​When couples come to me with infertility issues, they usually just assume that it is the female in the relationship that has problems.  However, what most couples don’t realize is that about 1/3 of the time it is male factor infertility that is preventing them from getting pregnant, and in another third of cases, both male and female issues can be present.  Making this worse is the fact that over the past 40 years, man’s sperm count has dropped steadily by 59%. Let that sink in- almost 60% drop in sperm count since the 1970’s.  What is causing the quality and quantity of sperm to decrease? Several recent studies have suggested that certain foods may be harming sperm. The timeline for the drop in sperm count parallels the rise in popularity of processed foods.

Foods that have been shown to affect sperm health

1. Processed Red Meats: Processed meats like hot dogs, bacon, and beef jerky seem to be major culprits in decreasing sperm counts and motility.  
2. Trans Fats: Fries, frozen pizza, baked goods (cakes, pies, cookies-especially with frosting), fast food, and even microwave popcorn.  The list for foods that contain trans fats is extensive. Avoiding processed foods in the grocery store and fast food restaurants is key to avoiding trans fats.  
3. High fat dairy products like cream and cheese was associated with decreased sperm motility and abnormal sperm shape.  It is thought that this is because of the sex steroids given to cows. Milk is one of those products that is probably better to buy from a source that ensures hormone free dairy.
4. Soy Products: soy products contain phytoestrogens (estrogen-like compounds) from plants, and excessive soy intake has been shown to decrease sperm concentration. 

How Can I improve my sperm health?

1. Try to stay away from processed meats, processed foods and trans fats!  Realistically the only way to do this is to cook most of your meals so you know what ingredients are going into your food.  This will allow you to control the salt and sugar content of your meals as well.
2. Eat your fruits and veggies. 
3. If you are overweight or obese, losing weight can help with sperm health.  Weight loss achieved with exercise has also shown to improve testosterone levels and sperm count!
4. Eat more fish!  Omega 3 fatty acids in fish has been associated with better sperm motility in some studies.  If nothing else, it provides a nice alternative to consuming red and processed meats.  
5. Eat Walnuts: It is thought that the fatty acids in walnuts help sperm development and can improve sperm shape, movement and vitality. 
   

There you have it.  Not only can diet have negative effects on a person's health, but it can also affect his sperm and ability to conceive as well.  Sometimes simple changes can be enough.  That being said, if you're doing all of the right things but still not having luck with conception, it may be beneficial to see someone for further testing.  Depending on the test results, there can be several options to help those having difficulty with conceiving, so be sure to discuss any concerns with your provider.  Good luck to all of those working to grow their families!

 Dr. Pam

While sex is intended to be fun by nature, for many couples there is a lot of stress to either make sure to have a baby or to make sure NOT to have a baby.  We’ve talked about infertility in the past, so today we’ll talk about the stress of avoiding pregnancy until you’re ready.  With about half of all pregnancies in the US being unplanned, here’s how likely you are to be successful with your chosen method to prevent pregnancy.

1. Progesterone-releasing IUD – this type of IUD is over 99% effective at preventing pregnancy and is good for up to 5 years, depending on the brand.  As an added bonus, your menstrual cycle is usually lighter, although sometimes the cycle can be a bit irregular.
2. Copper IUD – this type of IUD is also over 99% effective at pregnancy prevention and can be used up to 10 years.  It’s also hormone free, although sometimes it can make for heavier periods.
3. Nexplanon – another very effective birth control option, it releases progesterone and is over 99% effective for pregnancy prevention and works for up to 3 years.  Some users may experience irregular bleeding or weight gain.
4. Birth control injection – a progesterone shot that when used perfectly, is over 99% effective, but typically falls around 94% effective due to late injections.  Its side effect profile is similar to the implant, but slow return of menstrual cycle can cause a delay in the ability to conceive when stopped.  Also, there is an FDA warning regarding loss of bone density with longterm use.
5. Birth control patch – with the next few methods, efficacy can vary somewhat.  Perfect use happens when the contraception is used precisely as directed; typical use is, you guessed it, the way the method is typically used.  For the patch, perfect use would be about 99% effective, but typical use is closer to 91% effective.  The patch combines estrogen and progesterone is changed weekly, but sometimes it may fall off sooner.  This would require early replacement and may decrease efficacy.  Also, if you weigh over 198 lbs, then it may be less effective at pregnancy prevention.
6. Vaginal ring – another combination of estrogen and progesterone, the vaginal ring has a perfect use efficacy of 99% but again is only about 91% effective with typical use.  If not replaced on time or left out for more than 48 hours during the weeks it’s supposed to be in place, then these missteps can decrease efficacy.
7. Birth control pills – these can either be a combination of estrogen and progesterone or progesterone only (there are different indications for each), but again perfect use is over 99% effective whereas typical use is about 91% effective.  Be sure to review antibiotics and other medications with your provider to ensure there’s no interaction that can make the birth control pills less effective.
8. Condoms – condoms are great at reducing risk of sexually-transmitted infection, but they are a bit less effective at pregnancy prevention.  Even used perfectly, the male condom is only 98% effective, and this decreases to 85% with typical use.  Female condoms are even less effective, with only 95% effectiveness with perfect use and dropping to 79% with typical use.
9. Fertility tracking – whether basal body temperature, calendar method or cervical mucous method, this type of pregnancy prevention only works between 76-88% of the time, and if you have irregular cycles, the efficacy can decrease even further.
10. “Pullout method” – interestingly, this method can have a very substantial variation in just how effective it is.  While in theory, if done before ejaculation, the efficacy could be as high as 96-98%, typically it fails 20-30% of the time.  That’s essentially the same as using no contraception.  Part of that may be due to user error, whether in withdrawing too late or not understanding exactly when the sperm is released, and part of it may have to do with an individual’s particular composition of pre-ejaculate fluid, and another part may be due to residual sperm in the urethra from previous ejaculation (those little swimmers live for up to 5 days after all).
11. Permanent sterilization – both vasectomy and tubal ligation are over 99% effective; however, both are meant to be PERMANENT, so be sure that you’re sure no more children are in your future before considering a sterilization procedure.  While there are procedure to attempt reversal of sterilization, these are expensive, generally not covered by insurance and not always effective.
12. Nothing – pregnancy generally occurs 20-30% of the time with regularly unprotected intercourse each month, and most couples conceive within a year.

So, there you have it.  Be sure to discuss any change in contraception with your provider as some methods may not be appropriate if you have certain medical conditions, and there can be a delay of up to a week (or more for vasectomy) before your chosen contraception method becomes effective.  For some couples, an unplanned pregnancy is simply an unexpected surprise.  For others, it may be a much bigger deal, whether due to the stability of the relationship, financial limitations, medical restrictions or conflicts with job, education or other goals.  Generally speaking, if pregnancy would be a very big deal, then using one (or more) of the more effective contraception methods probably makes sense.  If the thought of a cute little surprise doesn’t stress you that much, then feel free to use any of the options for pregnancy prevention.  Just make sure to take prenatal vitamins in case you end up making that new addition to the family 😊

​Dr. Nick

Decreased libido is probably one of the most common complaints I get.  The conversation usually goes something like this- I have no desire to have sex- can you please check my hormones.   For women, hormones like estrogen, progesterone, and testosterone usually fluctuate based on the time of the cycle they are checked. Their value at different times in the cycle rarely gives us any insight as to the source of low libido. 

However, what most people forget is that the most common culprit for low libido is side effects from medications used to treat common maladies like hypertension and depression.  About 44% of Americans take at least 1 prescription medication and 17% take 3 or more.  If you look at a list of side effects for commonly prescribed medications, the list is so long that something like low libido can be easily overlooked.  Let’s go over some common medications that can affect your libido.
​

1. Antidepressants: SSRI’s like Prozac and Zoloft just to name a few are very well known to decrease sexual desire and diminish or delay orgasm.  58 to 70% of people taking SSRI’s experience these kinds of sexual side effects.  Why does this happen? SSRI’s work to increase the amount of serotonin circulating in the brain.  While serotonin helps you feel less depressed, too much serotonin can decrease a person’s sex drive and make it harder to achieve orgasms.  Talk to your provider if you experience this.  There are other antidepressants that have less of an impact on sex drive, and depending on your medical history, these may be an option. 
2. Birth Control Pills: Oral contraceptive pills, especially those with estrogen, can lower hormones like testosterone, and this can affect libido.  If you experience this, talk to your provider about other options like IUD’s. 
3. Marijuana: While not always used in a medical application, just because it is legal in some states does not mean that there aren’t side effects.  Marijuana can have a significantly negative impact both on libido and even the ability to have intercourse.
4. Opioids: Opioids can lower testosterone and have an adverse effect on sex drive. 
5. Hypertension medication: Blood pressure medications help lower the pressure inside blood vessels, so the heart doesn’t have to work so hard.  This reduced flow can interfere with orgasms in women and erections and ejaculation in men.   Common hypertension medications like beta blockers and diuretics can help lower blood pressure but can also have a negative impact on your libido.
6. Benzodiazepines: Xanax can help reduce anxiety, but it can also dampen your sex drive. The sedative and muscle relaxant properties are thought to lessen interest, excitement and sensation. Essentially, while making you numb to anxiety, it can also make you numb to arousal.
7. Statins: Statins are used to treat patients with high cholesterol.  Cholesterol is one of the building blocks for testosterone.  Interfering with the production of sex hormones like testosterone can adversely affect sexual desire. 
8. Antihistamines:  Benadryl and other allergy medications can dry out your runny nose, but they can also make you dry down there.
9. H2 Blockers (Zantac, Tagamet, Pepcid), which are used to treat gastroesophageal reflux and ulcers, while not as much of an issue for women, can cause impotence as well as breast enlargement in men. 

 
This blog is actually the short version of the list of medications that can interfere with both desire and performance of intercourse.  There are many more medications that can adversely affect your sex drive.  If you are on one of these medications and have noticed an adverse effect on your libido, please talk to your provider before discontinuing the medication.  Weighing the benefits of the medication as it relates to your individual health as well as whether alternative treatment options are available is a conversation that you should have with your provider prior to making any changes in your medical regimen.  Good luck keeping that healthy desire burning!

Dr. Pam