So what about boxer versus briefs? I get that all the time if we remember back to the presidential elections of over 23 years ago we learned about Bill Clinton’s boxers/briefs habits and it’s since that it’s always been a topic of conversation. Now really there’s been a lot of literature and seems as if there’s a very very weak correlation between a man’s underwear choice. Having said that a lot of men that’s the first thing they do before they come see me is it proudly tell me that they’ve gone commando in hopes of improving their sperm counts. So it’s certainly a fun topic of discussion but maybe not clinically useful.
So what about overall health? So whatever is good for the man is good for the sperm. Conversely whatever is bad for the man is also bad for the sperm. So cigarette smoking is bad for sperm – bad for men. An alcohol consumption in moderation probably not bad for sperm, in excess – greater than five to six drinks at one setting especially highly correlated with poor sperm quality.
What about obesity itself? Interestingly enough obesity also has problems with hormones. So men that have very large body mass indices will also have abnormalities in their testosterone production as well as their conversion of testosterone to estradiol which is the female hormone and can have some negative effects on sperm production as well. So obesity really a multi-hit problem with sperm production as well as we know overall health.
Hypertension as well associated with male subfertility. Some of that hypertension medications also can have a negative effect. So something to discuss with your physician if you are attempting to have a child and are unsuccessful, and something you can bring up with your male fertility specialist as well to perhaps look for an alternative medication or figure out other ways to control blood pressure (diet, exercise, all the other good stuff we hear about).
So on the hormone side and non-obstructive subfertility men are not as simple as testosterone alone although that’s what we are sort of known for and given credit for. Actually a lot of hormones that can be responsible for problems with fertility, they most start in the pituitary gland. So there is a sperm producing hormone called FSH, is actually named for the female hormone which is a follicle-stimulating hormone. It turns out it has a similar function in the pituitary gland of men and essentially works as a regulatory hormone for the production of sperm.
So if a guy is making normal sperm numbers, his FSH should actually be pretty low. If a guy is making no sperm then his FSH is going to be elevated, is going be high because its pituitary gland is telling his testicle “look you need to crank up the factory production here, and you’re not meeting the goals”. And the only way that our body has to tell the tests to do that is that FSH hormone. So it’s a very important indicator for me to determine where the problem is. There’s really no great number throughout 12 million international units per milliliter as the upper limit of what I would consider normal. However, a lot of different considerations go into that number. So I can get concerned about FSH is as low at 6 but certainly over 12 I start to be a lot more concerned that we have a primary testicular problem.