Male factor is the cause of infertility in 40 to 50 percent of couples yet is rarely discussed. The Washington Informer turned to Shady Grove Fertility’s own Paul R. Shin, M.D., board certified Reproductive Urologist at our K Street, Woodbridge, Frederick and Fair Oaks offices, to gain a better understanding of men’s sexual and reproductive health.
Q: It is estimated that between 40 and 50 percent of fertility-related challenges facing a couple are due to men’s sexual health, yet little note is taken of men’s reproductive health until issues arise with their fertility. Do you believe the overall health of men would benefit from a reproductive platform that begins with puberty, similar to those provided for females through gynecology?
Dr. Shin: “It’s mind-blowing if you look at the raw numbers. The majority of referrals of sperm tests are initiated by female partners whose gynecologists ask for it. It makes sense. Women have more moving parts than men and have more things that can go wrong, but nothing could be further from the truth that infertility is a women’s issue. No one thinks in terms of having trouble having a baby. You find someone you like, get married (or not), and have a baby. The minute you stop using contraceptives, the belief is that you are going to get someone pregnant. It’s easy to get pregnant so why can’t it happen to me? Women engage in the medical system and routine medical care at much earlier rates than men. Adolescent boys have a physical once every year or every few years for cursory assessments. The girls have a level of engagement that makes them much more comfortable seeking advice and treatment. Some men also see going to a physician about their genitalia as a sign of weakness. It is a popular perception that is not rooted in fact. If boys’ exams included more than a cursory look, physicians could chart some potential issues and head them off. For instance, a doctor would note if development seems delayed in the testicles, which could be a sign of Klinefelter syndrome (where boys are born with an extra copy of the X chromosome) or Hypogonadal syndrome (which impacts levels of testosterone or estrogen during puberty).”
Q: Are there healthy lifestyle choices that ward off erectile dysfunction and enhance male fertility?
Dr. Shin: “Causes are multifactorial, as there may be mental and emotional causes as well. Classic things that cause vascular conditions, like hypertension, do have a hand in things when the person is in their 50s or 60s and that makes sense. When a person is in their 20s and 30s, those physical things that create a pattern of regular erectile dysfunction signal a harbinger of later in life problems. Don’t smoke, eat a reasonable diet, rest, seem like common sense; only some people don’t have access to healthy foods, live in food deserts, and are hit with social hot button issues. There are couples and lifestyle choices for your broader lifestyle that will help with fertility and sexual health. Between 60 and 70 percent of the population experience some issues with sexual health and fertility, whether it is delayed ejaculation, premature ejaculation, sperm count, or injuries. When they come to us, we tease out those issues with patients—which may be physical, but also complicated by anxiety and a loss of confidence.”
Q: What are the most common causes of infertility in men and can you debunk the myth that treatments for infertility for men are painful?
Dr. Shin: “Causes and conditions vary, but many have to do with dilated varicose veins that can cause testicular warming. The only treatment is surgical repair of the veins and while it does hurt, patients are given pain meds. They may miss a few days of work, but I often tell men that whatever discomfort they go through is nothing compared to pregnancy and having a baby. The concept is that of a “man cold” where men sometimes have a hypersensitivity to pain. Some discomfort is the nature of treatment.”
Q: What protocol does your practice have for alleviating the anxieties many men face when seeking help for sexual or reproductive concerns?
Dr. Shin: “We stress that they are not alone because, with infertility, the perception is that they are alone. Everyone on social media and their mother who has a baby put it up on Facebook. Men are reminded what others have and they don’t. We talk to couples so that they understand that infertility is common and we’re in the process of figuring it out. We go through demystifying basic anatomy—discussing how babies are made and what we’re trying to improve upon. Most couples never had to talk about intercourse and are less comfortable admitting they don’t know these things. We talk about reproductive concepts and work to build up their knowledge. Also, there is the unique problem faced by generally older women who put off having babies to pursue education or because they had not found the right person. They feel they are behind the 8-ball. Then, you have to throw in male factors and the discussion of fertility rates and things become clearer. We start with a basic understanding that even in two healthy, young people, only 15 to 20 percent are the best odds for getting pregnant. Factor in low sperm counts, irregular menstrual cycles, and we know what is reasonable. And when it comes to sperm count, think of sperm like the American ninja warriors. Is it better to start with one or two runners or 40 to 50?”
The Center for Male Fertility at Shady Grove Fertility offers a range of services including basic evaluation and testing to state-of-the-art microsurgical techniques including varicocele repair, vasectomy reversal, and vasectomy, or percutaneous epididymal sperm aspiration (PESA) and testicular sperm extraction (TESE) in the in vitro fertilization (IVF) setting. The program is led by Paul R. Shin, M.D. and Cori Tanrikut, M.D., board certified reproductive urologists who care for patients in our D.C. metro and Baltimore metro locations, respectively.
To learn more or to schedule an appointment with Dr. Shin, please contact the New Patient Center at 1-877-971-7755 or complete our brief online form.