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{In no situation do we ever recommend that fertility diagnosis or treatment be undertaken without the oversight of a qualified medical practitioner. Please use the enclosed information as quick reference and for discussion aids with your practitioner.}

Men who have low sperm counts are understandably likely to be concerned about the potential causes. The following information outlines the most current medical thinking on those topics most likely to be of concern to patients in the area of male infertility.

CIGARETTE SMOKING:
Cigarette smoking has been proven to significantly effect semen quality.

Regular smoking:

• Causes a 23% decrease in sperm density (concentration) and 13% decrease in motility (when averages are taken from nine separate studies).
  
  
• To a lesser extent, smoking causes an increased number of morphologically abnormal sperm.
  
  
• Smoking also causes toxicity to the seminal plasma: sperm from non-smokers had significantly decreased viability when placed in the seminal plasma of smokers.
  
  
• Effects the hypothalamic-pituitary-gonadtropin (HPG) axis, most commonly affecting levels of estradiol and estrone. The Leydig Cells, which are in the testes and produce testosterone, may have secretory dysfunction.
  
  
• Most worrisome is that there is evidence which suggests that paternal smoking may also be associated with congenital abnormalities and childhood cancer, though the relative risk in most studies is less than two.

RECREATIONAL DRUGS

Marijuana use:

• Often causes a decreased average sperm count, motility, and normal morphology.
  
  
• Effects HPG axis, causing decreased plasma testosterone.
  
  
• May have a direct negative effect on the Leydig Cells.

Cocaine
Even infrequent cocaine use:

• Causes decreased sperm counts, motility and normal morphology. These effects can be found in men who have used cocaine in the two years proceeding their initial semen analysis.
  
  
• Decreases the ability of sperm to penetrate cervical mucous.

Anabolic Steroids: The use of anabolic androgenic steroids has reached almost epidemic proportions. 6.6% of 12th grade male use or have used them to build muscle mass and improve athletic performance. These exogenous androgens:

• Depress testicular production of testosterone and, thus, intra-testicular testosterone levels. This may cause severely diminished spermatogenesis or complete azoospermia.
  
  
• Cause a persistent depression of the hypothalamus and pituitary which may be irreversible, even when the steroids are stopped.

Alcohol:
Moderate alcohol use does not affect male fertility. Excessive alcohol use:

• Effects the HPG axis and is a direct gonadotoxin.
  
  
• May cause associated liver dysfunction and nutritional deficiencies which are also detrimental for sperm production.

LUBRICANTS:
Most vaginal lubricants, including K-Y Jelly, Surgilube, and Lubifax are toxic to sperm. Couples should avoid their use during the fertile time of a woman's cycle.

TESTICULAR TEMPERATURE
Elevated testicular temperature is known to have a negative effect on sperm production and ultimately on semen quality and fertility. Varicoceles and undescended testes are two important causes of male fertility. At least part of their negative effect is considered due to the increase in testicular temperature. Hot baths and saunas should be avoided, as they increase the core temperature of the testes (hot showers are not a problem).

Many men are counseled to change from briefs to boxers under the assumption that the briefs do not allow the testes to regulate its temperature. There is no evidence for this and, in fact, a recent article in The Journal of Urology showed that there was no difference in either the semen analysis or the core testicular temperature between groups of men who wear boxers or briefs.

EXERCISE:
Moderate amounts of exercise can only be helpful. However, long distance runners (men who run greater than 100 miles per week) and distance cyclers (men who ride greater than 50 miles per week) have decreased spermatogenesis. These activities should be moderated when a sub-fertile man is attempting conception.

INTERCOURSE:
About 5% of couples with infertility have factors relating to intercourse. This includes the inability to obtain or maintain an erection, premature ejaculation, lack of ejaculation, retrograde (backwards) ejaculation, lack of appropriate timing of intercourse and excessive masturbation. Interestingly, the most common problem is infrequency of intercourse. Studies have shown that 5 out of 6 previously fertile couples who have intercourse four times per week will conceive over six months, while only 1 out of 6 with intercourse once per week will conceive during the same period.

Male infertility is a broad and complex area. This information is intended only as a very general introduction to some common concerns. We strongly encourage you to find a specialist to fully evaluate your particular situation so that you can better understand the cause of your particular situation as well as the potential treatments. You can find specialists and answers to more of your questions on male infertility at Male Infertility Specialists.com