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Fertility Matters

Ambulatory Surgery Center Achieves AAAHC Accreditation

The Center for Advanced Reproductive Services (CARS) ambulatory surgery center has been accredited by the Accreditation Association for Ambulatory Health Care (AAAHC). Accreditation distinguishes the CARS ambulatory surgery center from many other outpatient facilities through its adherence to rigorous standards of care and safety. Status as an accredited organization means CARS has met nationally recognized standards for the provision of quality health care set by AAAHC. “Accreditation underscores our commitment to providing the highest possible levels of quality care,” stated Paul Verrastro, CEO, The Center for Advanced Reproductive Services. “We are extremely proud to have our efforts recognized with this accreditation.”

While the onsite survey is an important component of the process, ongoing compliance and continuous improvement are part of the accreditation maintenance mindset that a facility should integrate into its daily activities long after the survey has been completed. The intent of accreditation is for organizations to adopt policies and procedures that fuel ongoing quality improvement and self-evaluation every day. Ambulatory health care organizations seeking AAAHC accreditation undergo an extensive self-assessment and onsite survey by AAAHC expert surveyors – physicians, nurses, and administrators who are actively involved in ambulatory care. The survey is peer-based and educational, presenting best practices to help an organization improve its care and services. More than 6,100 ambulatory health care organizations across the United States are currently accredited by AAAHC.

1095 Strong is a transformational movement and call-to-action spearheaded by the AAAHC to equip ambulatory leaders with the best of what they need to operationalize quality practices. The three-year, or 1,095-day, period between accreditations is a critical time when ambulatory health organizations, with help from proven experts, can develop the kind of everyday habits that enable leaders in the industry to provide the utmost in quality care to their patients. Organizations, such as CARS that earn AAAHC accreditation embody the spirit of 1095 Strong, quality every day, an ongoing commitment to high-quality care and patient safety.

Guidelines for Male Infertility

Newly Released 2020/2021 ASRM/AUA Guidelines for Male Infertility Suggest Greater Role in Evaluation and Treatment of the Male

By Stanton Honig, MD

The American Urological Association (AUA) and the American Society of Reproductive Medicine (ASRM) have combined to release new Guidelines for the evaluation and treatment of male infertility. This updates the guidelines that were last reviewed about eight years ago and gives a much more detailed approach to men who have fertility problems. In this update, we will review some of the important new concepts and why it is important for men to be evaluated.

One of the new guidelines stresses the importance of doctors to review the health risks associated with infertile men with abnormal sperm production. This has been known for years and includes the concept that men with these abnormalities may have some underlying medical conditions such as testicular cancer, genetic abnormalities such as Klinefelter’s syndrome, tumors of the pituitary gland, etc that may be responsible for their low sperm production. This is important because as one of the guidelines says “men with one or more abnormal semen markers should be evaluated by a male reproductive expert with a complete history and physical exam.” In the era of telehealth, discussion is important but physical exam can identify specific abnormalities like a testis mass.

There is also growing evidence that men who have abnormal semen parameters may have a slightly higher mortality rate or “chance of dying earlier.” This is based on preliminary data in one study, is certainly concerning. More studies are necessary to confirm whether this is true or not.

One of the other important new guidelines involves advising couples that “men who are older are at increased risk of adverse health outcomes for their offspring.” This has been noted previously with older women but now there is evidence that this is true for paternal age as well. There is a higher incidence of schizophrenia, autism and chondrodysplasia (genetically caused bony and cartilage disorders). While there is no clear definition for advanced paternal age, this risk starts to increase over the age 40 and increases further above the age of 50.

One of the important new guidelines stresses the importance that doctors discuss risk factors such as lifestyle, medication usage and environmental exposures associated with male infertility. However, the guidelines stress that the current data on the majority of these risk factors is limited. It is clear to most reproductive urologists that a “healthy lifestyle will most likely result in healthier sperm.” So eating healthy, not smoking, not drinking excessively, not using marijuana excessively and generally living a healthy lifestyle is going to portend a better outcome in terms of getting your partner pregnant.

The benefits of supplements such as antioxidants and vitamins in the treatment of male infertility are highlighted in the new guidelines as well. At the present time, existing data is inadequate to provide specific recommendations for men regarding dietary supplements. Supplements that have thought to be valuable for men include vitamin C, vitamin E, carnitine, and Coenzyme Q.

One of the most important guidelines addresses the use of testosterone in men of reproductive years.

Testosterone use will shut off sperm production and is NOT indicated in the treatment of male factor infertility. In patients with low testosterone, these patients may be treated with “off label” use medications such as clomiphene citrate or “clomid,” (a selective estrogen receptor modulator) or human chorionic gonadotropin (hCG) or with a combination of these medicines. These medications will increase testosterone but will not have a negative effect on sperm production.

One of the other new guidelines addresses the use of FSH analogues (Follicle-Stimulating Hormone) with the aim of improving sperm count, pregnancy rate and live birth rates in men with unexplained infertility male infertility. Although these studies are old, there is data to show a benefit to men. Unfortunately, these medications can be expensive and may not covered by insurance plans.

Men who have a clinical or palpable varicocele should be repaired with the hopes of improving abnormal sperm parameters. In this patient population, with normal female partners, a significant # of men will see an improvement in semen quality. In patients who have non-palpable varicoceles detected only by imaging, these should not be repaired as they do not typically result in improvement in semen quality. Seeing a reproductive urologist can be helpful to tell the difference.

In men who have azoospermia as a result of an obstruction, there are two options to achieve a pregnancy. These patients should be counseled regarding the possibility of surgical reconstruction, surgical sperm retrieval and IVF (in vitro fertilization) or a combination. The most common cases are a result of a prior vasectomy or blockages in the epididymis. In the patients who choose surgical sperm retrieval, this can either be performed timed with the ivf cycle or performed prior to an egg retrieval and frozen. The new Guidelines identify that success rates are equivalent.

In patients who have no sperm in ejaculate as a result of low sperm production (non-obstructive azoospermia), a procedure called a microsurgical testicular sperm extraction or “microTESE” should be performed to give the best results in finding sperm. 50% of the time, sperm can be found in these cases and if found, then can be combined with oocytes in vitro to achieve a pregnancy.

It is important for patients and their partners to understand the new guidelines developed by the American Urological Association and the American Society of Reproductive Medicine. Much of this is based on scientific data but it also includes the expert opinions of many reproductive urologists and has been “peer reviewed’ by multiple physicians and scientists from around the country.

Dr. Honig works closely with The Center for Advanced Reproductive Services and is a Clinical Professor of Surgery in the Division of Urology at UConn Health. He is also the Director of Men’s Health and a full time faculty member at Yale University Department of Urology and President Elect of the Society of Male Reproduction and Urology. Dr. Honig sees patients in New Haven, the Shoreline and in Farmington. He can be reached at 203-785-2815 or 860-679-4100.

PGT: When Is Preimplantation Genetic Testing An Option?

By Claudio Benadiva, MD, HCLD

Of the 150,000 babies born with a birth defect each year, chromosomal and/or genetic anomalies are either solely or partially to blame, according to the March of Dimes. Preimplanatation Genetic Testing (PGT) is a procedure that screens embryos for genetic abnormalities before they are transferred into the uterus. PGT can be used for fertile couples that have been identified as high-risk for passing on a genetic disease, as well as for infertile couples.

The Center for Advanced Reproductive Services at UConn was the first program in Connecticut to offer PGT as an alternative to prenatal testing for those at risk of transmitting a genetic disorder. PGT is most indicated for the following patients:

1. Genetic disorders. PGT-M can be performed to help couples aware of genetic disorders through family history or based on carrier testing. In genetic disorders where the genetic mutation is known, such as Cystic Fibrosis or Tay-Sachs, the actual genes of the embryo are examined for presence of the condition and only the normal embryos are transferred back to the mother.

2. Advanced maternal age. Chromosomal abnormalities due to advancing maternal age are more likely to occur in women over the age of 35. These abnormalities can lead to problems such as Down Syndrome or early miscarriage. PGT-A can determine the number of chromosomes and determine which embryos are the most likely to result in a healthy pregnancy.

3. Recurrent miscarriages. Aneuploidy or structural chromosome rearrangements (translocations) can lead to recurrent miscarriages. PGT-A and PGT-SR can determine which embryos are most likely to result in a healthy pregnancy.

In 2020, approximately 50% of CARS IVF cycles included PGT for aneuploidy screening (PGT-A). PGT consists of the biopsy of embryos at the blastocyst stage and chromosomal analysis using next generation sequencing (NGS) on the biopsied cells. After the biopsy procedure, the embryos are frozen and stored in our liquid nitrogen tanks. Once the PGT results are received, the euploid embryos are thawed and utilized in a frozen embryo (FET) cycle or remain frozen and stored for future use.

The chart below shows ongoing pregnancy rates for CARS PGT patients after their first FET cycle and then for all FET cycles. As the age of the patient increases, so too do the benefits of PGT-A. Specifically, in patients 38 and older, we see an approximate 30% increase in ongoing pregnancy rates per transfer when PGT is used compared to cycles in which PGT-A is not used.

Testing: Accuracy and Process

The accuracy of PGT depends upon the disease being tested for, but overall it is able to diagnose genetic defects with a very high accuracy. The advantage of PGT is that it reveals these genetic defects before pregnancy, as opposed to amniocentesis and CVS which show these defects during pregnancy.

The PGT process begins with the same steps taken during preparation for a routine IVF cycle. Once the embryos have developed, one or more cells are taken from each embryo for analysis. At The Center, we work with dedicated embryologists trained specifically in the most recent biopsy techniques to help insure the highest quality of results.

Dr. Benadiva Announced as New Medical Director

Claudio Benadiva, MD, HCLD Announced As New Medical Director at The Center for Advanced Reproductive Services

Alison Bartolucci, PhD, HCLD Promoted to Laboratory Director

Farmington, CT, January 19, 2021… The Center for Advanced Reproductive Services (The Center), a prominent family building program, announced Dr. Claudio Benadiva as Medical Director. Dr. Benadiva, who previously served as The Center’s High Complexity Lab Director, replaces Dr. John Nulsen, who is stepping down as medical director to focus more on The Center’s IVF and Donor Egg Programs as well as its academic mission. Dr. Alison Bartolucci has been promoted and will replace Dr. Benadiva as High Complexity Laboratory Director.

As Medical Director, Dr. Benadiva will be responsible for oversight and have responsibility for ensuring appropriateness and quality of services and care is continually provided to all patients and their families as prescribed in The Center’s clinical policies and procedures and applicable national standards.

As High Complexity Laboratory Director, Dr. Bartolucci will be responsible for the day-to-day operation, management, organization and supervision of the laboratory operations and staff and for ensuring that the highest standards in quality, safety and success rates are met.

According to The Center’s CEO, Paul Verrastro, “A cornerstone of The Center’s success is the in-depth experience of our clinical leadership team. Both Dr. Benadiva and Dr. Bartolucci are considered thought leaders in the field of reproductive endocrinology and infertility (REI) and have distinguished themselves nationally as committed clinicians and academics. This combination of clinical care and basic science is what translates into success for our patients. Residents of Connecticut and our surrounding towns are lucky to have this team available to them to meet their family building needs.”

Both Dr. Benadiva and Dr. Bartolucci have extensive experience in the REI field. Dr. Benadiva has been a lead physician at the Center since 1998 and is the former High Complexity Lab Director. Under his direction with Dr. Bartolucci by his side, The Center’s lab has received national recognition for its high standards and has received CAP Laboratory Accreditation, a program designed to ensure the highest standard of care for all laboratory patients. Dr. Benadiva is a Clinical Professor of Obstetrics & Gynecology at UConn Health, is a Fellow of the American College of Ob/Gyn, and is board certified in Obstetrics & Gynecology and Reproductive Endocrinology and Infertility. During Dr. Benadiva’s 3-year REI Fellowship at Cornell, he spent 18 months focusing on IVF research in their world-famous lab. During this time, he worked elbow to elbow with fertility pioneers like Jacque Cohen, PhD (embryology), Santi Munne, PhD (PGD/S) and Gianpiero Palermo, PhD (ICSI).

Dr. Bartolucci joined the Center in 2012 and most recently was Operational Laboratory Director. She received her PhD in 2019 from Eastern Virginia Medical School and is a Faculty Instructor at UConn Health. She started her embryology career at Mass General under the guidance of Catherine Rancowski, PhD, and was later was mentored by embryo grading pioneer Lynette Scott, PhD. Dr. Bartolucci completed her PhD in basic science research at UConn Health under the mentorship of John Peluso, PhD.

2020 Superstar Award

At the Center, we work hard to create a culture of gratitude and appreciation, especially among peers. Very simply, it makes our team stronger. We are honored to announce this year’s nominees for our 2020 Superstar Award. This award is an opportunity for our employees to nominate their peers who excel in the areas of Appreciation, Communication, Hard Work and Customer Service. Please join us in congratulating this year’s nominees and our winner.
 
This year’s nominees were:
From our Branford Office: Haley
From our Hartford office: Chelsea
From our Farmington Office: Laura F., Keisha, Jen L., Robyn, Lynn, Glorimar, Lindsey, Jenny B, Betsy, Loralyn, Stacey, Demis
 
And the Winner of Our 2020 CARS Superstar Award! Jane C.

Our Winning Team

Once again, the Center has distinguished itself at the American Society for Reproductive Medicine (ASRM) Virtual Congress through our commitment to academics and research. ASRM’s annual meeting is the premier education and research meeting for Reproductive Medicine. Our clinical team of MDs, fellows [past and present], residents, and lab staff worked tirelessly throughout the year to complete a variety of thoughtful and relevant research projects. Below is a list of all the oral and poster presentations that were accepted to ASRM.

Our research mentor of the year award goes to Dr. Lawrence Engmann. He is a wonderful teacher and has shepherded many of these projects to completion. His inspired ideas, knowledge of the literature, his gentle guidance, and knowledge of statistics have guided our residents and Fellows to make these presentations happen. Several manuscripts are in preparation for peer review journals. Dr. Engmann, thank you!

Truly outstanding work!

Oral Presentations

1)      THE EFFECT OF OBESITY ON EUPLOIDY RATES IN WOMEN UNDERGOING IN VITRO FERTILIZATION (IVF) WITH PREIMPLANTATION GENETIC TESTING (PGT) – Stephanie Hallisey, Reeva Makhijani, Jeffrey Thorne, Prachi Godiwala, John Nulsen, Claudio Benadiva, Daniel Grow, Lawrence Engmann

Oral Session Title: IVF Outcome Predictors 2

2)      BLACK RACE RESULTS IN LOWER LIVE BIRTH RATE (LBR) IN FROZEN-THAWED BLASTOCYST TRANSFER CYCLES (FET): AN ANALYSIS OF 7,002 SART FET CYCLES – Reeva B Makhijani, MD, Alicia Y Christy, MD, Prachi N Godiwala, MD, Kim L Thornton, MD, Daniel R Grow, MD and Lawrence Engmann, MD

Oral Session Title: Health Disparities

https://www.asrm.org/news-and-publications/news-and-research/press-releases-and-bulletins/black-women-experiencing-lower-birth-rates-in-fet-cycles

 

Poster Presentations

3)      OUTCOMES AFTER ADJUNCT GROWTH HORMONE TREATMENT WITH A LOW, INTERMEDIATE, OR HIGH DOSE PROTOCOL IN IVF CYCLES WITH POOR RESPONDERS – Reeva B Makhijani, MD, Stephanie M Hallisey, MD, Prachi Godiwala, MD, Chantal Bartels, MD, Daniel R Grow, MD, Lawrence Engmann, MD, John Nulsen, MD and Claudio A Benadiva, MD

4)      PREGNANCY OUTCOMES IN LETROZOLE OVULATION INDUCTION FROZEN-THAWED EMBRYO TRANSFER CYCLES AS COMPARED TO NATURAL AND PROGRAMMED CYCLES – Prachi Godiwala MD, Reeva Makhijani MD, Chantal Bartels MD, Alison Bartolucci PhD, Daniel Grow MD, John Nulsen MD, Claudio Benadiva MD, Lawrence Engmann MD

5)      EMBRYOLOGIC OUTCOMES IN INTRACYTOPLASMIC SPERM INJECTION (ICSI) CYCLES UTILIZING SPERM SELECTED VIA A MICROFLUIDICS DEVICE COMPARED TO STANDARD SELECTION – Prachi Godiwala MD, Jane Kwieraga BSc TS, Reeva Makhijani MD, Chantal Bartels MD, Alison Bartolucci PhD, Daniel Grow MD, John Nulsen MD, Claudio Benadiva MD, Lawrence Engmann MD

6)      EFFECT OF BODY MASS INDEX (BMI) ON PREGNANCY OUTCOMES IN FROZEN-THAWED BLASTOCYST TRANSFER (FET) CYCLES – Adrienne Schmidt MD, Prachi Godiwala MD, Reeva Makhijani MD, Chantal Bartels MD, John Nulsen MD, Claudio Benadiva MD, Daniel Grow MD, Lawrence Engmann MD

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Introducing Virtual Support Groups

Given the Covid-19 pandemic, we have been unable to hold our in-person RESOLVE of New England peer support groups. Instead, we periodically will offer free, Center for Advanced Reproductive Services [the Center] sponsored virtual groups via Zoom Meeting.

What is a Peer Support Group?

Ami Chokshi

Our peer support groups–open to women and men, individuals and couples–provide an opportunity for open discussion where you can come together and meet others who are facing similar challenges in a relaxed and confidential setting. Discussion at our general infertility groups may include talking about current treatment, dealing with friends and family, and coping strategies. Whether you’re newly diagnosed or have been in the trenches for years, attendees from all stages of the infertility journey will be warmly welcomed.

The Center’s virtual groups will be managed and facilitated by Ami Chokshi, Certified Health coach. Ami is an experienced live group facilitator having facilitated the RESOLVE of New England live peer support group at the Center for many years. She is also a former fertility patient.

The Center is committed to providing in-person and/or peer support and is proud to have been hosting RESOLVE and RESOLVE of New England peer support groups for nearly 30 years.

The groups are currently on hold.

Also, please look out for posts on our Facebook page from RESOLVE of New England to join one of their virtual peer supports groups or visit their web site for more information https://www.resolvenewengland.org/support/#virtual

Can We Prevent or Reverse Male Infertility?

By Stanton Honig, MD

June is Men’s Health Month and we want to heighten awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. We are highlighting men’s infertility.

Male factor infertility accounts for approximately 50% of all infertility. For this reason, the evaluation and treatment of the male are critical to a comprehensive program for the infertile couple. Because there are many treatable, reversible, and preventable causes of male factor infertility, early evaluation and treatment are very important.  While in-office visits are returning, we have developed a telehealth program for patients who are not ready to come to the office for a consultation. 

In 1994, Drs. Honig, Jarow, and Lipshultz reported the incidence of significant medical conditions associated with the evaluation and treatment of male factor infertility. In 1% of patients, a significant medical condition, sometimes life-threatening (such as a cancer of the testis, brain, or spinal cord tumor) caused male infertility. Subsequent studies have shown a significantly higher incidence of testis cancer in infertile men despite variable semen quality. Early intervention was crucial to treat the life-threatening condition and improve the couple’s overall chance of conceiving.

Early evaluation of the male should include a semen analysis. If this is abnormal, an early consultation with a urologist well-trained in male infertility disorders should follow. This should occur before or in conjunction with assisted reproductive technologies.

What can be done as “preventive medicine” for male factor infertility?   

Prevention starts with avoiding lifestyle issues that may be detrimental to sperm quality. Acquired causes of male infertility include exposure to substances that can be toxic to sperm such as illicit drugs (marijuana, cocaine, anabolic steroids), heavy alcohol use, cigarette smoking, medications, and excessive heat to the scrotal area.  

It is becoming increasingly clear that recreational drugs can have an adverse effect on the testes and sperm quality. Chronic marijuana use may lower testosterone levels and affect sperm quality. This has become more of a problem since laws requiring marijuana use have loosened. Cocaine has been shown to have direct effects on the testis and may affect sperm concentration, motility, and DNA of the sperm. Anabolic steroids used for bodybuilding clearly have direct effects on the testis by lowering the body’s ability to make its own testosterone. It also decreases spermatogenesis and may cause temporarily no sperm in the ejaculate, which is sometimes irreversible. Education of high school and college students regarding the negative impact of anabolic steroids and other recreational drugs is critical to prevent male fertility problems down the road.  

Cigarette smoking and heavy alcohol use have been shown in clinical and research studies to affect hormone levels, as well as direct toxic effects on the testicle. Basic science data has shown increased testicular injury when exposed to environmental toxins. 

Many medications used for the treatment of unrelated medical conditions may have negative effects on sperm quality, as well. It is the job of the reproductive specialist to educate physicians and the public on these effects. Some medications that may affect sperm quality are testosterone, calcium channel blockers for high blood pressure, sulfasalazine (Crohn’s disease-bowel disease), cyclosporine (organ transplants), and chemotherapy for cancers or rheumatologic disease and anti-virals utilized for severe COVID disease.

Many of these medications can be interchanged with similar drugs that have less toxic side effects. For example, we have seen a MAJOR increase in the use of testosterone in men of reproductive age. This has been driven by the sense that testosterone will bring “the fountain of youth”. Unfortunately, this “overuse” in men has resulted in the lowering of sperm counts, in some cases to zero. Luckily, most of the time, this is reversible. In addition, there are other medications that can increase testosterone via the hypothalamic pituitary axis that can be utilized instead to improve libido, sexual function, energy level, etc. With high blood pressure, it appears that calcium channel blocker medication may directly affect the sperm’s ability to bind to egg receptors. Switching to a different medication may remove this risk. In irritable bowel disease, mesalazone may be substituted for sulfasalazine having less reproductive side effects with similarly good disease control results.  

Chemotherapy for cancer and other chronic diseases (like rheumatoid arthritis, renal disease, autoimmune illnesses) can also affect sperm quality. Important considerations include freezing sperm prior to starting any toxic drug regimens and using the least toxic chemotherapy regime with equal survival results. Younger males with prostate cancer should be asked about future fertility interests prior to definitive therapy. Radical prostatectomy, radiation therapy, and hormone deprivation therapy have specific deleterious effects on sperm and/or sperm transport.

Occupational exposure to toxins may also affect sperm quality. Agents like pesticides, cadmium, lead, and manganese may interfere with male reproduction, so checking and removing work exposures is important.  

Direct heat to the testis can be a major cause of diminished sperm quality and male infertility. Varicoceles are one of the most common, treatable, and reversible causes of male factor infertility. Although the exact mechanism of how varicoceles affect sperm quality is not known, it is believed that this is usually through an increased heat effect. Multiple studies have shown that scrotal temperature is increased in patients with varicoceles. Varicocele repair has been shown to improve sperm concentration, motility, morphology, and the DNA of sperm. Minimally invasive ligation of varicoceles can significantly improve the chances of pregnancy as compared to natural intercourse. In varicocele-associated infertility, multiple studies have shown that it is more cost-effective to perform varicocele repair as compared to going directly to IVF/ICSI in moderate male factor infertility cases. In addition, varicocele repair may upgrade semen quality to allow couples to proceed with less invasive/less costly hyperstimulation/IUI as opposed to going directly to IVF/ICSI. 

External heat effects on the testis may affect semen quality as well. We recommend abstinence from hot tub use or lowering the temperature to 97 degrees (same as scrotal temperature). It is unclear if the illness-related effects of COVID-19 will have a temporary or permanent effect of sperm but one study did show a drop in sperm quality in patients with severe effects of COVID-19.  On a lighter note, wear whatever underwear you want. Conventional lay information regarding types of underwear is vastly overplayed. Scientific studies have shown that there is no difference in sperm quality between boxer shorts and briefs.

Coital factors are extremely important in achieving pregnancy. Although timing intercourse with ovulation may be tedious, it is critical with male factor patients. Timing with basal body temperature or ovulation predictor kits is extremely useful. Intercourse every 24-48 hours around the time of ovulation is critical to achieving pregnancy naturally. Some patients maintain good semen parameters despite frequent ejaculation, and in these patients, intercourse every 24 hours or so may be beneficial. In addition, avoidance of spermatoxic lubricants such as K-Y jelly, surgilube and lubrifax, is important. A natural lubricant, such as “Replens” or “Pre-seed”, may be substituted and is not sperm toxic.  

Are vitamins and supplements helpful? The answer is… sometimes.

Scientific data is quite mixed. Some supplements used for other reasons (depression, memory loss, “prostate health”) may affect semen quality in a negative way, while others have been studied to determine if they’ll improve semen quality in patients with male infertility. Below are vitamins and supplements that are recommended:

Vitamin C   500-1000 mg/daily

Carnitine and/or L-acetyl carnitine         3gms/daily 

Vitamin E  400 -800 iu/daily

There is a large amount of literature evaluating the effects of antioxidant vitamins (C and E) on sperm. These studies have been performed on patients taking these vitamins by mouth as well as mixing them with semen. It appears clear that some male factor patients have an increase in “reactive oxygen species” or oxidants in their semen. Reactive oxygen species may have effects both directly on the sperm and indirectly on the sperm environment. Vitamins C and E are antioxidants and may serve to lower the level of reactive oxygen species and, therefore, negate its negative effects. 

Carnitine appears to play an important role in both the function of the epididymis and possibly in sperm energy/motility. Some studies from Italy have suggested some benefit in using this supplement (mostly with improvement in sperm motility), with no significant side effects. We recommend 3gms of carnitine and L-acetyl carnitine. Be careful with supplements that claim they are “Male Fertility Supplements”, as they may contain only tiny amounts of the recommended supplements.

Most other supplements (such as zinc, selenium, folate, coenzyme Q-10) are not necessary if a balanced diet is maintained since most are present in healthy foods. Not all nutritional supplements are good for sperm. Saw palmetto may have a negative effect on sperm production and ejaculate volume. It is thought that saw palmetto lowers levels of dihydrotestosterone (DHT), which is thought to be important for sperm production and ejaculation. Studies on the effects of 1 mg of finasteride (Propecia-for male pattern baldness) showed no negative effects on sperm quality. Saw palmetto may work similarly to a higher dose of this drug used for benign prostate enlargement. It would be my recommendation that any patient trying to achieve a pregnancy stop using saw palmetto until further studies show that there are no deleterious effects.   

Summary

Preventive medicine has an important role in male factor infertility. A thorough evaluation and physical examination by a physician familiar with male infertility are important to identify treatable, reversible, and potentially life-threatening conditions. In addition, modification of behaviors, and avoiding toxic recreational drugs such as anabolic steroids may improve the chances of pregnancy. Avoiding supplements that may negatively affect male infertility and using other vitamins and supplements that may positively impact male fertility-related disorders are important to consider, as well.

Patients should ask their physicians and seek out organizations like RESOLVE, the American Society for Reproductive Medicine (www.asrm.org), The Society for the Study of Male Reproduction (www.ssmr.org), American Urological Association (www.urologyhealth.org/urologic-conditions/male-infertility).

Wall of Hope

This week is National Infertility Awareness Week. Typically, the Center would be incredibly busy with events designed to recognize this special week. This year, we all feel a sense of loss, particularly as this was always a fun opportunity to interact with so many of our many wonderful patients.

One of the events we had planned this year was the unveiling of the 2020 Wall of Hope. Since we couldn’t make it happen, Janine Fazzina Boudo, a former patient and photographer at Bella Blue Photography, put this montage together for us.

Wishing everyone a very happy National Infertility Awareness Week.

 

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