Prostate Health in Beverly Hills & San Francisco

Understanding the Prostate

Located deep within the male pelvis, the prostate surrounds the urethra and sits right underneath the bladder and in front of the rectum. Weighing less than one ounce, it is the size of a walnut at puberty — and it gradually enlarges once a man reaches middle age.

Although a man does not need a functioning prostate to live, the prostate is critical to normal reproduction, as it produces a fluid that makes up approximately 20 percent of the semen. This milky fluid contains various substances that are important for sperm function. Enzymes, zinc, citric acid, spermine, prostatic inhibin and other substances allow the semen to properly liquefy and support sperm as they try to reach the egg, ultimately promoting fertilization and pregnancy. Muscles of the prostate gland also help to propel the fluid into the semen during ejaculation.

Prostate Problems That Can Affect Fertility

Prostate Cancer

Prostate cancer is the second most common form of cancer in men, after non-melanoma skin cancer. About one out of every eight men will develop prostate cancer during their lives. Given the importance of the prostate to normal fertility, prostate cancer treatments in general impair or eliminate normal fertility. One of the most common treatments for prostate cancer is the removal of the prostate gland, which eliminates the ejaculate entirely. Certain forms of radiation therapy (external beam) cause scarring of the prostate which reduces its milky fluid production necessary for supporting sperm and blocks the small ducts in the reproductive tract, resulting obstruction of semen flow and impaired sperm production. Accordingly, men who are diagnosed with prostate cancer and wish to have children in the future may want to seek fertility advice before undergoing cancer treatment.

Prostatitis

Prostatitis, or an infection or inflammation of the prostate, is a common urological problem that can cause burning or painful urination, urinary frequency and urgency, the inability to empty the bladder well and difficult or painful ejaculation.

The implications of prostatitis on semen quality are controversial. It is thought that the white blood cells that coexist with prostate infections or inflammation can harm sperm, with studies showing that bacterial prostatitis negatively affects sperm morphology and motility. However, other studies show no differences in sperm motility or morphology between patients with prostatitis and healthy patients.

Treatment for prostatitis is based on the root cause which can be determined by an office visit and laboratory evaluation. Prostatitis caused by bacterial infections is treated with antibiotics. Treating infections may have favorable outcomes on fertility, likely by removing harmful inflammatory cells that hurt sperm.

Benign Prostatic Hyperplasia (BPH)

As men enter their mid-40s and early 50s, the prostate begins to slowly grow. The reason for this is unknown. For many men, the larger size of the prostate causes problems with urination, but it is also known to obstruct the flow of semen or alter the direction of semen flow (backwards into the bladder). Men who are over 45 who are having a difficult time conceiving may have an enlarged prostate as part of their infertility problem. While prescription medications are effective at improving urination issues or shrinking enlarged prostates, many are known to also cause their own fertility issues, which complicates fertility treatment in this setting. Consultation with an expert in managing this scenario is the best way to navigate this scenario.

Preserving Fertility in the Face of Prostate Cancer

Sperm Banking

Sperm banking is a way of gathering and storing sperm with the intention of later using it for assisted reproduction. Prior to cancer treatment, semen is collected and frozen until needed. Sperm are remarkably hardy when frozen and can last several decades “on ice.” Frozen sperm is stored at a special facility to ensure that it remains at a temperature of about -320 degrees Fahrenheit. Upon thawing, roughly half of sperm will survive and can be used for assisted reproductive technology. Studies have found that children conceived from frozen sperm are no more likely to have birth defects or other abnormalities than children conceived by conventional means.

Testicular Sperm Extraction

Testicular sperm extraction is effective for men who cannot ejaculate but still make sperm in the testicles. Testicular tissue is taken by needle aspiration (TESA) or biopsy (TESE) and sperm are directly extracted from the tissue and either frozen or used right away for assisted reproductive technology. Both options are outpatient procedures that use local anesthesia. Most patients feel well enough to resume normal activities within one or two days.

Epididymal Sperm Aspiration

Epididymal sperm aspiration is another effective way for men to conceive who cannot ejaculate but still make sperm in the testicles. Epididymal fluid is taken by needle aspiration (PESA) or through a small incision (MESA) and sperm are either frozen or used right away for assisted reproductive technology. Both options are outpatient procedures that use local anesthesia. Most patients feel well enough to resume normal activities within one or two days.

Schedule a Consultation at The Turek Clinic Today

Dr. Turek has an in-depth understanding of the prostate and its effects on male fertility. He has helped patients at all stages of their prostate treatment to become bio-dads in spite of their prostate problems. If you are experiencing symptoms of a prostate problem, or you and your partner are having problems conceiving, you need the support of an internationally respected expert. Schedule a consultation at The Turek Clinic today to discuss your options with Dr. Paul Turek.