Sperm: It's Quantity, Not Quality

Every day when I talk to my vasectomy reversal patients the subject of quality of sperm comes up. "But doctor, my sperm are not all healthy and normal. Does that mean I have a higher risk for birth defects? I am worried about the quality of the sperm. Is this a problem?"

No, no and no. It is very simple - guys work in numbers. Quality is not what we are about. We are driven by quantity not quality. Women on the other hand are all about quality. It's not just with eggs and sperm.

We know that women put out one egg each month. Not a gazillion, just one perfect, happy little egg. A guy's purpose is different - distribution of hundreds of millions of sperm. And with that, the quality is not what it is all about. It is numbers. Sheer numbers.

If we provide 100 million motile kicking sperm with each ejaculation, if timed correctly, then maybe a few hundred are likely to get through all the natural barriers and hurdles that exist in the female reproductive tract. It would be reasonable to say that the female tract is designed to kill sperm. So the fact that any get through and end up making a baby still amazes me.

But this is deeper that just sperm and egg talk. Consider all aspects of life. Men are like mosquitoes. Put millions of sperm out there and a few will survive. That is how men look at fertility, and probably sex, too. Lots of sex. Quality is not an issue. Lots of food. More burgers are better than one great sandwich. Not just one good tennis match - give men an entire weekend of football reruns.

Women want things to be just perfect. A single happy moment they can enjoy and relish. A romantic moment rather than a weekend of sex. For them, it's quality ... that is, unless we are talking about shoes. That is the only aspect of quantity/quality with men and women that consistently breaks the rules (probably a sex-linked shoe collecting gene).

So when you are looking at semen analysis results, you can relax as long as you've got the numbers. Leave the quality for the women.

Related Topics: Abstinence Makes the Sperm Grow Stronger, Diabetes and Your Sex Life

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Semen: How much is enough?

Highs and lows, and volume...again.

Every job has its highlights, and every job has its downsides. Questions about semen volume are probably less exciting aspects of writing for the WebMD Men's Health message board. Don't get me wrong. Helping men to better understand their own health is what I love doing (other than vasectomy reversals). But sometimes, explaining to a 70 year old man why he cannot ejaculate like he did when he was 18 is not the high point of my day. So now I will do my best to go over a few key concepts for those men who are "ejaculatorily challenged," or EC as we say in the business.

First of all, let me start out by saying that 75-year-old men are not 18. Their bodies are different. It is as if whoever designed our bodies knew what he was doing.

If we think back to each phase of our lives, and the purpose of those phases, it makes more sense. When we were young we are most likely to be fathering children. Sperm numbers and semen quality and quantity should be at their peak. As men get older, changes occur in the prostate and surrounding accessory glands. These changes often result in a decrease in semen volume over time. This is completely and totally normal.

The good news is that as couples get older, many women do not look forward to having to deal with her husband's "gift" all day long or while playing tennis. So consider using this change to your advantage.

Other common causes of reduced ejaculatory volume include too frequent ejaculations. It takes time for the glands that make the fluid to produce more secretions. Again, the ability to rebound decreases as men grow older, so it may take a few days to restore the volume.

Other possible explanations include many medications, as can prior pelvic surgery or health problems such as diabetes. Being dehydrated is a known but easily overlooked cause, as semen is a fluid secretion. If you are dry, then you may not produce as much. If you have concerns, go see your urologist.

Related Topics: What to Expect as You Age, Routine Maintenance for Men

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PSA: Okay today, not tomorrow?

Today you are okay...tomorrow is another story.

This is one of those PSA stories that every urologist experiences at least a few times in their career. The good news for this particular situation is that there is a good ending for the patient.

About eight years ago I saw a patient whom we will call "Jim" for an elevated PSA. Though it was only slightly above normal, he was young enough that we went ahead with two rounds of ultrasound-guided biopsies, all of which returned completely and totally normal.

Since then he has had his PSA followed at least twice a year, with a digital rectal exam (DRE) annually. Because of schedule conflicts, my associate began seeing Jim a few years ago. Last month my associate approached me and told me that Jim's PSA had gone up dramatically, though his exam was unchanged.

The results from another round of biopsies were bad -- extensive amounts of a highly aggressive prostate cancer. Jim has opted for surgery, which considering all the circumstances is a good idea. But that is not the point.

The point that is so important and is so often forgotten is that it is essential that all men continue to follow their PSA and exam regularly, even if they have previously had prostate biopsies that show nothing. So many times I talk to men who feel that once they have biopsies that come back normal, that they are cleared of ever having prostate cancer. There are two problems with this thinking.

First, there is always a risk of sampling error with the biopsies. This means that there may be cancer present but simply missed (not "sampled"). Therefore, no cancer was seen in the tissue that was analyzed. Performing a prostate biopsy is like trying to stick a tiny needle through a plum to find something the size of a peanut.

Sometimes even with the best equipment and skilled techniques we miss. This is unavoidable. At least one in 10 men that have had biopsies that show no cancer still have cancer somewhere in the prostate. This is why so many experts strongly recommend a second round of biopsies three to six months later, if the PSA remains elevated or the exam remains abnormal.

Second, a set of biopsies in the past does not prevent cancer from developing, as I suspect was the case with Jim. Changing the oil in your car once does not mean that you can avoid changing the oil ever again.

To live a full and healthy life, it is essential that you be your own advocate. Demand to have the PSA annually with a DRE. If the doctor disagrees, then thank him/her for his opinion and tell him you want it anyway.

Many men choose to see a urologist as well just for an annual exam by an expert. If there are ever any changes in exam, or elevation of the PSA, then you need to see a urologist for evaluation and probably biopsies. Hoping everything will resolve on its own is a nice idea that rarely happens. Delays in evaluation and treatment can be dangerous and even life threatening.

Related Topics: Men's Top 5 Health Concerns, Prostate Cancer: Separate Fact from Myth

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Prostate Cancer: Is Waiting an Option?

The truth about "watchful waiting"...and why do they call it that?

A 78-year-old man with heart disease and a few other problems was found to have a prostate cancer. Not a bad one, not a large one. Just an average run-of-the-mill prostate cancer. One that, chances are, will not kill him.

In fact, for many men who are older and may not be healthy, some prostate cancers will not be the cause of their passing (as I get older I think passing sounds better than death). I am sure if you have read enough you realize that most men diagnosed with prostate cancer do not die of it, they die with it.

Cardiovascular deaths are still the biggest killer of men. When talking to patients I like to bring up an old saying "If I do my job right, you won't die of prostate cancer, even if you still have it with you."

So who needs their prostate removed, radiation, hormone therapy or chemotherapy? Who gets to go home and do nothing but check a PSA and prostate exam a few times each year? This is the big question all urologists would like to answer.

In general, it comes down to this -- if it is felt that the prostate cancer will be significant in your expected lifetime, then it is a good idea to have it taken care of. There are almost 50,000 men who die of prostate cancer each year.

With that in mind, and taking into account the different aspects of the cancer and the individual, there are some instances where it is believed that doing nothing may be the best approach. There are some instances where we feel that any or all the treatments will be more hazardous than the cancer, or that the odds are good the patient will die of other causes before the cancer can become a problem.

So if you choose this non-treatment we used to call watchful waiting, what does that mean? First of all, watchful waiting is not a good phrase as it implies we are waiting for something to happen. What is better is "expectant management" of a known prostate cancer.

Expectant management with curative intent, also called active surveillance, is the new way of looking at this prostate cancer option. Older men with smaller volumes of non-aggressive cancer can be watched very closely with PSA blood tests and exams.

The plan is to initiate curative treatments, such as surgery or radiation, if and when changes occur to suggest cancer growth and progression. This will allow many men that qualify to avoid the potential side effects of treatments, and limiting aggressive therapy to those men that truly need it. The key is patient selection -- to identify and select only those men who can benefit from expectant management and do not need treatment right away.

Related Topics: 10 Important Questions for Your Doctor, (WebMD Video) Two-Drug Chemo Winning Combo for Prostate Cancer

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Real Men Grill Right

Say it isn't so.

Okay, there are just a few things that are near and dear to all men - and one of them is being threatened again. Yes, I am referring to the manly art of grilling. Over the past few years whenever I have seen headlines proclaiming the hazards of grilling meat at very high temperatures, I have quickly tuned the page or looked the other way. A sort of "out of sight, out of mind" type of male response to unwanted sights. This time I slipped, and actually read the article.

When meats are cooked at very high temperatures, chemicals form that have been demonstrated to initiate and promote prostate cancer in rats. In other words, these compounds stimulate cancer to grow. These are the very same chemicals that have already been blamed in other studies for stimulating cancer growth. And it's not just prostate cancer. This includes colon, stomach, pancreatic and breast cancer.

Here's the key. These chemicals are made during high temperature cooking of meat, such as grilling or frying. Well-done meat is filled with these dangerous substances, and especially charred meats. This includes chicken, pork and the usual culprit -- beef.

What can we do? Partially precook food in the house before grilling, avoid the "burned" look, and eat less well-done meats. It is probably a smart idea to balance these foods with something that is a known cancer fighting food such as broccoli. And of course, the smartest thing is to eat everything in moderation, though this violates man rule # 3 (quantity, quantity, quantity!).

Related Topics: Cancer: A Closer Look, Father's Day Health and Fitness Gifts

Circumcision Carnivals: Best Left in the Past

There are some ancient traditions that are better left as part of the past...

Yes, I am referring to that all-time favorite Ottoman Empire ritual of a circumcision carnival*. Think about it. The high prince is about to get a ritual circumcision, so everyone decides, "Hey, let's have a carnival and everyone can get circumcised!"

Wow, why didn't I think of that? Actually, there are several documented festivals in celebration of the up-and-coming Ottoman royalty reaching the magic age of circumcision.

Ancient Islamic ritual has boys circumcised as young teens. Following weeks of around-the-clock celebration, the princes of the Sultan are circumcised in the female side of the palace (Harem).

Afterwards, a team of surgeons shares the joy of this key step of manhood by circumcising 15,000 boys from poor families. These children were then presented with gifts of clothing, toys and gold coins.

Later in the festival, the Sultan thanks all those that helped make the festival a success by throwing more gold coins to the palace personnel. A major social event of the Ottoman ruling class, circumcision still retains some of the celebration in many cultures.


*Taken from a beautifully written and illustrated chapter in de Historia Urologiae Europaeae 13 by A. Verit and others

Related Topics: Circumcision: Why it is done, Circumcision May Reduce Risk of HIV Infection

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