The AFA Blog

Please exercise

by Fred Licciardi, M.D.

Please exercise.

In the preceding centuries, tremendous physical activity was required for human survival, and yet, reproduction carried on. Imagine the exhaustion and stress if we had to spend one week hunting or farming with few tools or resources. Yet probably, under these conditions, most women would be able to get pregnant.

Excessive extreme exercise causing weight loss will cause ovulation to stop because the body figures that there are not enough nutrients stored for both the woman and a fetus. If she can just barely feed herself, she can’t feed the growing baby. The same is true for an anorectic. But here we are talking about extreme extreme. Moderate exercise is fine.

Surprising to me, I did come across a paper from Harvard showing that women who underwent moderate levels of exercise had lower pregnancy rates that those who did not. Like we always say, it’s just one paper. I do not really believe it. The Harvard doctors that I know do not restrict moderate exercise.

Exercise is bad if you are taking fertility drugs because the medications make the ovaries grow. Normally the ovaries are about the size of a walnut, and the drugs increase the number of follicles, therefore the ovarian size increases. Sometimes the ovaries can get to the size of plums or even oranges. They hang inside the pelvis. As they become heavier, they become more likely to twist, and this is called torsion. Here the twisting cuts off the blood supply and causes the ovary to choke. This really hurts, and is treated by laparoscopy. Exercise will increase the odds of this twisting. So in this case, exercise is not good.

Exercise increases blood flow to all areas of the body. The uterus and ovaries are organs that would love to get as much blood flow as they could.

Exercise clears your head. Yes, endorphins are released with strenuous activity, and these can help us fell better, but I think it’s more than that. My theory is that it’s not just about increasing the good chemicals; it’s about getting rid of the bad. Increased blood flow flushes away the old stale thought chemicals that are just hanging around causing trouble. Get rid of them.

Even better, do exercise that requires tremendous concentration. This really clears you head. Any sport will do: sailing, golf, soccer, basketball, biking, you name it. Some are more strenuous than others, but they all work. Same thing; flood your brain with fresh blood and new thoughts, lose the waste products.

Exercise builds muscle mass. This is also good. It just makes you feel better if you have a little tone. Even if you think you are fat, the tone goes a long way. It’s healthier to have some tone and muscle. It helps with balance and lowers you chances of getting injured during an accident (falling, for example).

And people with a little tone just age better.

Not to mention all of the obvious benefits of upping your cardio-vascular reserve.

I am not an expert in Yoga, although I have happily done it a few times. It's very good alternative.

So you don’t have time for exercise? Yes you do, make time. If you are tired, go to gym tired, it works just as well. You will sleep better.

If you do decide to take my advice (and the advice of others), go all out. A little exercise once a week is better than nothing, but more is better. You need at least 2 sessions per week of vigorous activity to really make a difference. Don’t start on any aggressive workout without checking with our doctor first, and consider a trainer at least initially.

Performance enhancing drugs kill another career

by Ken Mosesian

I love baseball. Two of my proudest moments from my childhood were catching my first fly ball while playing center field, and having my hitting improve enough that the outfielders moved back to the fence when I came up to bat. 

We're lucky enough to have an MLB stadium (go Diamondbacks!) a short ride from our home on light rail. For me, there's nothing like cheering for your team on a beautiful Spring day, enjoying a hot dog and a beer at the ball park.  So when I read that Manny Ramirez chose to retire rather than face another suspension for testing positive to performance enhancing drugs for the second time, I was angry.

I've always seen baseball as "cleaner" than other sports. It's a romantic notion not grounded in reality, but it's one that I cling to. I wasn't just angry at Ramirez for "dirtying up" my sport, I was angry at him for throwing away a career that most people can only dream of. At the end of his career he was making $20 million a year playing baseball, and playing it well. One example: in 2004, he hit a league leading 43 home runs, and took Boston to its first World Series title in 86 years. 

This hits home for another reason. The AFA took the lead in creating MRHA - the male reproductive health alliance - with CDC, Men's Health Network, and the Society for the Study of Male Reproduction. One of the key issues we're working on is helping to raise awareness about the dangers that anabolic steroids and other so-called performance enhancing drugs pose to health in general and reproductive health in specific. Moreover, they can wreck your life as we saw this past week. 

Manny Ramirez is a prime example of what can happen when someone uses these drugs. Instead of talking about his 43 home runs in 2004, or hitting nearly .400 in 2008, he'll be remembered as a great player who threw it all away because of drugs. 

It's a shame on every level. Whether we like it or not, sports figures are heros to kids, and a lot of kids saw their hero fall. My hope is that they understand that it didn't have to be this way, and that they learn the lesson that Manny Ramirez didn't. 

Ken Mosesian

Executive Director

Too hot to handle. Tips for avoiding male factor infertility.

by Corey Whelan

For many young men, Father's Day represents nothing more than the obligation to buy a card for dear old dad, or maybe, to attend a mandatory brunch before dashing off to pursue their own lives.  While thoughts of potential fatherhood for themselves may be miles away, the choices that these young men make now can seriously impact upon their ability to become dads later on, when maturity and readiness finally present themselves.

Topping the list of negative choices that young men often make is steroid use. According to urologist Michael Werner, "The taking of anabolic steroids has reached almost epidemic proportions.  Nearly seven percent of 12th grade boys use or have used steroids to build muscle mass and improve athletic performance.  What they don't realize is that these synthetic male hormones suppress the testes' ability to make testosterone.  This can cause severely diminished sperm production or even, a complete absence of sperm.  And this may be irreversible".

Other sperm killing, negative lifestyle choices include the use of recreational drugs such as pot or cocaine, and heavy drinking.  According to the Centers for Disease Control (CDC) ingesting more than two alcoholic beverages a day is considered excessive for men.  These too may have a deleterious effect on sperm production.

Countless studies have substantiated the negative effect of smoking on both male and female fertility potential.  While this may sound like a no brainer, CDC statistics show that approximately 3,600 young people between the ages of 12 and 17 years of age initiate cigarette smoking, and an estimated 1,100 young people become daily cigarette smokers. 

Thinking twice before pouring on men's cologne might not be a bad idea either. "Certain human reproductive health problems are linked to synthetic or industrial chemical exposure in males.  These problems include testicular dysgenesis snydrome, which has been linked to low sperm count.  This condition is thought to arise from disrupted hormone signaling, due to industrial chemical exposure. Reducing exposure to environmental contaminants, such as phthalates, pesticides, bisphenol A and other chemicals helps to protect and preserve male fertility" according to  Julia Varshavsky, of CHE (Collaborative on Health and the Environment).

And then there are those bike seats, and the heat that they can generate.  Anything that raises the temperature of the scrotum can have an adverse effect on sperm production.  "Though there are a lot of myths concerning men's fertility there are some things that guys should pay attention to" according to The American Fertility Association's Executive Director, Ken Mosesian.  Says Mosesian, "Hot tubs or sauna use when trying to conceive is not the best strategy.  Sitting with a laptop directly on your lap can also have negative effects, as can cycling with a bicycle seat that is too hard and too narrow, especially if it focuses the weight of the rider forward instead of towards the rear".   Too tight undies, or those made of non breathable fabrics like silk can turn up the heat also and should be avoided.

While most types of male infertility cannot be prevented, establishing healthy habits can make a huge difference in young men's ability to become dads themselves.  They may not know it now, but lots of guys are going to want to be on the receiving end of those sappy Father's Day cards someday.  Teaching them the do's and don'ts about male infertility while they're still too young to care, might really make all the difference they will need in a few very short years.   

Reprinted with permission from examiner.com

AP Photo

A Color Semen Shouldn't Be

By Harry Fisch, MD

On a fairly regular basis, I come into an exam room and find a guy with a very worried look on his face. Sometimes it takes awhile for them to articulate their concern, but, eventually, I hear some variation of:  “Doc…you know…it’s pink…my semen is pink.” 

This is an understandably alarming situation – though, fortunately, it is seldom serious. My first task, in these situations, is to explain what’s happening and reassure my patient that this condition isn’t as strange or dire as it probably appears to him.

Semen, of course, is normally milky white. If it’s some shade of pink that means blood is mixing with the semen. The medical name for the condition is hematospermia. We believe the condition is common, but the prevalence of hematospermia is very difficult to calculate for the simple reason that many men ejaculate while inside their partner and, hence, they don’t actually take a look at their semen. Many cases, therefore, undoubtedly go unreported.

Most patients have more than one episode of hematospermia, occurring over weeks to months.  

If blood in the semen persists for more than 10 ejaculations or for longer than 2 months, it should be formally evaluated.

Although hematospermia is usually benign, a thorough history, physical examination, and (maybe) laboratory testing should be conducted in order to rule out something serious. The most common cause of hematospermia is some kind of infection, either of the urethra, the prostate, or the seminal vesicles. In these cases, the condition often goes away once the infection clears up (either naturally or with the help of antibiotics). Sometimes the hematospermia is triggered by prolonged physical activity such as bicycle riding (the seat of the bicycle presses on the prostate which can aggravate the situation).         
Less common causes of hematospermia include

• Procedures to sample prostate tissue (prostate biopsy)
• Calcium buildup inside the prostate (prostatic calculi)
• Lesions or polyps of the urethra
• Trauma (i.e. a blow or injury to the groin area)
• Prostate cancer

In young men, hematospermia is very rarely serious – though, of course, infections should be treated promptly because they can impair a man’s fertility. If there are no signs of an infection, then other types of tests may be performed to rule out other causes. If the cause is some kind of abnormal growth or process in the urinary or reproductive tracts, surgery may be required to fix the problem.           

Most of the time, however, the primary goal in the management of hematospermia is to allay the anxiety of the frightened patient. Fortunately, this is a rapid, painless, and inexpensive treatment!

Infertility and Steroids

By Harry Fisch, MD

The other day a patient came to see me who looked like the picture of health. He was tan and wore a tight-fitting polo shirt that revealed a heavily-muscled torso. But his testicles were small and soft, and he and his wife had been trying without luck for more than a year to have kids. His wife was checked out and everything seemed fine on her end. So what was going on?

I immediately suspected the man was using some kind of supplement to boost his testosterone and build muscle mass. A couple of days later when his blood work came back it was obvious: his testosterone level was 3 times higher than normal. Bingo. Without knowing it, this guy had effectively sterilized himself. Unfortunately, this guy is not alone. Hundreds of thousands of men are compromising their fertility in their quest for bigger muscles, better athletic performance, or better sex.

Here’s what happens. Every guy’s brain is equipped with a tiny testosterone “thermostat” that constantly monitors the level of this key hormone in his blood. When levels fall, the brain sends signals to the testicles to boost production, and when levels rise, signals tell the testicles to shut down. Adding extra testosterone tricks the brain. Sensing the high levels, the brain shuts down testosterone production and sperm production, both of which happen in the testicles. As a result the testicles shrink, soften, and the man’s fertility plummets. He may still have normal erections and orgasms, so he probably won’t realize anything’s wrong, but he’ll be shooting blanks.

When I explained all of this to my patient, he was shocked.  He had no idea. He agreed to stop taking the supplements he was using and I prescribed a medication to help kick-start his body’s natural testosterone production machinery. His sperm count will probably start to return to normal in three months or so. If his experience is like my other patients who have unwittingly sterilized themselves with supplements, he should be none the worse for wear in 6 months and his chances of having children should be normal.

The problems with testosterone supplements apply even to supplements such as dehydroepiandrosterone (DHEA) and androstenedione.  These substances get converted to testosterone in the body, so all of the risks noted above apply to them. The array of products now available is so huge and the number of brand names so large that a comprehensive list isn’t feasible. In general, however, any supplement containing the following ingredients or which include the following words should be suspect:

• testosterone
• dehydroepiandrosterone (DHEA)
• androstenedione
• androstenediol
• prohormone
• prehormone
• “hormone”
• “anabolic”

The safest approach is to avoid all nutritional supplements if you are trying to have a baby because many contain hormones or hormone precursors that can hurt fertility and ingredients are often labeled in deceptive ways.

Please Exercise

by Fred Licciardi, M.D.

author of the infertilityblog.com

Please exercise.

In the preceding centuries, tremendous physical activity was required for human survival, and yet, reproduction carried on. Imagine the exhaustion and stress if we had to spend one week hunting or farming with few tools or resources. Yet probably, under these conditions, most women would be able to get pregnant.

Excessive extreme exercise causing weight loss will cause ovulation to stop because the body figures that there are not enough nutrients stored for both the woman and a fetus. If she can just barely feed herself, she can’t feed the growing baby. The same is true for an anorectic. But here we are talking about extreme extreme. Moderate exercise is fine.

Surprising to me, I did come across a paper from Harvard showing that women who underwent moderate levels of exercise had lower pregnancy rates that those who did not. Like we always say, it’s just one paper. I do not really believe it. The Harvard doctors that I know do not restrict moderate exercise.

Exercise is bad if you are taking fertility drugs because the medications make the ovaries grow. Normally the ovaries are about the size of a walnut, and the drugs increase the number of follicles, therefore the ovarian size increases. Sometimes the ovaries can get to the size of plums or even oranges. They hang inside the pelvis. As they become heavier, they become more likely to twist, and this is called torsion. Here the twisting cuts off the blood supply and causes the ovary to choke. This really hurts, and is treated by laparoscopy. Exercise will increase the odds of this twisting. So in this case, exercise is not good.

Exercise increases blood flow to all areas of the body. The uterus and ovaries are organs that would love to get as much blood flow as they could.

Exercise clears you head. Yes, endorphins are released with strenuous activity, and these can help us fell better, but I think it’s more than that. My theory is that it’s not just about increasing the good chemicals; it’s about getting rid of the bad. Increased blood flow flushes away the old stale thought chemicals that are just hanging around causing trouble. Get rid of them.

Even better, do exercise that requires tremendous concentration. This really clears you head. Any sport will do: sailing, golf, soccer, basketball, biking, you name it. Some are more strenuous than others, but they all work. Same thing; flood your brain with fresh blood and new thoughts, lose the waste products.

Exercise builds muscle mass. This is also good. It just makes you feel better if you have a little tone. Even if you think you are fat, the tone goes a long way. It’s healthier to have some tone and muscle. It helps with balance and lowers you chances of getting injured during an accident (falling, for example).

And people with a little tone just age better.

Not to mention all of the obvious benefits of upping your cardio-vascular reserve.

I am not an expert in Yoga, although I have happily done it a few times. It's very good alternative.

So you don’t have time for exercise? Yes you do, make time. If you are tired, go to gym tired, it works just as well. You will sleep better.

If you do decide to take my advice (and the advice of others), go all out. A little exercise once a week is better than nothing, but more is better. You need at least 2 sessions per week of vigorous activity to really make a difference. Don’t start on any aggressive workout without checking with our doctor first, and consider a trainer at least initially.

See disclaimer 5/17/06 and Happy Workout,

Hot Stuff, That Mama

by Corey Whelan

 

As the proud owner of a vagina, I have always considered myself to be a woman.  But evidentally, that decision may not always be so cut and dried.  Have you been reading about Caster Semenya? 

 

 

Caster Semenya is 18 years old.  She’s been running for practically the entire length of that 18 years, but we in the U.S. had never heard of the South African teenager until last week, when she won the World Championship 800 meter race in Berlin, against seven other female runners from various countries, including Russia and Italy.

The thing about Caster is this.  Is she a she? 

 

 

Those who know her best say Caster Semenya is a girl.  But according to the runners whose rear ends she whopped in the 800 meter, as well as to the International Association of Athletic Federations (IAAF), the line is blurry and Caster Semenya’s sexual orientation, and therefore her medal, is in doubt. 

 

 

That line is, in fact, often blurry.  About one in every thousand individuals born worldwide are intersex, a term used for people with, get this.  Gender abnormalities.  According to the U.S. & World Population Clock, as of today there are 677964179 people living in the world and no, I don’t know where to put the comas.  (If my kids were home they would do it for me.)  But divide that number by 1,000 and you know what you get?   Another really large number. 

 

 

So.  If that many people are born each year that have a so-called “intersex condition”, why is the term gender abnormalities routinely used to describe them?  Can that many people born actually be coined abnormal?   Wikipedia doesn’t even list the word abnormal on its site, but does state that “Abnormality, in the sense of something deviating from the normal or differing from the typical (such as an aberration), is a subjectively defined behavioral characteristic, assigned to those with rare or dysfunctional conditions". They then go on to state that “defining who is normal or abnormal is a contentious issue in abnormal psychology.”  Ya think?

 

 

Caster has been derided by many around her for her entire life because she looks like a boy and acts like a boy.  But most importantly, at least in the eyes of many, this speed of lightening, talented athlete, runs like a boy.  Caster is a blessing to some and a threat to others.

South Africa adores her and is heralding her as a hero.  And her momma stated plainly, “I’m proud of her, I gave birth to her, and she is a woman.  She is beautiful and perfect and anyone who has a problem with that can come and see me.” 

 

Hot stuff, that mamma.  Her name is Dorcus, and she is my hero.  Caster Semenya may have grown up dirt poor, beyond anything that we know.  But she has the most valuable thing in the world – a mother who will fight like hell for her.      

 

 

Women can be fierce as anything, especially when they feel the need to protect their children.  What mother living doesn’t know that?  What potential, future, mother does not know that as well?  What step mother?  Grandmother?  Surrogate mother?  Birth mother?  If necessary, we are indestructible, a stone wall, an iron clad brick insurmountable structure, at least where our children are concerned.  Maybe not always for ourselves.  But certainly always for our children.

 

 

Especially if anyone tries to hurt them. 

 

 

I’m not a doctor and I know very little about the barrage of genetic and chromosomal tests that Caster is being put through right now by the IAAF.  That information will come in another blog on this page, written by another voice.   My concern is for Caster herself, not for the future of her sport, or for her competitors, or for the accuracy of scientific testing.

 

How does Caster feel, right now?  Proud of her accomplishment or embarrassed about her appearance, the public curiosity about her gender? Both?   How has this eighteen year old, this kid!  Always felt, or been made to feel, about herself?  Who, and what, does Caster say she, herself, is? 

 

 

While it isn’t enough, of course, for the governing bodies of any sport to utilize as a yard stick, to me that is the true barometer.  You yourself, only you, have the right to stake that claim.  You are who you say you are.  You are what you say you are.  It is your choice, and your declaration, if you are brave enough to make it.  Yours is the only voice that counts.  Labels be damned.  You get to decide for yourself who you are now, and who you want to be. 

 

Thanks for reading. 

For more information on this story go to:

      

www.census.gov/main/www/popclock.html/

http://www.timesonline.co.uk/tol/news/world/africa/article6806403.ece

 

http://www.sportsscientists.com/2009/08/caster-semenya-male-or-female.html

http://www.latimes.com/news/nationworld/world/la-fg-south-africa-runner21-

2009aug21,0,5294672.story

http://blogs.thetimes.co.za/hartley/2009/08/24/caster-all-of-south-africa-is-proud-of-you/