Low sperm count not just a problem for fertility

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A man’s semen count is a marker of his general health, according to the largest study to date evaluating semen quality, reproductive function and metabolic risk in men referred for fertility evaluation. The study results, in 5,177 male partners of infertile couples from Italy, will be presented Sunday at ENDO 2018, the Endocrine Society’s 100th annual meeting in Chicago, Ill.

“Our study clearly shows that low sperm count by itself is associated with metabolic alterations, cardiovascular risk and low bone mass,” said the study’s lead investigator, Alberto Ferlin, M.D., Ph.D. He recently moved as associate professor of endocrinology to Italy’s University of Brescia from the University of Padova, where the study took place in collaboration with professor Carlo Foresta, M.D.

“Infertile men are likely to have important co-existing health problems or risk factors that can impair quality of life and shorten their lives,” said Ferlin, who is also president of the Italian Society of Andrology and Sexual Medicine. “Fertility evaluation gives men the unique opportunity for health assessment and disease prevention.”

Specifically, Ferlin and his colleagues found that about half the men had low sperm counts and were 1.2 times more likely than those with normal sperm counts to have greater body fat (bigger waistline and higher body mass index, or BMI); higher blood pressure (systolic, or top reading), “bad” (LDL) cholesterol and triglycerides; and lower “good” (HDL) cholesterol. They also had a higher frequency of metabolic syndrome, a cluster of these and other metabolic risk factors that increase the chance of developing diabetes, heart disease and stroke, the investigators reported. A measure of insulin resistance, another problem that can lead to diabetes, also was higher in men with low sperm counts.

Low sperm count was defined as less than 39 million per ejaculate, a value also used in the U.S. All the men in the study had a sperm analysis as part of a comprehensive health evaluation in the university’s fertility clinic, which included measurement of their reproductive hormones and metabolic parameters.

The researchers found a 12-fold increased risk of hypogonadism, or low testosterone levels, in men with low sperm counts. Half the men with low testosterone had osteoporosis or low bone mass, a possible precursor to osteoporosis, as found on a bone density scan.

These study findings, according to Ferlin, suggest that low sperm count of itself is associated with poorer measures of cardiometabolic health but that hypogonadism is mainly involved in this association. He cautioned that their study does not prove that low sperm counts cause metabolic derangements, but rather that sperm quality is a mirror of the general male health.

The bottom line, Ferlin stressed, is that treatment of male infertility should not focus only on having a child when diagnostic testing finds other health risks, such as overweight, high cholesterol or high blood pressure.

“Men of couples having difficulties achieving pregnancy should be correctly diagnosed and followed up by their fertility specialists and primary care doctor because they could have an increased chance of morbidity and mortality,” he said.

Article Source: https://www.eurekalert.org/pub_releases/2018-03/tes-lsc031418.php

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Can Having Sex More Frequently Lower A Man’s Sperm Count?

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Common word around frequent sex is that it may lead to infertility in men due to lowered sperm count. But how true is the commonly believed statement? Find out here.

Excess of everything is bad. Or not?

Sex is so much fun that you just feel like doing it over and over again. The desire to do it again and again is never-ending. But how much sex is good for you? How often can you have sex without the fear that it may affect your fertility? For a woman, fertility refers to her ability to get pregnant and for men; it is about his ability to impregnate a woman. But the question that stays is, ‘Does frequent sex affect a man’s sperm count?’ Let’s find out!

You may have heard that having sex once a week is good for you and does not harm fertility. Too much sex may eventually lower a man’s sperm count which eventually leads to infertility. Well, it’s just a myth!

Myths like having sex too much and too often can lead to physical weakness and fatigue and most importantly lowering of sperm count are all around us. But what happens is, sperms inside the testicles pass through the testes during masturbation. If not released, the sperms stay here for as long as 15 to 25 days.

What happens when sex becomes infrequent?

When sperms are stored inside the body for too long, it causes damage to DNA. Sperms in the body are too sensitive to heat and exposure. When released after a long time, their mobility is affected by heat and radiation. As a result, the sperms released are of an abnormal shape, low in count and have low mobility which together contributes to male infertility.
How does frequent ejaculation affect sperm count?

The body needs anything between 24-36 hours for creating more sperms. So apparently, frequent sex can lower sperm count. But here’s a catch, fresher the sperm, higher the motility! Fresh sperms are more live and have higher motility improving fertility. Hence, if sperms are stored inside the body for too long, it can lead to lower fertility as they become more sensitive to harm from heat and exposure. Experts explain that infrequent ejaculation can put a man’s fertility at risk and a man can stay without ejaculation for as many as 7 days.

So, if you are trying to conceive, having sex every 2-3 days is good for you. This way, fresh sperms are available for the ovum and it can lead to higher chances of conception. Also, having sex daily before ovulation is an added advantage as it improves fertility to a great extent.

So gentlemen, time to get over the fear that too much sex will harm your fertility and bring your sperm count to a low level. Quit counting numbers and engage in passionate love-making with your partner to bond and get rid of too much stress as well.

Article Source: https://doctor.ndtv.com/mens-health/frequent-sex-leads-to-infertility-in-men-fact-or-fiction-1771734


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As Men’s Weight Rises, Sperm Health May Fall

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A widening waistline may make for shrinking numbers of sperm, new research suggests. Indian scientists studied more than 1,200 men and found that too much extra weight was linked to a lower volume of semen, a lower sperm count and lower sperm concentration.

Dr. Ronald Klatz, President of the A4M, Sept. 29, 2017 remarks, “I’ve been aware of this fact for decades. We have been attempting to educate doctors and patients of the horrific effects of being overweight or obese for over 20 years. Isn’t it interesting that Indian Scientists seem more aware of this fact than Americans? One has to wonder if the quality of sperm also effects the overall genetic health of people through life?”

(HealthDay News) — A widening waistline may make for shrinking numbers of sperm, new research suggests.

Indian scientists studied more than 1,200 men and found that too much extra weight was linked to a lower volume of semen, a lower sperm count and lower sperm concentration.

In addition, sperm motility (the ability to move quickly through the female reproductive tract) was poor. The sperm had other defects as well, the researchers added. Poor sperm quality can lower fertility and the chances of conception.

“It’s known that obese women take longer to conceive,” said lead researcher Dr. Gottumukkala Achyuta Rama Raju, from the Center for Assisted Reproduction at the Krishna IVF Clinic, in Visakhapatnam. “This study proves that obese men are also a cause for delay in conception,” he added.

“Parental obesity at conception has deleterious effects on embryo health, implantation, pregnancy and birth rates,” Rama Raju explained.

How obesity affects sperm quality isn’t known, he pointed out.

But in continuing research, the study team is looking to see if losing weight will improve the quality of sperm.

Although that study is still in progress, early signs look good that sperm quality improves as men lose weight, Rama Raju said.

One U.S. fertility expert said the findings have broad implications in America.

“About one-third of men in the United States are obese,” said Dr. Avner Hershlag, chief of Northwell Health Fertility in Manhasset, N.Y.

America is getting fatter and fatter, despite the proliferation of new diets and exercise routines. And about one-sixth of children and adolescents are already obese, Hershlag noted.

“Along with the growing obesity trend, there has been a steady decline in sperm quality,” Hershlag said. “The findings in this study, while not specifically related to infertility, represent a trend towards a decline that is worrisome.”

Recent reports have found that extreme weight loss after bariatric surgery reversed some of the sperm decline, he said.

“The message to men is don’t continue to abuse your body,” Hershlag said. “Comfort foods and excess alcohol are bound to make you uncomfortable and put you at a higher risk for diabetes, high blood pressure and heart disease, which are all life-shortening, and may also put a damper on your path to fatherhood.”

For the study, Rama Raju and his colleagues used computer-aided sperm analysis to assess the sperm of 1,285 men. Obese men, they found, had fewer sperm, a lower concentration of sperm and inability of the sperm to move at a normal speed, compared with the sperm of men of normal weight.

Moreover, the sperm of obese men had more defects than other sperm. These defects included defects in the head of the sperm, such as thin heads and pear-shaped heads.

All of these sperm abnormalities may make it more difficult for obese men to achieve conception, either through sexual intercourse or through IVF, the researchers said. But the study did not prove that obesity causes sperm quality to drop.

According to Rama Raju, this is the first study of abnormal sperm in obese men based on computer-aided assessment. The report was published online Sept. 19 in the journalAndrologia.

Computer-aided sperm analysis might be something doctors should do before IVF, he suggested.

Dr. Nachum Katlowitz, director of urology at Staten Island University Hospital, in New York City, pointed out that “the effect of obesity on sperm is another reason why Americans need to work on this epidemic.”

The idea that obesity affects sperm is well known, he said. “There’s no doubt we should take this information as another link in the chain to push us to help our patients obtain a healthy balance and a slimmer waistline,” Katlowitz said.

By Steven Reinberg HealthDay Reporter

Article Source: https://www.worldhealth.net/news/mens-weight-rises-sperm-health-may-fall/


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13 Foods You’re Better Off Avoiding Before Having Sex

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While most of us are aware of the foods that act as aphrodisiacs, only a handful are aware of the foods we should avoid at all costs. Not only will these make you feel bloated, unsexy and lethargic, they are likely to prevent you from getting it on!

#1. French fries

As tempting as reaching for those French fries are at all times fried foods (including the likes of pizza) are disastrous for your libido. They lower your testosterone levels, decrease blood circulation, and reduce your chances of maintaining strong erections.

#2. Hot dogs

Thinking of chomping on a hot dog towards the end of your grand night out before heading back for a raunchy session under the sheets? Although this super popular snack is great when paired with beer while watching your favorite sport it’s loaded with the kind of saturated fat that can clog the arteries that improve blood flow to your sexual organs. 

#3. Processed foods

Whether it is the aforementioned hot dog or the savory cupcake, the trans fat and sugars in processed food items can weigh down your digestion and slow your blood flow; hampering your sex drive.  Over time this can cause a loss of muscle mass, increase in fat and a dip in your testosterone levels.

#4. Canned or packaged foods

Canned or packaged foods are loaded with crippling levels of sodium. When we say crippling we mean that it can elevate your blood pressure to unfavorable levels and blockade the flow of blood to certain parts your body, like your genitals, leaving your limp.  

#5. Beer

If your night out entails having sex, later on, make sure it doesn’t include cracking open pints of beer in the build-up to it. Although it might give you the buzz you seek the phytoestrogens present in beer stand a good chance to alter the hormones that tamper with your libido. 

#6. Energy drinks

These bottled up potions of liquid give you instant energy due to the caffeine and sugar they are loaded with, but they do just the opposite to your sexual stamina. Once the caffeine and sugar burn off in your system they leave you with lesser energy than you had before. Studies also suggest that it lowers the level of the hormone serotonin that impacts your mood.

#7. Tonic water


Although this makes for a perfect combination with gin it doesn’t fair that well with your testosterone levels. The chemical quinine present in the water not only kills your sex drive and lowers your sperm count but it also can cause gas and bloating. 

#8. All sorts of beans


Love your rice and beans? Science has it that beans contain oligosaccharides (sugar molecules that the body cannot fully breakdown), which create gas and excessive cramping. And these are the last two things you want to be feeling down there when you’re setting yourself to get it on.

#9. Cruciferous vegetables


Sometimes the healthiest of vegetables can be just what you need to avoid in certain situations. Cruciferous vegetables like cabbage, broccoli and cauliflower create a lot of gas since our body cannot digest the natural sugars found in them. The methane, carbon dioxide and hydrogen produced by your body, as a result, can really stink up your surroundings.

#10. Tofu

Tofu has earned its name as one of the healthier options of protein for vegetarians and non-vegetarians as well, but not so much before a sexual encounter. Soy laden products increase your estrogen levels that have shown to decrease the estrogen levels in both sexes.

#11. Onions and garlic

If your food is loaded with onions and garlic, like most of our food is, try to avoid them in your meal prep before you engage in coitus. These pungent vegetables can affect your body odor for the worse; similar to how spices do. 

#12. Red meats


If you’re big on eating meats like lamb, pork or beef, especially on night outs where you’re looking forward to a romp in the sack, later on, swap it with seafood instead. Red meat is associated with the production of foul-smelling gas that can be downright offensive in nature!

#13. Cream-based sauces

Avoid cream-based sauces, such as the ones they use to make pasta in some restaurants; their heavy nature will put your system into a slump. The cream can upset your stomach and cause gas if you’re lactose intolerant dampening your elevated spirits.



Article Source: http://www.indiatimes.com/health/healthyliving/13-foods-you-re-better-off-avoiding-before-having-sex-329846.html

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Exercise May Improve Male Fertility

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Infertility is recognized as a disease by the World Health Organization (WHO), American Society for Reproductive Medicine (ASRM) and the American College of Obstetricians and Gynecologists (ACOG).1

Defined as the inability to conceive a child after one year of unprotected sex, infertility affects approximately 1 out of every 8 couples.2

Approximately 90 percent of male infertility is due to low sperm count or poor sperm quality, and the remaining 10 percent are the result of structural abnormalities, hormonal imbalances, genetic defects or other problems.3 Sperm abnormalities are critical to infertility and the health of a resulting pregnancy.

While much media attention has been placed on the necessity for women to care for their bodies prior to pregnancy, research has demonstrated the need for men to care for themselves in the same way to prevent birth defects, miscarriages and infertility.

Recent research now indicates that exercise may improve quality and quantity of sperm in men who were previously sedentary.4

Exercise May Improve Sperm Quality and Quantity

In a study completed in Iran, researchers evaluated the effect of four different levels of exercise on sperm quality in sedentary men. Of the couples struggling with infertility, 1 in 3 are the result of poor sperm quality.5

In this study, researchers from Urmia University evaluated the sperm of 261 healthy men over six months.

The participants were first determined to be otherwise healthy, between 25 and 40 years of age, and didn’t regularly participate in an exercise program. They were then separated into the following four groups:6

  • No exercise
  • Three workouts a week of high-intensity training on a treadmill (HIIT)
  • Three workouts a week of 30 minutes moderate-intensity continuous training on a treadmill (MICT)
  • Three workouts a week of one-hour high-intensity continuous training on a treadmill (HICT)

The researchers used semen samples before, during and after the six-month exercise period to evaluate sperm motility, size, morphology (shape), count, semen volume and levels of inflammatory markers.

After 24 weeks, it was the MICT group who experienced the greatest improvements, although the HICT and HIIT groups also experienced improvement over the group who did not exercise.7

The MICT group had a greater than 8 percent rise in semen volume, over 12 percent improvement in sperm motility, 17 percent improvement in morphology and just over 21 percent more sperm cells on average.8

However, while the men enjoyed these improvements during the exercise program, the sperm count, concentration and morphology began dropping back to pre-workout levels within a week after stopping. Lead author of the study, Behzad Hajizadeh Maleki commented:9

“Our results show that doing exercise can be a simple, cheap and effective strategy for improving sperm quality in sedentary men.

However, it’s important to acknowledge that the reason some men can’t have children isn’t just based on their sperm count. Male infertility problems can be complex and changing lifestyles might not solve these cases easily.”

Moderate Exercise Increases Sperm Quality

The authors of the study theorized that although weight loss achieved by the men during the six months of the study was likely to have contributed to improving sperm quality, the men participating in MICT may have experienced the greatest impact as MICT reduces exposure to inflammatory agents and oxidative stress.10

Scientists have determined that exposure to electromagnetic fields, increased heat, poor nutrition, obesity, drugs, alcohol and bicycling may reduce sperm quality, and theorize that reducing these factors and improving health would then improve sperm health.

Another study of 31 men, 16 of whom were active (but did not bike) and 15 sedentary, underwent a shorter evaluation of sperm quality,11 using the WHO’s sperm quality parameters, including volume, count, motility and morphology.12

Researchers found physically active men had a higher concentration of sperm, semen volume and a higher percentage of sperm with normal morphology.

In a previous study, these same authors found men who engaged in intense exercise instead experienced a reduction in sperm quality, but moderate exercise appeared to be linked to improve sperm quality.

Researchers from the most recent study also found that moderate activity, as described in their study parameters, yielded better results. The researchers commented:13

“The present study adds to this body of evidence and shows seminal markers of inflammation and oxidative stress improved significantly after 24 weeks of MICT, HICT or HIIT, and these changes correspond with favorable improvements in semen quality parameters and sperm DNA integrity.

These results further indicate that MICT was more beneficial in improving markers of male reproductive function, compared to HICT and HIIT.

These observations suggest that the intensity, duration and type of exercise training could be taken into consideration when investigating reproductive responses to exercise training in men.”

Male Infertility Responsible for 30 Percent of Cases

Allan Pacey, Ph.D., and fellow of the Royal College of Obstetricians and Gynecologists (RCOG), is the British Fertility Society spokesman and professor of andrology at the University of Sheffield. He also commented on the research results and how they may affect fertility:14

“In this context, the study makes a good contribution to the knowledge base. It is a very well conducted and a strength is that it is a randomized controlled trial with extensive data collection.

Also, the study examines how exercise affects many of the parameters of male reproductive health, not just sperm quality. However, what is likely to be of most interest to men and their doctors are the results concerning sperm quality.

Importantly, these seem to show a statistical improvement to various degrees when the men embarked on their different exercise regimes compared to men who did no exercise at all. However, an important question is whether these statistical changes are enough to be of any clinical significance.”

Male infertility contributes to 30 percent of all infertility cases.15 Of the four major causes of male infertility, between 40 percent and 50 percent of poor sperm quality is attributed to unknown factors. Male infertility is a complex condition encompassing both the health of the sperm and the mechanical functioning of the male reproductive system.16

Testing for male infertility includes a semen sample analysis, blood work, physical examination and an evaluation for any current infections or structural damage from past infections. Although frustrating to a couple trying to conceive a child, the risk of poor sperm quality extends beyond the inability to conceive.

Risks Associated With Poor Sperm Quality

Sperm motility, or the ability of sperm to move quickly and in a straight line, is one factor associated with sperm quality. Sperm that are sluggish or move poorly may be associated with DNA fragmentation, and the potential risk for passing genetic diseases.17There is also some evidence that male infertility may be a risk factor for testicular cancer.18

Recurrent miscarriages may be attributed to chromosomal damage to either the egg or the sperm,19 and reduced sperm quality is associated with congenital deformities.20 Chromosomal abnormalities in the sperm may contribute to poor sperm quality.

The risks of poor quality sperm also extend to the health of the man. Defects in sperm quality are linked to a variety of health concerns, including high blood pressure, diabetes, heart disease and skin and glandular disorders.21 Lead researcher Dr. Michael Eisenberg, assistant professor of urology and director of reproductive medicine and surgery at Stanford School of Medicine, commented that “[i]t may be that infertility is a marker for sickness overall.”22

A study evaluating more than 9,000 men with fertility issues found a correlation between defects in a man’s sperm and the likelihood he suffers from other health conditions.23 A previous study Eisenberg co-authored also indicated that men who experienced infertility issues had an overall higher rate of mortality in the following years. According to Eisenberg:24

“A man’s health is strongly correlated with his semen quality. Given the high incidence of infertility, we need to take a broader view. As we treat men’s infertility, we should also assess their overall health. That visit to a fertility clinic represents a big opportunity to improve their treatment for other conditions, which we now suspect could actually help resolve the infertility they came in for in the first place.”

Natural Sperm Boosting Options

While moderate exercise may help to improve sperm quality, there are other lifestyle choices that may help to enhance the improvements you experience. Infertility is a complex condition that is intimately incorporated the rest of your health. You may improve your sperm quality as you also improve your overall health and wellness.

Use Moderate-Intensity Continuous Exercise While Trying to Conceive

Although HIIT is a healthy adjunct to an exercise program, the increased heat and oxidative stress on your body may produce time-limited changes to your sperm quality, and reduce your potential to conceive.

Reduce Exposure to Toxic Chemicals

Unprecedented decline in fertility rates and semen quality in the past decade may be attributed to exposure to phthalates in your environment.25 Animal studies have demonstrated an association between phthalates and testicular toxicity26 and lowered sperm count.27 Other chemicals to avoid include paint fumes, pesticides, formaldehyde, organic solvents and dry cleaning chemicals.

Optimize Your Vitamin D Level

Low vitamin D levels have been linked to infertility in both men and women. In men it is essential for the healthy development of the nucleus of the sperm cell, and helps maintain semen quality and sperm count.

Vitamin D also increases levels of testosterone, which may boost libido. Aim to maintain a level of 40 to 60 nanograms per milliliter (ng/mL) year-round.

Maintain Your Weight Within Normal Limits Through a Whole Food Diet

Obesity changes male hormone levels, which has a direct impact on sperm molecular composition and function.28 Use fresh foods as often as possible, ideally organically grown, to avoid pesticides. Seek out pastured, organic meat and dairy products, raw nuts, seeds and vegetables, and avoid dangerous trans fats found in many processed foods and vegetable oils.

Reduce or Eliminate Smoking, Alcohol and Drugs

Each of these creates an added stress on your body with demonstrated reduction in fertility, sperm motility and quality.

Avoid the Heat

Sperm require a specific temperature to remain active and viable. Avoid wearing tight underwear and tight pants, taking hot showers or baths and sitting in hot tubs. Keep your laptop off your lap as the increased heat from the machine also increases the temperature of your scrotum.29

Your body will naturally keep your sperm at the right temperature when you avoid circumstances that abnormally increase the temperature of your scrotum.

Avoid Placing Your Mobile Phone in Your Front Pants Pocket

Research shows mobile phone radiation increases DNA fragmentation and reduces sperm motility.30

Written By: Dr. Mercola http://fitness.mercola.com/sites/fitness/archive/2016/12/23/exercise-improve-male-fertility.aspx


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Male birth control shot found effective, but side effects cut study short

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Both men and women are responsible for pregnancy, yet the burden of preventing it often falls on one gender. Women can choose from a variety of options to control fertility while for generations, men have been limited to withdrawal, condoms and sterilization. But someday soon, a new method may allow men to shoulder a greater share of responsibility.

A new hormonal birth control shot for men effectively prevented pregnancy in female partners, a new study found.
The study, co-sponsored by the United Nations and published Thursday in the Journal of Clinical Endocrinology and Metabolism, tested the safety and effectiveness of a contraceptive shot in 320 healthy men in monogamous relationships with female partners. Conducted at health centers around the world, enrollment began on a rolling basis in September 2008. The men, who ranged in age from 18 to 45, underwent testing to ensure that they had a normal sperm count at the start.
The injection, given every eight weeks, consisted of 1,000 milligrams of a synthetic form of testosterone and 200 milligrams of norethisterone enanthate, essentially a derivative of the female hormones progesterone and estrogen referred to as “progestin” in the synthetic form.
According to Dr. Seth Cohen, a urologist at NYU Langone Medical Center, when a man is given a shot of testosterone, “basically, the brain assumes the body is getting enough,” so the body shuts down its own production of testosterone — specifically “the testicle’s production of testosterone as well as the testicle’s production of sperm.”
The progestin “further drives the brain malfunction, so it stops the testicle’s production of both testosterone and sperm,” explained Cohen, who was not involved in the new study.
The researchers used a combination of hormones in order to reduce the testosterone dose to a level that they believed, based on previous studies, would effectively lower fertility yet still be safe.

Study terminated early

During the ramp-up pre-efficacy stage of the study, the couples were instructed to use non-hormonal birth control methods, while the men participants received shots and provided semen samples until their sperm counts dropped to less than 1 million per milliliter in two consecutive tests. At that point, couples relied on the injections as contraception.
Throughout the study, the men provided semen samples to ensure that their sperm counts stayed low. Once the participants stopped receiving the injections, they were monitored to see whether and how quickly their sperm counts recovered to levels described as “fertile” by the World Health Organization.
The researchers discovered that the shot effectively held the sperm count at 1 million per milliliter or less within 24 weeks for 274 of the participants. The contraceptive method was effective in nearly 96% of continuing users.
Four pregnancies (resulting in three live births) occurred among the men’s partners, all during the phase where other contraception was required. All the babies were normal, noted Doug Colvard, co-author of the study and deputy director for programs at the nonprofit research organization CONRAD, Eastern Virginia Medical School, a co-sponsor of the study.
Serious negative effects resulting from the shots included one case of depression and one experience of an abnormally fast and irregular heartbeat after the injections stopped. The researchers considered one intentional overdose of acetaminophen possibly related.
“It is possible that the fluctuations in the circulating progestin following bimonthly injections could haveresulted in the reported or observed mood swings, such as occurs in women, whether on a hormonal contraceptive or not,” Colvard speculated.
Overall, 20 men dropped out early due to side effects. A total of 1,491 adverse events were reported by participants, including injection site pain, muscle pain, increased libido and acne. The researchers say that nearly 39% of these symptoms — including one death by suicide — were unrelated to the shots.
However, due to side effects, particularly depression and other mood disorders, the researchers decided in March 2011 to stop the study earlier than planned, with the final participants completing in 2012.
“I immediately thought of the recent findings on female birth control,” Elisabeth Lloyd said of a study published last month in the journal JAMA Psychiatry. A faculty scholar at the Kinsey Institute, she is a professor of biology and an adjunct professor of philosophy at Indiana University Bloomington.
The study she refers to found an association between the use of hormonal birth control and depression. It looked at prescriptions filled during an 18-year period by more than 1 million women included in Denmark’s national registry.
According to the lead author, Dr. Øjvind Lidegaard of the University of Copenhagen, among women both with and without a psychiatric history who were using hormonal contraceptives, about 10% to 15% got a prescription for an antidepressant during a five-year period.
Annually, the risk of antidepressant use among the youngest group of women taking hormonal contraception amounts to between 2% and 3%. Two or three out of every 100 women between 15 and 19 years old who take hormonal contraceptives will become depressed over the course of a year. “Adolescents seemed more vulnerable to this risk than women 20 to 34 years old,” the researchers noted in their study.
Lidegaard said doctors need to tell women about the benefits and risks of hormonal contraceptive products when deciding which birth control to use.

Effects on fertility

After the men stopped receiving shots, most returned to fertility during a recovery period.
“The minimum recovery time was about 12 weeks after the last injection, and the average time was about 26 weeks,” said Colvard.
Still, there were problems. After 52 weeks in recovery, eight participants had not returned to fertility. The researchers continued to follow these men individually, and five eventually regained normal sperm counts over a longer period of time. One volunteer did not fully recover within four years, though he did “partially recover, so whether he is actually fertile is not known,” Colvard said.
“It shows that it’s a risk, a low-probability risk of it, and it’s not to be sneezed at as a risk of it, surely,” said Lloyd, who is unaffiliated with the new study.
Lloyd said, adding that this risk needs to be compared with those involved in hormonal birth control for women, such as potentially fatal strokes and blood clots.
“These risks of fertility damage are not fatal risks like the women endure with their birth control,” said Lloyd. “You have to compare what women are doing in terms of taking hormones with what men are doing in terms of taking hormones. Are they taking their life in their hands when they take the hormones? Women are. And that needs to be put right up in front when considering the risk.”
Colvard and his co-authors say more research is needed as they work to perfect their cocktail of hormonal contraceptives in an attempt to reduce the risk of side effects, including depression, increased sex drive and acne.
Despite the side effects of the male birth control shot, more than 75% of participants reported being willing to use this method of contraception at the conclusion of the study.
Cohen believes at least part of the reason for this is that they were getting testosterone.

Looking to the future

“Testosterone makes men feel pretty good,” Cohen said. “Testosterone is not a stimulant per se, but it is a steroid, and like a lot of steroids, it can give you a boost of energy. It can give you a boost of muscle mass. It can help with weight loss. It can help with mentation,” or mental activity.
Lloyd believes that if 75% of the men said they’d be interested in getting the shot if it were available, there’s real interest in the product. “That’s unbelievable. That’s fabulous. I’m very very impressed with that number,” she said.
Cohen, who says he he sees patients who face infertility or other hormonal problems, worries about the safety of this method. “Let’s just say, when I read it, I was highly alarmed,” he said, explaining that putting men on testosterone who have normal testosterone levels is not safe and amounts to a violation of the “ethical clinical practice guidelines.”
However, Lloyd thinks this product is a long time coming.
“It’s been a long time since people have been talking about male birth control. This goes back to the 1950s at least.” When scientists first began talking about hormonal birth control for women, they also discussed the same for men, explained Lloyd, but hormonal contraceptives for men were not acted on or investigated.
Cohen questions the general safety of hormonal birth control — for anyone.
“We’re talking about young people, and the scary thing is messing around with young people’s hormones, and that can be detrimental for the rest of their life, right?” Cohen said. “You take an 18-year-old girl or a 20-year-old boy and mess around with their hormones, you’ve really altered possibly how they go through their life.
“If anything, this may wake us up to finding out better hormonal contraceptives for women, right? Because certainly, I know that a lot of young women don’t get the type of counseling that maybe they deserve when it comes to contraception,” Cohen said. “Just a (prescription) and a visit to Duane Reade is all they get, and that may not be enough.”

Article Source: http://www.cnn.com/2016/10/30/health/male-birth-control/index.html?sr=fbCNN103116male-birth-control1030AMStoryGalLink&linkId=30515664

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Why the Male Pill Still Doesn’t Exist

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Had there been a male contraceptive pill in 1976, I probably wouldn’t be here to write this. That was the year when, after my mom—may she rest in peace—had been on the pill for 12 years, health worries made her doctor tell her to come off it. “She said to the doctor, ‘I’ll get pregnant,’” my dad recalls. “And within a very short while, she was.” He explains, much to my discomfort, that although my parents switched to condoms, I was conceived because “sometimes you feel reckless.” But if a male pill had existed, my dad says, he’d definitely have used it.

So why didn’t it exist? It certainly wasn’t because of a lack of scientific interest. Gregory Pincus, who co-invented the female contraceptive pill, first tested the same hormonal approach on men in 1957, and various hormonal and non-hormonal methods have been explored since. And although attitudes among those who might use a male pill were once thought to be a daunting obstacle, it’s now clear that many men want a new option.

Despite this, we’re still waiting. Developing a method that men would accept has brought decades of frustration, yet researchers are as confident as they can be that they’re close to overcoming the scientific barriers. But, crucially, drug makers’ commitment to contraceptives has always been tentative, particularly when it comes to products for men—and today, the whole contraceptive industry is struggling. Now, the multimillion-dollar question seems to be: Who is actually going to make the male pill happen?

In the 1970s, when my dad might have used a contraceptive pill, prospects seemed better in some ways. Male fertility control was an active research field, with governments backing various ideas to limit overcrowding on Earth. One product he might have been interested in—a non-hormonal drug called gossypol—was being tested on a scale that has never been matched since. At the UN’s 1974 World Population Conference, Elsimar Coutinho, today a famous sex and fertility doctor in Brazil, was promoting the drug, which he was testing on men at the Federal University of Bahia. However, attitudes surrounding sex and reproduction can be unpredictable, and not everyone was convinced of its worth.

“The conference hall was full of women,” Coutinho says on the phone, his gravelly voice matching his website’s picture of a suave doctor with slicked-back grey hair. “I was going to tell them, ‘Now you don’t have to take pills if you don’t want.’” Yet, having determined their own fertility through the contraceptive pill for little more than a decade, his female audience were determined not to relinquish control. “To my surprise, I was shouted down and booed out.”

Despite such reactions, poorer countries with fast-growing populations found gossypol appealing because it could be extracted cheaply from cotton farming waste. Coutinho had first seen its potential while visiting Brazilian farmers who fed cotton plant debris to their bulls. “The bulls were having sex more often, the farmers thought it was good for sexual prowess,” he recalls. But actually, the bulls were not making enough sperm and were therefore still surrounded by receptive, non-pregnant cows—and just doing what came naturally.

From the 1960s onwards, Coutinho worked on contraception with the Chinese government, which in 1972 ran trials with 8,806 men taking gossypol pills. Daily doses successfully reduced the men’s sperm count enough to satisfy the researchers, but side-effects were a cause for concern. One notable problem was that 66 of the men had low potassium in their blood. More importantly, sperm levels in many men didn’t return to normal when they stopped taking the drug.

Researchers therefore conducted tests for years longer, showing in rats that gossypol doesn’t just stop sperm moving, but also damages the lining of epididymis ducts, which store sperm made by the testicles. Eventually, an October 1986 symposium in Wuhan, China—whose sponsors included the Chinese government and the World Health Organization (WHO)—concluded that gossypol was “of little interest.”

“You may call it a problem, but we saw it as a solution,” Coutinho tells me. He felt that the fact it could be irreversible made gossypol a potential alternative to surgical vasectomy. He joined with an international team of scientists to conduct further trials, the last of whose results were published in 2000. They found no problems with potassium, putting the effects seen in China down to poor diet.

The researchers therefore applied to the Brazilian government for permission to sell the drug, needing to overcome the strong influence of the Roman Catholic Church, which forbids artificial contraception. On 14 June 2001, Josimar Henrique da Silva, founder of the Brazilian drug company Hebron, which was hoping to commercialize gossypol, wrote to Coutinho. “I’m working at the Ministry of Health in such a way as not to create more obstacles,” Coutinho reads from the letter. “I can’t fight against them. Give me two more weeks.”

Coutinho never heard from da Silva again. The gossypol contraceptive saga ended in failure after more than three decades. Coutinho mischievously suggests Ministry machismo may have been a contributing factor. “We worked on this for many years and realized men are very afraid of losing virility,” he says. “Maybe those judging our application were amongst them.”

By contrast, my dad apparently wouldn’t have seen a male pill as a threat to his virility, and I too would be interested in rather than threatened by a new male contraceptive—I believe it would benefit, rather than harm, the sex my partner and I have. Are we unusual in that?

Actually, plenty of men are interested in a male pill. In 2005, researchers in Germany published a study asking over 9,000 men from nine countries on four continents whether they’d use a contraceptive method “capable of preventing sperm production.” Over half were willing, the proportion ranging from three-tenths to seven-tenths depending on the country.

Other surveys report similar attitudes. In 2011, Susan Walker at Anglia Ruskin University in Chelmsford, U.K., published a small study including 54 men in an anonymous town in England. Twenty-six of them said yes, they would take it. “They were not concerned about losing fertility—as long as they could be sure of regaining it,” Walker stresses.

The remainder, who split between responding ‘no’ and ‘don’t know,’ showed some gender-based reluctance. “It’s a strange idea,” one man said. “I’m so used to women taking the pill.” Those who were unsure were more concerned about side-effects, Walker notes. “They said, ‘I’ve seen what the pill does to my girlfriend,’ ‘What would the long-term effects on my fertility be?,’ ‘Could I be sure my fertility would return?,’ that kind of really quite sensible concern.”

The survey also included 134 women, roughly half of whom would let their partners use a male pill. However, more than half were worried that men would forget to take the pill regularly, whereas just one in six of the men had this worry. “Of course, women have the experience of having to remember to take the pill,” Walker says. One study from 1996, in which 103 women were given electronic pill dispensers that monitored what they’d taken, found that they missed 2.6 pills per month on average.

“The general concept is that there are men out there that would use it,” says Richard Anderson, a professor of reproductive science at the University of Edinburgh. And some women would trust them—although often media coverage might suggest otherwise. “Whenever there’s a study published, a radio journalist will walk up and down the high street in their local town and ask women whether they’d trust a man to take a pill, and of course they all run for the hills. But if you ask a woman if they would trust their partner, who they share children, their bank account, and a bed every night with, then you’re going to get a different answer.”

In 1995 and 1996, researchers including Anderson interviewed 1,829 men across four cities: Edinburgh, Cape Town, Shanghai, and Hong Kong. White men in Cape Town were most eager, with four-fifths saying they would at least probably use a male hormonal contraceptive pill. Hong Kong residents were least keen, with two-fifths saying that they would definitely or probably take a pill. Fewer were interested if the drug was injected—three-fifths of white men in Cape Town and a third of men in Hong Kong, for example. “It’s not going to be right for everybody,” Anderson says. “The whole concept is to provide a range of options so that individuals can find what suits them best.”

A photo of Anderson’s reveals the injection question’s importance. In it, a woman is grinning as she depresses the plunger on the hormone-filled syringe she’s injecting into her husband’s naked bottom. This was the method used in the first WHO-backed clinical trial that Anderson was involved in, back in 1991. “It was proof that you could use a hormonal method to produce real contraceptive efficacy,” Anderson says. This trial also helped show that male contraceptives didn’t need to cut sperm count to zero. With anything upwards of 15 million sperm per millilitre considered normal, the trial set its maximum threshold at 3 million per millilitre. The consensus today is that “anything below 1 million per millilitre is going to provide pretty good contraception,” Anderson says.

A single crumpled piece of A4 paper on an almost bare wall in Anderson’s office illustrates how hormonal male contraceptives work, reducing men to brain and balls. In the brain, it picks out the hypothalamus and pituitary gland. In the testicles it shows cells that make testosterone, and the tubules they neighbor, where sperm are made. Progestogen hormones like those used in female pills can stop the glands in a man’s brain making luteinizing hormone and follicle-stimulating hormone. The absence of these hormones stops the man’s testicles producing sperm—but it also stops them producing testosterone. So testosterone replacement is given along with progestogens, to avoid undesirable effects like weaker muscles and lessened sex drive.

The Edinburgh scientists’ various trials have long attracted media attention. “‘100% success’ for male pill trial,” trumpeted the BBC in 2000, reporting on the suppression of sperm production in 30 men reportedly without side-effects—from a combined progestogen pill and testosterone-releasing implant. Both hormones came from the Dutch drug company Organon, which, after what Anderson calls “a lot of persuading,” began to pay attention.

Eventually Organon teamed up with Germany’s Schering on a larger clinical trial in 2003–04. Researchers gave 297 men progestogen implants Organon was developing for women and injections of a Schering testosterone product. They gave around 52 more men placebos—all the participants were also using other contraception—and monitored their sperm count. For almost nine-tenths of the men on the hormonal contraceptive, sperm counts fell below the million mark, and once the trial was over they all recovered normal fertility after around four months. But not everything was ideal. More men taking hormones suffered ‘adverse events’ like acne, sweating, and effects on weight, mood and sex drive than the placebo group. Some of these were more serious and even life-threatening, including one attempted suicide.

This would be the pinnacle of Big Pharma’s interest. Between running the trial and publishing results in 2008, Schering was bought by German rival Bayer, which ended work on the subject. Organon likewise ended its interest, which Herjan Coelingh Bennink, global executive vice-president in the company’s reproductive medicine program until 2000, believes is partly because this work lacked support in the company. Encouraged by the survey done by Anderson and his colleagues, Coelingh Bennink had pushed the approach, and helped design the joint trial. But—echoing Coutinho’s account of his experience with gossypol—among Organon’s most senior leaders attitudes were not as open as elsewhere.

“At board level it was only middle-aged, white males,” Coelingh Bennink recalls. “I tried to explain how important it could be, but they never got further than saying to each other, ‘Would you do it?’ ‘No, I wouldn’t do it.’ It was not considered male behavior to take responsibility for contraception.”

On leaving Organon, Coelingh Bennink founded Pantarhei Bio. There, he has overseen development of an improved female contraceptive pill that offers lessons for the male version. When women start using hormonal contraceptives, there’s a possibility that blood clots can form. While the risk is very low, it does happen and can lead to serious complications—for the women and for the drug companies. For example, Bayer is estimated to have paid around $2 billion to women who have sued it over such blood clots. Likewise Merck and Johnson & Johnson have paid millions of dollars to settle similar cases brought against them. The new drug “most likely” doesn’t cause clots, Coelingh Bennink says.

In 2016, the new female pill will enter large-scale phase III human trials—the ultimate test of whether drugs work—to determine whether government regulators will approve its sale. But Coelingh Bennink estimates these will cost €50–100 million, and Pantarhei doesn’t have the money. Instead, it has sold rights to the drug to a Belgian company, Mithra Pharmaceuticals, who are running the necessary clinical trials.

Getting to this point has taken Pantarhei 14 years, and finding a partner prepared to risk large-scale testing has been one of the hardest parts. Contraceptive drug companies have all drastically cut funding for new products, Coelingh Bennink says. “It’s a disastrous world to develop drugs in. It’s much more profitable to develop another cancer drug. Contraceptives are a retail business—it’s a matter of selling a lot, and profit is low.”

US-based Transparency Market Research estimates that people across the world spent almost $16 billion on contraceptives in 2013. Roughly two-thirds of that was on contraceptive devices, including condoms, implants and intrauterine devices (IUDs, or ‘coils’). Meanwhile, the IMS Institute for Healthcare Informatics estimates that in 2014 the world spent $100 billion on cancer drugs, and that figure has been growing at 6.5 per cent per year. Contraceptive drug expenditure is set to grow at just 1.3 percent a year. Add to this the risk of getting sued, and the continued belief that men won’t take a contraceptive pill, and Coelingh Bennink believes no drug company will get involved. “This is a task for public organizations,” he says.

The WHO continues to fulfill this role—but it too has hit problems. In 2011, another progestogen–testosterone trial on over 200 couples, run by the WHO and the non-profit research organization CONRAD, was stopped early. CONRAD announced two serious adverse events as the reason, although full details are still to be published.

Yet Anderson, who helped run the WHO–CONRAD trial, points out that some researchers are already offering the method to men outside of trials, and even using it on themselves. For him, the biggest obstacles are not scientific. “Getting male fertility down to acceptable levels is difficult but not impossible, and there have been many years of experience of how to do that,” he says. “What the field has really lacked is a champion with lots of money and enthusiasm. Thereafter you get industrial involvement.”

That champion may not yet have emerged, but in the U.S., two women are at least providing the enthusiasm.

“We’re talking about drugs men are going to take for a really long time, so the pathway for approval is long too,” says contraception researcher Diana Blithe. “So when scientists say, ‘I have a product in mice that looks promising, we’ll have a drug in five years,’ it’s very unrealistic.” Nevertheless, she admits to being “really excited” about the approaches she’s supporting.

Blithe is director of the male contraceptive development program at the U.S. National Institute of Child Health and Human Development (NICHD) in Bethesda, Maryland. She’s responsible for one of the largest pots of male pill research money available today and believes a hormonal method is most likely to do the job.

She points out that American men can already buy testosterone gels that could form part of a male contraceptive, and which show how to get a male hormone product approved. Advertisements everywhere in the U.S. talk about “low-T”—low testosterone levels—and the gels men can rub into their skin to treat them. Similarly, NICHD funds researchers at the University of California, Los Angeles and the University of Washington to do clinical trials using testosterone and progestogen in gels.

NICHD is also closing in on an elusive pill-form male hormonal contraceptive. Forms of testosterone that we can absorb from our stomach and gut rapidly break down in the body, meaning men would have to take pills three times a day. “Would men take a pill?” Blithe asks. “We think they will—but not every eight hours.” Therefore NICHD has developed a hormone that does the job of both progestogen and testosterone and only needs to be taken once a day. This too is moving into clinical trials.

Although she’s enthusiastic about these ideas, Blithe stresses that NICHD can’t do what Coelingh Bennink wants them to, and take male products through to approval independently. Instead, she and her colleagues are continuing to seek involvement from drug makers. “Our hope is to show that it works well and men like it, and then a pharmaceutical company will recognize that it’s safe,” she says. “We are doing phase II now on the gels and if it works really well and we still don’t have a partner, I don’t know what the Institute’s decision will be, whether they will want to continue.”

While scientists can work on how hormonal drugs are taken and their side-effects, one downside seems unavoidable. It takes one to four months to clear out already-made sperm and achieve the contraceptive effect, and a similar period for fertility to return. NICHD is therefore also backing research on non-hormonal methods that might be effective more quickly, but Blithe admits these are “way further back” in animal testing.

If NICHD worked in the U.K., they might therefore be interested in Nnaemeka Amobi from King’s College London’s non-hormonal ‘instant male pill’. Also known as the ‘dry orgasm pill’, Amobi’s contraceptive stops men releasing semen and the sperm it contains. He stresses that otherwise the normal physical processes involved in a man’s orgasm are unaffected.

“The movement of semen from the testes to where it stays until you have the projectile phase of emission, called ejaculation, happens long before climax,” Amobi says. “As soon as you’re aroused, spermatic fluid is moved towards the seminal vesicles and prostate. Our pill stops that initial movement by inactivating the tubes that propel fluid from the testes to the prostate.”

Amobi and his fellow researchers started from two existing drugs that had caused dry orgasms as an undesirable side-effect. They redesigned the drugs to remove the original intended actions and focus on this. Animal tests suggest that they have succeeded. “We used rams because rats and rabbits don’t have seminal fluid like humans,” Amobi says. “We tried boars, and boars produce 250 millilitres of semen. Can you imagine that? Rams have 1 milliliter, closer to humans’ 2–5 milliliters.”

These tests show the method could become effective within three to four hours, and wear off after a day. “A woman can say, ‘Here’s the pill—let me see you take it’,” Amobi says. And as well as avoiding pregnancy, preventing semen emission should help reduce sexual transmission of semen-borne diseases, such as HIV.

One potential backer interested in the drug was the Parsemus Foundation, a small private organization based in Berkeley, California. Ultimately, though, its founder Elaine Lissner faced a tough choice between funding Amobi’s research and another promising new male contraceptive technology. She chose to spend the foundation’s little cash on the latter. Amobi isn’t bitter because, in his opinion, Lissner is the main reason people still talk about male contraception. But she still has regrets. “It’s shocking that they can’t get backing for the first new idea about HIV transmission prevention in ages.”

Having started the Parsemus Foundation in 2005 with a little of her own money, Lissner has a personal relationship with how it’s spent. In contrast to Blithe, she dislikes hormonal approaches because of their side-effects, and she also dislikes risk. Parsemus has therefore adopted an approach similar to one already tested in men, in India. But it’s not a pill—it’s a ‘hydrogel’ injected into the vas deferens, the tube linking the epididymis to the penis.

Called Vasalgel, it lets through semen, but not sperm, and is intended to be washed out by another injection when men want the use of their sperm back. The blocked sperm are cleared from the epididymis and eaten up by immune cells, as happens normally if a man hasn’t had an orgasm for a while. Lissner publicizes Vasalgel energetically, and one glance at its thriving Facebook page should dispel any doubts that men would be interested. “People are crazy for Vasalgel, desperate for it,” she says. “We have over 32,000 people on the mailing list waiting to hear about clinical trials.”

One man who’s keen to try it is Justin Terry, a married 30-year-old machinist who makes vehicle parts in Alabama. He and his wife don’t have children, and his wife is taking the contraceptive pill. “We’ve been married ten years,” Justin says. “She doesn’t want kids and neither do I, really. She wants to get off the pill.” The pill gives his wife tender breasts, and she is concerned about adverse effects of continuing to take it. As with hormonal approaches, his sperm would still flow for weeks after Vasalgel is injected, but this doesn’t bother Justin. He has considered vasectomy, as have I, but has hesitated in part because it’s not completely reversible. “Vasalgel sounds like it will be reversible and would involve much less invasive surgery,” he says.

Parsemus’s efforts have been helped by the David and Lucile Packard Foundation, also based in California, which provided $50,000 to help them test the approach in baboons. “We expected to be out of money last year and we’re not,” Lissner says. “But the clinical trial is half a million dollars, so that’s a different scale, and beyond that it’s multimillions.” The trial will involve about 30 men and will test Vasalgel as a vasectomy alternative, without looking at reversibility.

Knowing the field’s status, Lissner is not relying on government or the pharmaceutical industry. Instead, she’s looking for backing from wealthy ‘social investors’—and of course potential end users—and is publicizing what might be possible in the field to bring interested parties together. “The difference is that we have built an infrastructure where the public is able to channel its support,” she says.

On Blithe’s suggestion, I’m watching a documentary called The Great Sperm Race, made by the U.K.’s Channel 4, showing the journey sperm make through a woman’s uterus to her fallopian tube. It has cast people dressed in white clothing as sperm, dying in vast numbers. From millions of sperm ejaculated, just 20–100 get close enough to the egg to try to fertilize it.

As I watch, I imagine the white-clad actors instead represent the many possible male pills. There have been and still are masses of ideas, far more than I’ve been able to mention. Yet, like the unsuccessful sperm, so many have fallen by the wayside. I think of the contraceptive drug industry’s current status and I can’t help think we have missed its fertile period. If the perfect idea were to fight its way through development today, there’s only a tiny chance that there would be a partner to meet it and eventually produce a fully formed male pill from it.

It seems obvious that if a new male contraceptive does make it to maturity, it will come thanks to the efforts of people like Blithe and Lissner. They, as much as anyone, are trying to create environments where the right technology can take seed. Without keen interest from the industry that we have traditionally relied on to supply our contraceptives, that requires enormous effort. Lissner’s energetic exertions to concentrate support from men like Justin Terry, my dad, and me could prove critical.

And Lissner is adamant that the ideas that seem to have faltered are not dead, they’re just resting. “We keep collecting new methods and never finish the ones we have,” she fumes. “Pick one and make something! Finish the job!”

Written By: Andy Extance

Article Source: http://www.theatlantic.com/health/archive/2016/07/why-the-male-pill-still-doesnt-exist/490985/

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