Ask the experts
What Fertility Treatment Options are Available for Men?
Infertility affects about 15 percent of all couples trying to get pregnant. Infertility is an issue for the couple as a whole and should be viewed that way by your doctor. The decision to start a family is an exciting time for a couple, but can sometimes be met with challenges. The good news is there are treatment options for both men and women based on the cause of infertility, these include:
There are various medications available for the treatment of low sperm counts. They are designed to stimulate the testicles to produce sperm. Deciding which of these medications is right for you depends on the cause of your infertility and what your lab work shows. Most of these medications take up to 6-9 months for full effect.
In men who have very low sperm counts or who do not have sperm in their ejaculate, various sperm extraction procedures can be performed to retrieve sperm from the testicle or epididymis. Many of these procedures can be performed under local anesthesia in the office of an infertility specialist. The sperm harvested can then be used for in-vitro fertilization.
Sperm banking is a cost effective way to keep healthy sperm for future use in intrauterine insemination or in-vitro fertilization. In addition to the cost of collecting, testing and freezing the sperm, there is a $150-$300 yearly storage fee. Sperm banking is typically used in cases where a man develops cancer that will require treatment with chemotherapy and/or radiation, both of which have harmful effects on sperm production.
Sevann Helo, MD, is a urologist who specializes in Male Infertility and Sexual Medicine at the Mayo Clinic in Rochester, Minnesota.
What Treatments are Available for BPH?
Benign Prostatic Hyperplasia (BPH) is an enlarged prostate. BPH is not prostate cancer and does not make you more likely to get it. When you have BPH, your prostate squeezes the urethra. This can cause a weak urine stream, dribbling when you’ve finished or a hard time getting urine to come out. Needing to urinate often (day or night) is a common sign of BPH. The main treatment choices include lifestyle management, medications, minimally invasive treatment or traditional surgeries.
The first way to treat BPH is with lifestyle management. Take a step back and find out what lifestyle factors may be adding to your urination symptoms. It could be fluid intake, and/or too many liquids later in the evening. This treatment option can help a lot of men, but many times, it’s not enough. The next step would be to take medications.
A class of medications called alpha blockers may help relax some of the basic muscles of the prostate, allowing men to urinate more easily. Another class of medications commonly used are called phosphodiesterase type 5 inhibitors (PDE5) inhibitors, which may help ease some of the symptoms.
A third category of medication are 5-alpha reductase inhibitors. These could help decrease the level of DHT in the prostate, and in doing so, the prostate shrinks down.
If medications don’t work, or if the man has side effects from the medication, and they don’t want to take pills anymore, then the urologist, at this point, would normally talk to the patient about surgery.
Surgery comes in two broad categories. One is a standard/traditional surgical approach. These call for general anesthesia and involve some means of getting rid of a part of the prostate blocking the urine flow. The other is a category called minimally invasive surgical treatment where treatments are delivered in a non-invasive, or a minimally invasive, way to the part of the prostate causing the blockage.
Kevin McVary, MD, FACS, is a urologist, and the Director of Men’s Health at Loyola University Medical Center in Maywood, Ill.
What Happens During a Kidney Transplant?
A kidney transplant is one of the most common organ transplant surgeries performed today. It is a lifesaving choice for thousands of patients with kidney failure.
About 30 percent of patients with kidney failure can have a kidney transplant. This surgery returns kidney function by replacing 2 failed kidneys with 1 healthy organ. About two-thirds of kidney transplants come from nonliving (deceased) donors. Living donors can donate safely if tests show that the donor will have nearly normal kidney function after giving up 1 kidney.
A kidney transplant is most often placed in the lower stomach without removing the failed kidneys. The artery and vein of the new kidney are joined to an artery and a vein in the pelvis next to the bladder. The ureter (the tube that drains urine from the kidney to the bladder) attached to the new kidney is joined to the bladder or to one of the ureters.
Ninety percent of transplanted kidneys work well at the end of one year. About 40 percent of kidney transplants stop working each year after that. The kidney may be at risk for rejection, so it is vital to take all the drugs as prescribed by the health care provider. A kidney from a living donor has a better chance of lasting than one from a nonliving donor. The chance that kidney disease will return in the transplant depends on why the kidneys failed in the first place.
H. Albin Gritsch, MD, FACS, is Associate Professor of Urology and Surgical Director, Kidney Transplant Program at UCLA Health in Los Angeles.
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