men’s health after cancer what you need … medicine title or event men’s health after cancer...
TRANSCRIPT
UW MEDICINE TITLE OR EVENT
MENrsquoS HEALTH AFTER CANCER WHAT YOU NEED TO KNOW
INFERTILITY
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
TOM WALSH MD
WALSHTUWEDU
At the conclusion of this presentation you
should be able to
Elaborate on the state of Menrsquos Health
1 Key facts about male infertility amp the effects
of cancer
2 Describe the basic male evaluation
3 Know where to get an evaluation
LEARNING OBJECTIVES
Changes in Health Conditions
1999 2005 2009 2012
High cholesterol 25 28 29 30
High blood pressure 23 25 30 32
Diabetes 10 11 12 13
Obesity 20 25 29 32
STATE OF MENrsquoS HEALTH
3
Centers for Disease Control 2012 statistics
Infertility may be a surrogate for other health issues
Centers for Disease Control 2003 Statistics
HOW MEN amp WOMEN USE HEALTHCARE SERVICES
Age (years)
Num
ber
of v
isits
per
100
per
sons
All ages Under 15 15ndash24 25ndash44 45ndash64 65ndash74 ge75 0
200
400
600
800 Women Men
5
6
Team of providers and staff to evaluate
and treat the health issues for men
- Urinary issues
- Erectile Dysfunction
- Male Infertility
- Male hormones
- Peyroniersquos Disease (curvature of penis)
MENrsquoS HEALTH CENTER UW
7
INFERTILITY
The inability to conceive after 12 months of regular unprotected intercourse (10-15 of couples)1
20 male factor only 40 male and female factors2
Spira A Epidemiology of human reproduction Hum Reprod 19861111ndash5
Mosher WD Pratt WF Fecundity and infertility in the United States incidence and trends Fertil Steril199156192ndash3
MULTIPLE CANCERS WITH LOW SPERM COUNTS
Williams et al Pretreatment semen parameters in men with cancer J Urol 2009 Feb181(2)736-40
Decreased at time of diagnosis
bull Divert energy to fight cancer
Treatment
bull Radiation
bull Chemotherapy
bull Surgery effects
bull Stress
bull Psychological effects
CANCER EFFECTS ON SPERM PRODUCTION
11
12
INFERTILITY IS A COUPLE PROBLEM
0
5
10
15
20
25
30
20-25 26-30 31-35 36-40 41-45
Female Age
Mo
nth
ly
Fe
cu
nd
ity
MALE INFERTILITY EVALUATION
14
Medical History
Testicular insults
Physical Examination
Semen Analysis
Additional laboratory testing dependinghellip
14
Why ①Identify opportunities to optimize
reproductive potential
②Identify associated health problems
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
At the conclusion of this presentation you
should be able to
Elaborate on the state of Menrsquos Health
1 Key facts about male infertility amp the effects
of cancer
2 Describe the basic male evaluation
3 Know where to get an evaluation
LEARNING OBJECTIVES
Changes in Health Conditions
1999 2005 2009 2012
High cholesterol 25 28 29 30
High blood pressure 23 25 30 32
Diabetes 10 11 12 13
Obesity 20 25 29 32
STATE OF MENrsquoS HEALTH
3
Centers for Disease Control 2012 statistics
Infertility may be a surrogate for other health issues
Centers for Disease Control 2003 Statistics
HOW MEN amp WOMEN USE HEALTHCARE SERVICES
Age (years)
Num
ber
of v
isits
per
100
per
sons
All ages Under 15 15ndash24 25ndash44 45ndash64 65ndash74 ge75 0
200
400
600
800 Women Men
5
6
Team of providers and staff to evaluate
and treat the health issues for men
- Urinary issues
- Erectile Dysfunction
- Male Infertility
- Male hormones
- Peyroniersquos Disease (curvature of penis)
MENrsquoS HEALTH CENTER UW
7
INFERTILITY
The inability to conceive after 12 months of regular unprotected intercourse (10-15 of couples)1
20 male factor only 40 male and female factors2
Spira A Epidemiology of human reproduction Hum Reprod 19861111ndash5
Mosher WD Pratt WF Fecundity and infertility in the United States incidence and trends Fertil Steril199156192ndash3
MULTIPLE CANCERS WITH LOW SPERM COUNTS
Williams et al Pretreatment semen parameters in men with cancer J Urol 2009 Feb181(2)736-40
Decreased at time of diagnosis
bull Divert energy to fight cancer
Treatment
bull Radiation
bull Chemotherapy
bull Surgery effects
bull Stress
bull Psychological effects
CANCER EFFECTS ON SPERM PRODUCTION
11
12
INFERTILITY IS A COUPLE PROBLEM
0
5
10
15
20
25
30
20-25 26-30 31-35 36-40 41-45
Female Age
Mo
nth
ly
Fe
cu
nd
ity
MALE INFERTILITY EVALUATION
14
Medical History
Testicular insults
Physical Examination
Semen Analysis
Additional laboratory testing dependinghellip
14
Why ①Identify opportunities to optimize
reproductive potential
②Identify associated health problems
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
Changes in Health Conditions
1999 2005 2009 2012
High cholesterol 25 28 29 30
High blood pressure 23 25 30 32
Diabetes 10 11 12 13
Obesity 20 25 29 32
STATE OF MENrsquoS HEALTH
3
Centers for Disease Control 2012 statistics
Infertility may be a surrogate for other health issues
Centers for Disease Control 2003 Statistics
HOW MEN amp WOMEN USE HEALTHCARE SERVICES
Age (years)
Num
ber
of v
isits
per
100
per
sons
All ages Under 15 15ndash24 25ndash44 45ndash64 65ndash74 ge75 0
200
400
600
800 Women Men
5
6
Team of providers and staff to evaluate
and treat the health issues for men
- Urinary issues
- Erectile Dysfunction
- Male Infertility
- Male hormones
- Peyroniersquos Disease (curvature of penis)
MENrsquoS HEALTH CENTER UW
7
INFERTILITY
The inability to conceive after 12 months of regular unprotected intercourse (10-15 of couples)1
20 male factor only 40 male and female factors2
Spira A Epidemiology of human reproduction Hum Reprod 19861111ndash5
Mosher WD Pratt WF Fecundity and infertility in the United States incidence and trends Fertil Steril199156192ndash3
MULTIPLE CANCERS WITH LOW SPERM COUNTS
Williams et al Pretreatment semen parameters in men with cancer J Urol 2009 Feb181(2)736-40
Decreased at time of diagnosis
bull Divert energy to fight cancer
Treatment
bull Radiation
bull Chemotherapy
bull Surgery effects
bull Stress
bull Psychological effects
CANCER EFFECTS ON SPERM PRODUCTION
11
12
INFERTILITY IS A COUPLE PROBLEM
0
5
10
15
20
25
30
20-25 26-30 31-35 36-40 41-45
Female Age
Mo
nth
ly
Fe
cu
nd
ity
MALE INFERTILITY EVALUATION
14
Medical History
Testicular insults
Physical Examination
Semen Analysis
Additional laboratory testing dependinghellip
14
Why ①Identify opportunities to optimize
reproductive potential
②Identify associated health problems
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
Centers for Disease Control 2003 Statistics
HOW MEN amp WOMEN USE HEALTHCARE SERVICES
Age (years)
Num
ber
of v
isits
per
100
per
sons
All ages Under 15 15ndash24 25ndash44 45ndash64 65ndash74 ge75 0
200
400
600
800 Women Men
5
6
Team of providers and staff to evaluate
and treat the health issues for men
- Urinary issues
- Erectile Dysfunction
- Male Infertility
- Male hormones
- Peyroniersquos Disease (curvature of penis)
MENrsquoS HEALTH CENTER UW
7
INFERTILITY
The inability to conceive after 12 months of regular unprotected intercourse (10-15 of couples)1
20 male factor only 40 male and female factors2
Spira A Epidemiology of human reproduction Hum Reprod 19861111ndash5
Mosher WD Pratt WF Fecundity and infertility in the United States incidence and trends Fertil Steril199156192ndash3
MULTIPLE CANCERS WITH LOW SPERM COUNTS
Williams et al Pretreatment semen parameters in men with cancer J Urol 2009 Feb181(2)736-40
Decreased at time of diagnosis
bull Divert energy to fight cancer
Treatment
bull Radiation
bull Chemotherapy
bull Surgery effects
bull Stress
bull Psychological effects
CANCER EFFECTS ON SPERM PRODUCTION
11
12
INFERTILITY IS A COUPLE PROBLEM
0
5
10
15
20
25
30
20-25 26-30 31-35 36-40 41-45
Female Age
Mo
nth
ly
Fe
cu
nd
ity
MALE INFERTILITY EVALUATION
14
Medical History
Testicular insults
Physical Examination
Semen Analysis
Additional laboratory testing dependinghellip
14
Why ①Identify opportunities to optimize
reproductive potential
②Identify associated health problems
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
5
6
Team of providers and staff to evaluate
and treat the health issues for men
- Urinary issues
- Erectile Dysfunction
- Male Infertility
- Male hormones
- Peyroniersquos Disease (curvature of penis)
MENrsquoS HEALTH CENTER UW
7
INFERTILITY
The inability to conceive after 12 months of regular unprotected intercourse (10-15 of couples)1
20 male factor only 40 male and female factors2
Spira A Epidemiology of human reproduction Hum Reprod 19861111ndash5
Mosher WD Pratt WF Fecundity and infertility in the United States incidence and trends Fertil Steril199156192ndash3
MULTIPLE CANCERS WITH LOW SPERM COUNTS
Williams et al Pretreatment semen parameters in men with cancer J Urol 2009 Feb181(2)736-40
Decreased at time of diagnosis
bull Divert energy to fight cancer
Treatment
bull Radiation
bull Chemotherapy
bull Surgery effects
bull Stress
bull Psychological effects
CANCER EFFECTS ON SPERM PRODUCTION
11
12
INFERTILITY IS A COUPLE PROBLEM
0
5
10
15
20
25
30
20-25 26-30 31-35 36-40 41-45
Female Age
Mo
nth
ly
Fe
cu
nd
ity
MALE INFERTILITY EVALUATION
14
Medical History
Testicular insults
Physical Examination
Semen Analysis
Additional laboratory testing dependinghellip
14
Why ①Identify opportunities to optimize
reproductive potential
②Identify associated health problems
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
6
Team of providers and staff to evaluate
and treat the health issues for men
- Urinary issues
- Erectile Dysfunction
- Male Infertility
- Male hormones
- Peyroniersquos Disease (curvature of penis)
MENrsquoS HEALTH CENTER UW
7
INFERTILITY
The inability to conceive after 12 months of regular unprotected intercourse (10-15 of couples)1
20 male factor only 40 male and female factors2
Spira A Epidemiology of human reproduction Hum Reprod 19861111ndash5
Mosher WD Pratt WF Fecundity and infertility in the United States incidence and trends Fertil Steril199156192ndash3
MULTIPLE CANCERS WITH LOW SPERM COUNTS
Williams et al Pretreatment semen parameters in men with cancer J Urol 2009 Feb181(2)736-40
Decreased at time of diagnosis
bull Divert energy to fight cancer
Treatment
bull Radiation
bull Chemotherapy
bull Surgery effects
bull Stress
bull Psychological effects
CANCER EFFECTS ON SPERM PRODUCTION
11
12
INFERTILITY IS A COUPLE PROBLEM
0
5
10
15
20
25
30
20-25 26-30 31-35 36-40 41-45
Female Age
Mo
nth
ly
Fe
cu
nd
ity
MALE INFERTILITY EVALUATION
14
Medical History
Testicular insults
Physical Examination
Semen Analysis
Additional laboratory testing dependinghellip
14
Why ①Identify opportunities to optimize
reproductive potential
②Identify associated health problems
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
Team of providers and staff to evaluate
and treat the health issues for men
- Urinary issues
- Erectile Dysfunction
- Male Infertility
- Male hormones
- Peyroniersquos Disease (curvature of penis)
MENrsquoS HEALTH CENTER UW
7
INFERTILITY
The inability to conceive after 12 months of regular unprotected intercourse (10-15 of couples)1
20 male factor only 40 male and female factors2
Spira A Epidemiology of human reproduction Hum Reprod 19861111ndash5
Mosher WD Pratt WF Fecundity and infertility in the United States incidence and trends Fertil Steril199156192ndash3
MULTIPLE CANCERS WITH LOW SPERM COUNTS
Williams et al Pretreatment semen parameters in men with cancer J Urol 2009 Feb181(2)736-40
Decreased at time of diagnosis
bull Divert energy to fight cancer
Treatment
bull Radiation
bull Chemotherapy
bull Surgery effects
bull Stress
bull Psychological effects
CANCER EFFECTS ON SPERM PRODUCTION
11
12
INFERTILITY IS A COUPLE PROBLEM
0
5
10
15
20
25
30
20-25 26-30 31-35 36-40 41-45
Female Age
Mo
nth
ly
Fe
cu
nd
ity
MALE INFERTILITY EVALUATION
14
Medical History
Testicular insults
Physical Examination
Semen Analysis
Additional laboratory testing dependinghellip
14
Why ①Identify opportunities to optimize
reproductive potential
②Identify associated health problems
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
INFERTILITY
The inability to conceive after 12 months of regular unprotected intercourse (10-15 of couples)1
20 male factor only 40 male and female factors2
Spira A Epidemiology of human reproduction Hum Reprod 19861111ndash5
Mosher WD Pratt WF Fecundity and infertility in the United States incidence and trends Fertil Steril199156192ndash3
MULTIPLE CANCERS WITH LOW SPERM COUNTS
Williams et al Pretreatment semen parameters in men with cancer J Urol 2009 Feb181(2)736-40
Decreased at time of diagnosis
bull Divert energy to fight cancer
Treatment
bull Radiation
bull Chemotherapy
bull Surgery effects
bull Stress
bull Psychological effects
CANCER EFFECTS ON SPERM PRODUCTION
11
12
INFERTILITY IS A COUPLE PROBLEM
0
5
10
15
20
25
30
20-25 26-30 31-35 36-40 41-45
Female Age
Mo
nth
ly
Fe
cu
nd
ity
MALE INFERTILITY EVALUATION
14
Medical History
Testicular insults
Physical Examination
Semen Analysis
Additional laboratory testing dependinghellip
14
Why ①Identify opportunities to optimize
reproductive potential
②Identify associated health problems
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
MULTIPLE CANCERS WITH LOW SPERM COUNTS
Williams et al Pretreatment semen parameters in men with cancer J Urol 2009 Feb181(2)736-40
Decreased at time of diagnosis
bull Divert energy to fight cancer
Treatment
bull Radiation
bull Chemotherapy
bull Surgery effects
bull Stress
bull Psychological effects
CANCER EFFECTS ON SPERM PRODUCTION
11
12
INFERTILITY IS A COUPLE PROBLEM
0
5
10
15
20
25
30
20-25 26-30 31-35 36-40 41-45
Female Age
Mo
nth
ly
Fe
cu
nd
ity
MALE INFERTILITY EVALUATION
14
Medical History
Testicular insults
Physical Examination
Semen Analysis
Additional laboratory testing dependinghellip
14
Why ①Identify opportunities to optimize
reproductive potential
②Identify associated health problems
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
Decreased at time of diagnosis
bull Divert energy to fight cancer
Treatment
bull Radiation
bull Chemotherapy
bull Surgery effects
bull Stress
bull Psychological effects
CANCER EFFECTS ON SPERM PRODUCTION
11
12
INFERTILITY IS A COUPLE PROBLEM
0
5
10
15
20
25
30
20-25 26-30 31-35 36-40 41-45
Female Age
Mo
nth
ly
Fe
cu
nd
ity
MALE INFERTILITY EVALUATION
14
Medical History
Testicular insults
Physical Examination
Semen Analysis
Additional laboratory testing dependinghellip
14
Why ①Identify opportunities to optimize
reproductive potential
②Identify associated health problems
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
12
INFERTILITY IS A COUPLE PROBLEM
0
5
10
15
20
25
30
20-25 26-30 31-35 36-40 41-45
Female Age
Mo
nth
ly
Fe
cu
nd
ity
MALE INFERTILITY EVALUATION
14
Medical History
Testicular insults
Physical Examination
Semen Analysis
Additional laboratory testing dependinghellip
14
Why ①Identify opportunities to optimize
reproductive potential
②Identify associated health problems
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
INFERTILITY IS A COUPLE PROBLEM
0
5
10
15
20
25
30
20-25 26-30 31-35 36-40 41-45
Female Age
Mo
nth
ly
Fe
cu
nd
ity
MALE INFERTILITY EVALUATION
14
Medical History
Testicular insults
Physical Examination
Semen Analysis
Additional laboratory testing dependinghellip
14
Why ①Identify opportunities to optimize
reproductive potential
②Identify associated health problems
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
MALE INFERTILITY EVALUATION
14
Medical History
Testicular insults
Physical Examination
Semen Analysis
Additional laboratory testing dependinghellip
14
Why ①Identify opportunities to optimize
reproductive potential
②Identify associated health problems
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
SEMEN ANALYSIS - BASICS
15
2-5 days sexual abstinence reduces variability
Ejaculate volume Amount of fluid
Sperm concentration of sperm in 1 mL
Motility Movement of sperm
Morphology How sperm look
What is an abnormal semen analysis
- One of the above is not met on 2 occasions
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
SEMEN ANALYSIS - WHO NORMAL VALUES
16
Ejaculate volume 15 - 55 mL
Sperm concentration gt15 million spermmL
Motility gt40
Morphology gt4 normal forms
Total Motile Sperm Count - Ejaculate volume x sperm concentration x motility
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
SEMEN ANALYSIS VARIABILITY
17
Mallidis C et al Variation of semen quality in normal men Int J Androl
1499-107 1991
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
Combinations of
- Low concentration
- Low motility
- Poor morphology
Synergistically decrease the chance of fertility
SEMEN ANALYSIS
Guzick et al NEJM 20013451388
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
bull Natural Pregnancy
bull IUI - 5 to 10 million motile sperm
bull AKA ndash Turkey Baster Method
bull IVFICSI - 1 sperm
WAYS TO GET PREGNANT
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
- Ideally before cancer treatment
- Cryopreserve sperm for future use
- Often sperm will return after cancer
treatment but not guaranteed
SPERM ldquoBANKINGrdquo
20
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
WHAT CAN I DO
21
bull Diet and lifestyle
bull Exerciseweight loss
bull Smoking cessation
bull Cell phone amp laptops
bull Hot tubs amp jacuzzis
bull Multivitamin
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
Danish study - gt45000 couples
Compared BMI with time to pregnancy (TTP) gt 1 year
BMI EFFECTS ON FERTILITY
22
Ramlau-Hansen CH et al Subfecundity in overweight and obese couples Hum Reprod 2007 Jun22(6)1634-7
0
04
08
12
16
lt185 185-25 25-30 gt30
Male BMI
Odds Ratio (TTP gt1yr)
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
PSYCHOLOGICAL STRESS
Multiple reports showing decreased semen quality during
Examination periods11
Times of war12
Self reported life stress1314
Work stress1314
Death of family member1314
23
Lampiao F Variation of semen parameters in healthy medical students due to exam stress Malawi Med J 200921(4)166ndash7 Abu-Musa AA et al Effect of the Lebanese civil war on sperm parameters Fertil Steril 200788(6)1579ndash82 Clarke RN et al Relationship between psychological stress and semen quality among in-vitro fertilization patients Hum Reprod 199914(3)753ndash8 Jurewicz J et al The effect of stress on the semen quality Med Pr 201061(6) 607ndash13
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
HOW DO I GET A SEMEN ANALYSIS
Male Fertility Lab at the Menrsquos Health Center
bull Mens Health Center 3rd floor of UWMC - Roosevelt 4245 Roosevelt Way NE Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-registration 206-598-4388
24
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
Need to treat ED
Premature ejaculation
- Topical treatments
- oral medication
Post-radiation or surgery effects
- Retrograde ejaculation
- No ejaculate (still make sperm in testicles)
EJACULATORY ISSUES
25
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
Delayed ejaculation
- Medications can help
- Herbal supplement yohimbine can
help
- Can be difficult to treat
EJACULATORY ISSUES
26
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
WHAT ARE MY NEXT STEPS
bull If interested in fertility get a semen analysis
bull Schedule appointment at Menrsquos Health Center to
discuss your issues
27
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
WHERE CAN I FIND HELP
28
bull Mens Health Center
bull 3rd floor of UWMC - Roosevelt
4245 Roosevelt Way NE
Seattle WA 98105
Phone
bull Appointments 206-598-6358
bull New appointments also call UW Medicine Pre-
registration 206-598-4388
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU
UW MEDICINE TITLE OR EVENT
THANK YOU
QUESTIONS
KEVIN A OSTROWSKI MD
OSTROWSKUWEDU