Protecting Male Fertility, Especially When Enlarged Prostate Threatens

Men wishing to be fertile or improve their fertility for success in conceiving with a female partner are being warned of an increasingly wider array of behaviors and practices to avoid. Much of this was brought to readers' attention in a recent issue of The Wall Street Journal and worthy of noting by all interested in the subject of male infertility1.   I have a few related comments to add to the coverage of the subject by Melinda Beck who authored the very well done article.

While cigarette smoking and heavy alcohol consumption are generally well-known to lower sperm production, researchers are finding that some commonly prescribed drugs can all lower the level of testosterone needed to make sperm. One such category is anti-androgens for enlarged prostate including Proscar ® (and its sister medication for male pattern baldness, Propecia) (finasteride) and Avodart ® (dutasteride). Just because men are typically in their 50s and 60s when experiencing the first bothersome symptoms of enlarged prostate such as weak urine flow and urgency and frequency of urination doesn't necessarily mean their spouses are beyond child-bearing years. Since half of all infertility cases are attributable to the male partner or both partners, both the man and his female partner have to do their share to improve the odds of conceiving.

If fertility is a concern, there are other drugs to consider for enlarged prostate, such as Flomax ® (tamsulosin) and Uroxatrol ® (alfuzosin hydrochloride) that work by relaxing the prostate's smooth muscle and the bladder neck to improve the flow of urine and reduce bladder obstruction. There are also more invasive measures than medication, for the condition also known as benign prostatic hyperplasia (BPH). And while a procedure such as the GreenLight TM laser therapy offers long lasting symptom relief by vaporizing tissue, with far fewer patients (less than 1%) suffering erectile dysfunction than with the "gold standard" transurethral resection of the prostate (TURP) surgical procedure, still 33% of all laser patients experience retrograde ejaculation in which sperm is ejaculated backwards into the bladder instead of forward through the urethra during orgasm. Such considerations need to be discussed fully with a man's urologist and in the context of reproductive goals of the couple.

There are other behavioral changes a man can make to protect his fertility, some well known and others less well known. Preventing heat build-up in the groin area by avoiding hot baths, hot tubs, and tight pants are typically widely known. More recently, studies at Stony Brook University in New York demonstrated that even repeatedly resting a laptop on the lap for extended periods of time can elevate temperatures in the scrotum and hamper or stop sperm production. Sports trauma - and even the shape of a man's bicycle seat - can make a difference. One of the bigger culprits - and one affecting increasing numbers of our population - is obesity. Excessive weight lowers a man's libido, reduces sperm counts, and disrupts hormone balances because fatty tissue produces estrogen, which has a countervailing effect on testosterone production. Just as losing excess weight can significantly eliminate the severity of stress urinary incontinence in women, eliminating girth brings multiple benefits to a man's reproductive capabilities.

Ultimately, men need to be well educated about all of these risk factors and behaviors so they can make a combination of lifestyle choices to improve their reproductive health.

Nancy Muller, PhD

1 Beck M. Surprising causes of male infertility, The Wall Street Journal, June 28, 2011, D3.