Men Should Know

DadFamily planning includes not just determining how many kids to have, but also when to have them. You may decide to delay starting your family because you want to go back to school. Maybe you want to be more established in your career before you have kids. You might want to be a homeowner before you bring home a baby. Or maybe you just want to be debt-free before piling on hospital bills associated with pregnancy and birth. Whatever the case may be, before you decide to say “Not right now,” there are a few things you should consider.

Male Fertility Declines with Age

You probably know that your wife’s fertility declines as she grows older and eventually goes through menopause. But she’s not the only one with a biological clock. One study found that a man’s ability to reproduce declines sharply after the age of 41. According to researchers, fertility declines at a rate of 7% for each year after 41, with an even steeper rate of decline after the age of 45. In fact, in this short period, the rate of successful pregnancy drops from 60% (age 41) to just 35% (age 45)1. So if you wait until you are 45 to start your family, you may not like your chances.

Age Increases the Chance of Birth Defects

Not only is the chance of pregnancy reduced by age, but a father’s age can also introduce other complications. Studies have shown that older men are at higher risk to father children with birth defects and genetic abnormalities. One study found that, when both parents of a child with Down syndrome were over 35, the father’s age “played a significant role” in the child’s genetic abnormality. When the mother was over 40, the incidence of Down syndrome related to sperm was about 50%2.

Ditto schizophrenia. In one study, researchers concluded that “men between the ages of 45 to 49 were twice as likely to have children with schizophrenia as were men 25 and younger.” But for men over 50, the risk was three times as high2.

You Can Grow Old While Your Sperm Stays Young

Both of these concerns are related to the age of a man’s sperm, but not necessarily the man himself. You can keep your sperm young while you continue to mature toward your pre-family goals. Sperm banking allows you to cryopreserve your semen for later use. If you want a family, but not right now, you might consider banking your sperm. That way you can plan your family on your timetable while avoiding the complications that accompany the ticking of your biological clock.

References

1. Macrae, F. (2011, October 20). The male biological clock: After 41 your chances of becoming a father ‘declines rapidly’. Mail Online. Retrieved from http://www.dailymail.co.uk/health/article-2051041/MALE-biological-clock-After-41-chance-father-declines-rapidly.html

2. Heubeck, E. Reviewed by Brunilda Nazario, MD. Age raises infertility risk in men, too. Retrieved from http://www.webmd.com/infertility-and-reproduction/features/age-raises-infertility-risk-in-men-too

CatSper the Friendly Ion Channel and Male Infertility

In sperm tail, CatSper is activated through alkalinization and perhaps other activators. Intracellular alkalinization can be potentially achieved through a Na+/H+ exchanger (NHE) that might be sensitive to cAMP [downstream of a soluble cyclic adenylyl cyclase (sACY)] and voltage. Activation of receptors (e.g., ZP receptors in sperm head) generates messengers that eventually lead to CatSper channel activation in the tail. Ca2+ ions entering the sperm tail through CatSper act not only locally on motor proteins to affect sperm motility but also globally to lead to [Ca2+]i increases in sperm midpiece and head. There are likely unidentified Ca2+-permeable channels responsible for the CatSper-independent, sustained [Ca2+]i increases important for the acrosome reaction. Many of the proposed signaling pathways have not been directly tested and are indicated by question marks.

“I’ve got swimmers!” One of our patients actually listed this as the reason he was ready to discard the sperm he had banked with us prior to starting cancer treatment. I laughed aloud when I read it. What a humorous way of telling us that he recently had a semen analysis that demonstrated good motility and forward progression.

Being a swimmer (good motility) is critical to sperm’s ability to fertilize an egg. Sperm start to move once they’ve been ejaculated from the male urethra. However just because they’re moving doesn’t mean they’re able to fertilize an egg. First sperm must undergo a maturation process called capacitation. Capacitation involves the movement of calcium ions into the sperm cell. The calcium ions move into the sperm cell through specialized ion channels named CatSper. Once inside the cell, the calcium ions trigger a series of events that will hyperactivate sperm motility. In the female reproductive tract, hyperactivated motility occurs right by the egg, at the site of fertilization, and enables the sperm to penetrate the egg and achieve fertilization.

Sperm that are unable to undergo capacitation cannot penetrate an egg and thus fertilize it.  Researchers have discovered two gene mutations that cause sperm to be produced without CatSper channels. These genes are CatSper1 and CatSper2. Men with either of these mutations are infertile.

Clinically diagnosing CatSper-related male infertility can be tricky.  Changes in motility caused by the absence of CatSper channels are frequently missed in standard semen analyses.  “A more rigorous clinical examination that includes measurement of sperm motility parameters like path velocity, progressive velocity, and track speed”1 is required to help determine if sperm cells are hyperactivated. Computer-aided sperm analysis (CASA) systems have been developed that are capable of performing this type of assessment of motility. Genetic testing is also available to confirm a diagnosis of CatSper-related male infertility.

If lack of CatSper channels is the cause of a couple’s fertility woes, there is no treatment option available that will enable them to achieve a pregnancy naturally. However, pregnancy can be achieved with intracytoplasmic sperm injection (ICSI) using sperm from ejaculate, testis tissue, or epididymal tissue.

References

Hildebrand MS, Avenarius MR, Fellous M, et al. Genetic male infertility and mutation of CatSper ion channels. European Journal of Human Genetics. 2010; 18(11): 1178-1184.

Calcium Signaling Through CatSper Channels in Mammalian Fertilization, Dejian Ren and Jingsheng Xia, Physiology June 1, 2010 vol. 25 no. 3 165-175

Fertility and the Male Cancer Patient: The Need to Sperm Bank to Preserve Fertility

Couple in hug watching sunrise togetherMany people facing cancer know about some of the side effects of common treatment options. Chemotherapy can cause you to lose your hair and change the way food tastes to you. It can make you nauseous and fatigued. These are symptoms that cancer patients expect to face during treatment. But one side effect you may not have thought about is infertility. For both men and women, treatments can affect the ability to conceive children1. If you are planning on starting or expanding your family, this may be a concern you should talk about with your doctor. A medical professional can help you understand your risk for infertility due to cancer and treatments.

Sperm production can be temporarily reduced by certain cancers and treatments2. Some treatments, however, permanently alter your ability to reproduce. Cancer cells are fast growing. Cancer treatments are designed to target and eliminate fast-growing cells in the body. This is intended to eradicate cancer cells, but other fast-growing cells, like hair and sperm, are destroyed in the process3. Both radiation and chemotherapy treatments can slow or stop sperm production, and the effects can be permanent3. Additionally, chemotherapy and radiation therapy may alter the DNA of sperm, and it is recommended that a cancer survivor wait 1 to 2 years before trying to conceive a child for this effect to dissipate4.

If you have been diagnosed with cancer and are worried that treatment may interfere with your plans to have a family, there are options you can pursue to preserve your fertility before you begin treatment. Cryopreserving sperm is a simple, inexpensive process that can save sperm for years, in case you need it for intrauterine insemination or in vitro fertilization. Sperm must be collected and banked before your cancer treatment begins4 to ensure the best possible sample of undamaged cells.  Cryopreserving your sperm helps ensure your ability to have your own biological children in the event that cancer treatment has impacted your fertility or you are interested in having a child during or soon after treatment.

References

1. American Society of Clinical Oncology. Side effects of chemotherapy. Retrieved from http://www.cancer.net/all-about-cancer/cancernet-feature-articles/treatments-tests-and-procedures/side-effects-chemotherapy

2. Livestrong Foundation. Male fertility preservation. Retrieved from http://www.livestrong.org/we-can-help/just-diagnosed/male-fertility-preservation/

3. Roswell Park Cancer Institute. Cancer and male infertility. Retrieved from https://www.roswellpark.org/patients/fertility-guide/male-infertility

4. New York Cryo. FAQs: 3. When does one bank sperm? Retrieved from http://nycryo.com/faqs/

For additional information on Sperm Banking please visit NYCryo.com