Did you know that only about 1 in 4 infertile men in the U.S. actually receive the medical attention that they deserve? We’ve already discussed the value of the semen analysis in the infertility evaluation. Now let’s discuss the idea of care. Real care. That means a history and physical examination along with some medical decision making in addition to the semen analysis.
Young Men Are Underserved
How often do most young men see a doctor? Typically only when they are in pain, bleeding or their life is threatened. Remember men don’t have monthly periods to use as a biomarker of health like women do. So, assuming that human infertility reflects overall health, what better chance is there to act on, and educate men about, general health issues than during this evaluation? What a great opportunity to “jump start” care during the life course of a man’s health!
Why Do It?
Here are 3 important reasons to fully evaluate every infertile man:
- Cure the infertility. About 1/3 of the time, the male is the “issue” underlying the couple’s infertility. And, in many of these cases, the infertility is utterly reversible by lifestyle changes (weight loss, healthy eating, stopping hot baths and tobacco), medication changes (avoiding calcium channel blockers, finasteride, sulfasalazine) and treating correctable lesions (the ignominious varicocele, infections and blockages). The best outcome here is that conception can occur at home and not in an IVF laboratory. Stop the poisins!
- Make sure he is healthy. Approximately 1-5% of male infertility is caused by a potentially life-threatening disorder. This list includes: testis cancer, brain tumors, multiple sclerosis, diabetes, hypogonadism (low testosterone), organ failure, metabolic syndrome, sexually transmitted diseases and occupational exposures. Although uncommon, this has led to current thinking that male infertility, and the semen analysis in particular, are “biomarkers” of men’s health (White Paper in Reproductive Health, NICHD, 2011). Make sure that his body is healthy!
- Keep him healthy. The concept that male infertility is associated with other diseases later in life is based on animal studies. If you impair the ability of animals to normally repair the daily damage that occurs to their DNA (a normal process in all of us), they are not only infertile but also develop certain cancers at much higher rates. In humans, we have published compelling data from similar genetic and even large epidemiologic studies that reveal that a history of male infertility is associated with higher rates of later testis cancer (3-fold higher risk) and high-grade prostate cancer (2.5-fold higher risk). Evaluating male infertility can keep men healthy!
Call it “great care” or call it “functional medicine.” Whatever it is, men deserve it. Not only that, health is our single best asset in life and well worth an early investment. Health is real wealth!