An indelicate prying query into treatment for low sperm count

As a retired Urologist I can tell you that probably 2/3's of the men I saw for subfertility (true infertility is actually rather rare) had already had his wife go through the whole gamut of expensive and invasive tests through her gynecologist before he allowed his wife to drag him in to be checked. Although the wives seemed to pay attention to the explanation of proper techniques of semen collection, the guys typically fidgetted staring at either the ceiling or floor or would make inappropriate jokes. One guy, the most annoying one (for that problem anyway) would literally pace the floor while jingling keys and change in his pockets, all the while sighing heavily. The more I tried to tell them that it was nothing to be ashamed about, the more antsy they seemed to get. The other 1/3 were cool with it, did not drag their wives in and opted to have their noninvasive tests done prior to getting their wives checked. Most of the time those with true subfertility were easily treated with behavioral changes and medication that they took only three days a week.

Most of the men (2/3) obviously were ashamed and or embarrassed about it to the point that they had their wives speak for them.

A lot of line cooks have a problem because they are constantly exposed to high levels of heat at crotch-level.

Gordon Ramsey has spoken about this publicly in interviews.

Sleep in the nude, don't use an electric blanket, stay out of hot tubs, boxers as opposed to briefs are all reasonable things but only rang true for a few of them. A lot of the time there was a history of either trauma or post pubertal mumps. Ice probably can cause more much trouble than you might think it would help. Probably the simplest animal model for testes is yeast (as in brewing beer or baking bread). The extremes of temperature do more problems than the average temperature. Aside from simple education about sex, (timing, frequency etc) the most common behavioral change that I saw help was avoiding eating tofu. Soy contains phytoestrogens. Most of the men that I saw were ultimately from European backgrounds. Men of European extraction are far more sensitive to the estrogens in their diet than are men from Asian descent who have had the genetic selection pressure of a diet high in estrogens selecting their genes for the last hundred or so generations. As little as 8 oz per week and perhaps less can significantly reduce the sperm count in sensitive men. The true percentage that are sensitive isn't known because those whose wives get pregnant don't get sperm counts done. The most common medicine to work (usually in under 6 months) was clomid, the same commonly used med used in women. The difference is men need a lower dose spaced out evenly because they are producing sperm all the time whereas women only release eggs once a month. Probably because of the lowered dose, the men didn't complain about side effects. I think one guy might have had some minor breast tenderness/nipple sensitivity, but other than that it was extremely well tolerated, to the point that some asked if their meds were placebos.

Medievalist said:

A lot of line cooks have a problem because they are constantly exposed to high levels of heat at crotch-level.

Gordon Ramsey has spoken about this publicly in interviews.

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I haven't specifically seen that (occupation) in medical literature, but I'd be surprised if a scientific study showed otherwise. The extremes are a problem. It also makes sense with the things that have been studied.

Oh, almost forgot on the behavioral side were the use of lubricants for sex. A lot of them have spermicides, and sometimes only listed as an "inactive" ingredient. I told them to use plain KY if they wanted a lubricant and that even then they should check with the pharmacist because obviously books on my shelf aren't updated as the company changes the formula. In Med school, the infertility guru told everyone to avoid all lubricants except saliva. He got irked and avoided my question when I asked about amylase in saliva perhaps acting as a spermicide. I always wondered if he was just trying to encourage BJ's.

GeorgeK said:

Aside from simple education about sex, (timing, frequency etc) the most common behavioral change that I saw help was avoiding eating tofu.

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This ain't gonna help decrease prejudices...

WalkingContradiction said:

This ain't gonna help decrease prejudices...

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I don't understand what you are trying to say.

It's good that you don't make the connection, my mind seems to be too influenced by prejudices already. Not that I hold any, I simply immediately started laughing when I read that line..

To clarify: Tofu -> Vegetarian -> Pussy -> No balls.

Quite a lot of association there, now that I think about it.. I know very immature haha. And again, it's not my view (I'm actually considering vegetarianism, even though I hate tofu).

My H is a pretty open-minded guy, and tried quite a bit of stuff, which was ultimately unsuccessful. Acupuncture, a varicocele (sp?) repair (which is a surgical treatment that goes back to the overheating issue). The acupuncture lady even told him to try drinking lots of green tea - I forget what was in it that she said might help. His counts were really, really low though. Seemed crazy then, seems even crazier that we have our son (via adoption) He does have a natural daughter though, so I couldn't tell you what the root cause was for things to change.

WalkingContradiction said:

It's good that you don't make the connection, my mind seems to be too influenced by prejudices already. Not that I hold any, I simply immediately started laughing when I read that line..

To clarify: Tofu -> Vegetarian -> Pussy -> No balls.

Quite a lot of association there, now that I think about it.. I know very immature haha. And again, it's not my view (I'm actually considering vegetarianism, even though I hate tofu).

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Oh, now I understand what you were joking about. I didn't think of it simply because most people who eat tofu are not vegetarians. For most people it is either because they happen to like it, or meat is not available, but for the men who are sensitive to it, it's a pass fail sort of thing. Being a vegetarian is not the issue. For some, eating soy is. Either they are sensitive to it or they aren't. No amount of meat in the diet will counteract the phytoestrogens. That's why when people ask me about vegetarianism I usually tell them to go with chickpeas instead of soy. Now I've rambled on about science and ruined your joke, so sorry.

Yeah varicocoelectomy is an option if the guy has a significant varicocoele, but most men with varicocoeles don't have fertility issues so there is often debate over which men truly benefit from surgery. If he has some sperm being made and getting through most would offer a combination of the surgery along with clomid. There are a couple more meds, but they are so rarely needed that I'd have to go look them up. The reason for combined approach is that it really takes about a year, some say two to say that one is not working, hence the combo so as not to waste a year or two since usually the patients have been trying for a couple years already before they get seen. The next option if the counts are really low still would be a referral to one of the micro places that do invitro. For sex to work the minimum number of sperm it takes for one to get to the egg is around 14 million. That's how many that get killed off or immobilized along the way. Note that that 14 million is per ejaculate, not per cc. Most men have far beyond those numbers, but if that's the numbers you got, then usually it's adoption or invitro (or was before I retired). The weird thing is that it seems not unusual that when a couple gives up and stops worrying about it, it's not unusual to hear that the wife is then pregnant 6-12 months later.

GeorgeK said:

I haven't specifically seen that (occupation) in medical literature, but I'd be surprised if a scientific study showed otherwise. The extremes are a problem. It also makes sense with the things that have been studied.

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I haven't even checked, but if you hang out with professional cooks, there's a lot of anecdotal evidence. You spend as much as fourteen hours a day in front of a very hot heat-source, especially in some line positions. You'll hear lots of them talking fairly candidly about it, or their wives, at bars now, because there's been a pattern spotted in the industry, never mind individual kitchens.

Medievalist said:

a pattern spotted in the industry, .

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You know, that would make an interesting book; a compilation of occupational hazards regarding long term impact on health. Hatters go mad. Cooks and welders get infertility. Hairdressers and mechanics get bladder cancer...

When they make you take that test in High School that tells you what to do, they can also tell you how you're gonna die, gee what a morbid thought.

"What's that Johnnie? You got a 497? That is fireworks tester, and you will die at age 37 from Wile E Coyote Syndrome."