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In the world of male fertility, it has been recommended by the Practice Committee of the American Society for Reproductive Medicine to wait for an improvement in sperm parameters after a varicocele repair that is seen in approximately 2/3 of men. Researchers in Toronto, Canada decided to see if this claim held up in a group of Canadian men and published their work in January 2012.

Dr. Al Bakri and associates looked back at 100 men who had their varicoceles repaired with a baseline average sperm concentration of 18.2 million/mL. They watched how their sperm production improved over the first 6 months after the repair. They found that the average sperm concentration improved significantly by 3 months time. Moreover, waiting an additional 3 months did not seem to provide any additional improvement. Specifically the average sperm concentration improved by 53% at 3 months to 27.9 million/mL and by 38% at 6 months to 25.1 million/mL.

Bottomline: This novel research looking at the time line for improvement of sperm parameters after a varicocele repair needs to be confirmed; however, it does suggest that couples may be able to initiate alternate reproductive therapies such as inseminations or IVF by 3 to 6 months after a varicocele repair instead of waiting the previously recommended time of 12 months. Many thanks to this Canadian team for this exciting research which may help many couples better navigate their reproductive journey towards a building a healthy family.

Reference: Al Bakri 2012 J Urol 187: 227

The distance from the bottom of your scrotum to the top of your anus, the anogenital distance or AGD, may correlate with your testosterone levels. The AGD has been known to be a marker for the development of genitals. Historically, it has been used to identify the gender of animals, and the AGD has been found to be longer in boys than in girls. Moreover, recent studies have suggested that AGD correlates with better semen parameters. Researchers from Baylor College of Medicine in Houston, Texas recently looked at AGD and looked for correlations with reproductive hormones.

Dr. Eisenberg and associates in 2012 looked at 116 men with the average age of 36. They measured their AGD as well as the following reproductive hormones (FSH, LH, testosterone and estrogen). The averaged AGD was 3.4cm and the average testosterone was 316.5 ng/dL. They found that a man's testosterone increased by approximately 20 ng/dL for every 1 cm increased in AGD. Additionally, men with low testosterone (<300ng/dL) had a shorter AGD (3.2cm) as compared to men with normal testosterone (3.7cm).

Bottomline: This is definitely interesting research that we will hear more about in the future. It probably will not change how we evaluate men for male fertility since semen analysis and blood tests to look at hormone levels provide more definitive information; however, we just wanted to give guys a heads up just in case your male fertility doc near you whips out a ruler and starts taking measurements "down there". This way you won't be surprised!

Reference: Eisenberg et al. 2012 J Urol 187: 594

In 2011, the National Urology Research Agenda (NURA) and the American Urological Association have deemed "male-factor infertility" as a research area of high priority.
Here are some facts that led to this decision:
1. Almost 5 million men have sought out help for infertility at some time in their lives.
2. 20% of couples seek infertility treatment or care.
3. A male factor contributing to infertility is found in up to 50% of couples.

Reference: Urology Health Extra Fall 2011: 11

Have you ever wondered whether the kids of infertile couples were more likely to be boys or girls? Well, in 2011, Dr. Eisenberg and associates at the University of California San Francisco and the University of Washington in Seattle thought that it was worth looking into and looked back at 5293 couples who sought infertility care in California between the years of 1990 and 1998 and they had 6178 kids. They then compared them to 6730 fertile couples who had 9131 kids. What they found was that there was no significant difference in the ratio of boys to girls between the two groups. The male to female ratio of the kids was 3188:2989 for the infertile couples and 4660:4471 for the fertile couples (no significant difference). They then compared the two groups based on whether male factor infertility was an issue and found that the fertile couples had boys 51% of the time versus couples with male factor infertility who had boys 50.3% of the time. So basically there was do difference there as well.

Bottomline: This study of Californian couples in the 1990's found that infertile couples even with male factor infertility do not seem to be more or less likely to have kids of a specific gender as compared to fertile couples. Special thanks to these research groups at UCSF and UW for great stuff.

Reference: Eisenberg et al. 2011 Fertility & Sterility 96 (4): 833

Dr. K and his med school buddy from Seattle Same Warren crossed the Grand Canyon Rim-to-Rim-to-Rim for a total of 44.8 miles to celebrate Dr. K's 40th birthday. Leaving the South Rim at 2am in 32 degree weather, descending in the light of a full moon, being baked during the afternoon in the 93 degree heat and surviving the total of 10,700 feet elevation gain, they had another soulful experience to add to the memory books of yet another wacky Warren/Kuang escapade.
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