Welcome to Dr E’s Reference Library!

This library contains scientific and medical references, as well as other contact information, that might be helpful to you as you are trying to conceive (TTC). You CAN find articles about infertility and learn about your own situation; this will help you make choices and ask your doctor the questions you need answered. The information provided in Dr. E’s Reference Library is in no way inclusive of all the literature, but it does review some areas of critical importance for TTC couples. In particular, Dr. Ellington, an Andrologist (a scientist that studies male reproduction), has provided references in areas that often are not adequately discussed by other websites for you to read yourself. These include:

● aspects of male infertility
● the importance of sperm chromatin damage in infertility
● the role of vitamins in supporting male fertility
● how TTC can interfere with normal sexual function and enjoyment; and
● the adverse effects of most lubricant products on sperm function.

In addition, Dr Ellington has provided articles that discuss potential benefits of the plant sugar arabinogalactan (a bioactive polysaccharide) she has studied, and that is an important component of products such as Pre~Seed Intimate Moisturizer.

For questions or further information please email info@ingfertility.com.


How to use the Reference Library

This site lists scientific references in key topic areas that may be helpful to you. You can find short summaries of the papers (abstracts) you are interested in through the National Library of Medicine’s “PubMed” service (http://www.ncbi.nlm.nih.gov/sites/entrez/). PubMed provides access to over 12 million journal articles in the life sciences and medicine, including reproduction. The easiest way to use PubMed is to enter the title of an article you want to view into the search for box, or you can just enter terms (keywords) that define what you are interested in (for example “sperm lubricants”) and then click on “Go”. Note that when you are entering search keywords, joining words with “and” is not needed.

You can then click on each of the retrieved articles to see if it is of interest. You will usually see a short paragraph (abstract) that you can read. If you are really interested in one of the papers then you can receive (at cost) a copy of the whole contents to read, and perhaps later discuss with your doctor.

Abstract links from several papers having to deal with Pre~Seed, a new “sperm friendly” vaginal moisturizer, that have not undergone full publication (and therefore are not on PubMed yet) are also provided on this site.

As you evaluate papers in an area of interest to you, you can also find national, and even international leaders in the research field that you may want to approach for clinical assistance and/or referrals elsewhere. It is fine to contact the scientists or clinicians that do these studies, although many scientists will not enter into correspondence with patients as they are not medical doctors. The worst that can happen is that someone will ignore your e-mail! But, then again, they might be able to advise you.


How Common is Male Infertility?

In as many as 60% of TTC couples their problems with fertility involve a male component. However, the male partner is not always worked up as thoroughly as might be warranted, especially if a couple sees an IVF specialist. Most often the reason for a man’s poor fertility is unknown. Knowing how to diagnose and help male infertility is a different specialty to gynecology – so if you are having trouble conceiving it is worth the time and effort to find a Clinical Andrologist or Urologist to work with you. We hear from people all the time that wished they had sought experienced, professional help in dealing with male factor issues far sooner! Indeed, very few ObGyns or REs are specialists in male reproduction, and might not know the most advanced therapy options. Dr Ellington suggests that you spend the time to investigate the rapidly expanding literature and advances in male infertility early on in your TTC efforts.

There are NO proven effective drug treatments for male infertility (e.g. antiestrogens, aromatase inhibitors, and even antioxidants), and androgens (such as testosterone) should NOT be used because they may actually suppress spermatogenesis!

Sperm DNA can be damaged by fever (“febrile illness”), and it will take 3 months to recover from this damage. Therefore, it is important to bear this in mind when embarking upon assisted conception treatment (IVF or ICSI, or even IUI). Semen quality (and sperm DNA) are also adversely affected by smoking, and many authorities recommend that anyone seeking treatment for infertility should stop smoking before attempting any form of treatment.

In particular, evaluating sperm chromatin or DNA damage in the man’s sperm can be very important. Sperm with high levels of damaged chromatin can look completely normal under the microscope, yet they cannot support a healthy term pregnancy. It is also important to remember that a man can have a great deal of performance anxiety that can occur when TTC. Check out the articles on the importance of keeping sex fun and enjoyable for you as a couple, and to help your man produce the most motile sperm possible!


ASRM Practice Reports

The following reports relating to male infertility have recently been published by The Practice Committee of the American Society for Reproductive Medicine, in Supplement 4 (November 2006) to volume 86 of Fertility and Sterility. Given this group’s status, it would seem reasonable to expect that these recommendations should form the “minimum standards” for infertility practice in the United States.

● Report on optimal evaluation of the infertile male, pp.S202-S209.
● Report on varicocele and infertility, pp.S93-S95.
● Genetic considerations related to intracytoplasmic sperm injection (ICSI), pp. S103-S105.
● Effectiveness and treatment for unexplained infertility, pp. S111-S114.
● Sperm retrieval for obstructive azoospermia, pp. S115-S120.
● Smoking and infertility, pp. S172-S177.
● Round spermatid nucleus injection (ROSNI), pp. S184-S186.
● Report on evaluation of the azoospermic male, pp. S210-S215.
● Report on management of obstructive azoospermia, pp. S259-S263.
● Vasectomy reversal, pp. S268-S271.

This journal supplement also includes numerous reports relating to female factor infertility.

Listed Below is a Selection of Recent Papers on Male Infertility:

Aitken RJ. Sperm function tests and fertility. Int J Androl 2006; 29: 69-75.

Bhasin S. Approach to the infertile man. J Clin Endocrinol Metab 2007; 92: 1995-2004.

Bretveld R, Brouwers M, Ebisch I, Roeleveld N. Influence of pesticides on male fertility. Scand J Work Environ Health 2007; 33: 13-28.

Chow V, Cheung AP. Male infertility. J Reprod Med. 2006; 51: 149-156.

Ferlin A, Raicu F, Gatta V, Zuccarello D, Palka G, Foresta C. Male infertility: role of genetic background. Reprod Biomed Online 2007; 14: 734-45.

Fisch H, Lambert SM, Goluboff ET. Management of ejaculatory duct obstruction: etiology, diagnosis, and treatment. World J Urol 2006; 24: 604-610.

Fraczek M, Kurpisz M. Inflammatory mediators exert toxic effects of oxidative stress on human spermatozoa. J Androl 2007; 28:325-333.

Gaur DS, Talekar M, Pathak VP. Effect of cigarette smoking on semen quality of infertile men. Singapore Med J 2007; 48: 119-123.

Goldstein M, Tanrikut C. Microsurgical management of male infertility. Nat Clin Pract Urol 2006; 3: 381-391.

Hammoud AO, Gibson M, Peterson CM, et al. Obesity and male reproductive potential. J Androl. 2006; 27: 619-626.

Hauser R. The environment and male fertility: recent research on emerging chemicals and semen quality. Semin Reprod Med 2006; 24:156-167.

Jarow JP. Diagnostic approach to the infertile male patient. Endocrinol Metab Clin North Am 2007; 36: 297-311.

Kumar R, Gautam G, Gupta NP. Drug therapy for idiopathic male infertility: rationale versus evidence. J Urol 2006;176: 1307-1312.

Masarani M, Wazait H, Dinneen M. Mumps orchitis. J R Soc Med 2006; 99: 573-575.

Nguyen RH, Wilcox AJ, Skjærven R, Baird DD. Men's body mass index and infertility. Hum Reprod 2007; 22: 2488-2493.

Pasquali R. Obesity, fat distribution and infertility. Maturitas 2006; 54:363-371.

Ramlau-Hansen CH, Thulstrup AM, Aggerholm AS, et al. Is smoking a risk factor for decreased semen quality? A cross-sectional analysis. Hum Reprod 2007; 22: 188-196.

Schiff JD, Ramírez ML, Bar-Chama N. Medical and surgical management male infertility. Endocrinol Metab Clin North Am 2007; 36: 313-331.

Sergerie M, Mieusset R, Croute F, et al. High risk of temporary alteration of semen parameters after recent acute febrile illness. Fertil Steril. 2007; 88: 970e1-7.

Tournaye H. Evidence-based management of male subfertility. Curr Opin Obstet Gynecol 2006; 18:253-259.

Turek PJ. Practical approaches to the diagnosis and management of male infertility. Nat Clin Pract Urol 2005; 2:226-238.

Verpoest W, Tournaye H. ICSI: hype or hazard? Hum Fertil (Camb) 2006; 9: 81-92.

Williams DH, Karpman E, Lipshultz LI. Varicocele: surgical techniques in 2005. Can J Urol 2006; 13 Suppl 1: 13-17.
 

Understanding How Stress Can Affect Sperm Counts and Fertility

Stress can actually reduce sperm counts and hence your fecundity (i.e. the chance of a couple conceiving in each cycle of trying). One of the main factors causing stress for a TTC couple is the quality of their sexual pleasure during the ovulatory period. Couples who are able to enjoy sex, even if it has to be “timed”, have less marital stress and discord, and actually have a higher conception rate. Interestingly, making sure that sex is enjoyable for both partners is important – and SPERM SAMPLES PROVIDED AFTER MORE STIMULATION AND LESS STRESS HAVE HIGHER MOTILE SPERM COUNTS!

While the evidence between stress and reduced sperm count is weak, some men become so stressed while TTC that they have trouble ejaculating. This can be very stressful for the couple, and can lead to significant discord. Recent studies suggest that these men have more success ejaculating if they take Viagra or a similar medication (e.g. Cialis or Levitra), or if they use vibratory stimulation. Making intercourse more relaxed, or even experimental, can also help (check out the link to my Q&A section on the Links page for some sexy ideas!).
 

Recent Papers

Aversa A, Mazzilli F, Rossi T et al. Effects of Viagra administration on seminal parameters and post- ejaculatory refractory time in normal males. Hum Reprod 2000; 12: 131-134.

Conrad R, Schilling G, Haidl G et al., Relationships between personality traits, seminal parameters and hormones in male infertility. Andrologia 2002; 34: 317-324.

Hjollund NH, Bonde JP, Henriksen TB, Giwercman A, Olsen J; The Danish First Pregnancy Planner Study Team. Reproductive effects of male psychologic stress. Epidemiology. 2004; 15: 21-7.

Lenzi A, Lombardo F, Salacone P et al. Stress, sexual dysfunction and male infertility. J Endocrin Invest 2003; 26: 72-76.

Morelli G, De Gennaro L, Ferrara M, Dondero F, Lenzi A, Lombardo F, Gandini L. Psychosocial factors and male seminal parameters. Biol Psychol 2000; 53: 1-11.

Peterson BD, Newton CR, Rosen KH. Examining congruence between partners’ perceived infertility-related stress and its relationship to marital adjustment and depression in infertile couples. Fam Process 2003; 42: 59-70.

Pook M, Krause W, Drescher S. Distress of infertile males after fertility workup: a longitudinal study. J Psychosom Res 2003; 53: 1147-1152.

Sheiner EK, Sheiner E, Carel R et al. Potential association between male infertility and occupational psychological stress. J Occup Environ Med 2002; 44: 1093-1099.
 

Other Papers

Giblin PT, Poland ML, Moghissi KS, et al. Effects of stress and characteristic adaptability on semen quality in healthy men. Fertil Steril 1988; 49: 127-132.

Harrison KL, Callan VJ, Hennessey JF. Stress and semen quality in an in vitro fertilization program. Fertil Steril 1987; 48: 633-636.

Hirsch AM, Hirsch SM. The long-term psychosocial effects of infertility. J Obstet Gyn Neonatal Nurs 1995; 24: 517-522.

Hjollund NHI, Jensen TK, Bonde, JPE, et al. Distress and reduced fertility: A follow-up study of first pregnancy planners. Fertil Steril 1999; 72: 47-63.

Pook M, Rohrle B, Krause W. Individual prognosis for changes in sperm quality on the basis of perceived stress. Psychother Psychsom 1999; 68: 95-101.

Ruggieri V, Roccetto F, Giovenso P, et al. Relationships among pleasure, anxiety and physiological response patterns during the sexual sequence in normal and dispermic subjects. Perceptual and Motor Skills 1985; 60: 603-610.

Takefman JE, Brender W, Boivin J, et al. Sexual and emotional adjustment of couples undergoing infertility investigation and the effectiveness of preparatory information. J Psych Obstet Gyn 1990; 11: 275-290.

Tuschen-Caffier B, Florin I, Krause W, et al. Cognitive-behavioral therapy for idiopathic infertile couples. Psychother Psychsom 1999; 68: 15-21.

Saleh RA, Ranga GM, Raina R et al. Sexual dysfunction in men undergoing infertility evaluation: a cohort observational study. Fertil Steril 2003; 79: 909-912.
 

Understanding the Effects of Personal Lubricants on Sperm Function


Many studies have found a deleterious effect of personal lubricants on sperm function such as motility, including a decreased ability of sperm to penetrate cervical mucus after exposure to lubricants.

In fact, several studies show that several well-known products, including KY Jelly, Astroglide and Replens actually KILLED SPERM EQUIVALENTLY TO CONTRACEPTIVE JELLIES.

A recent abstract (View Abstract) also shows an actual and severe decline in the ability of embryos to form in vitro (using a bovine model) when the sperm are exposed to the leading personal lubricant product.

This is particularly important in view of the fact that TTC couples report an increased incidence of vaginal dryness, due to stress and fertility medications. Most TTCers (>70%) have not spoken with their physician about vaginal dryness, and unfortunately, some of those that do are referred to sperm toxic products.

In contrast, Pre~Seed, a new product developed to relieve vaginal dryness while providing an optimal environment for sperm, did not interfere with sperm function or embryo development in studies done to date as cited below.


References

Agarwal, A, Said TM, Seifarth K,et al. Short. Changes in sperm motility and chromatin integrity following contact with vaginal lubricants. American Society of Reproductive Medicine, October 2005, Abstract O-177 (View Abstract).

Anderson L, Lewis SE, McClure N. The effects of coital lubricants on sperm motility in vitro. Hum Reprod 1998; 13: 3351-3356.

Ellington JE, Short RA, Schimmels J. Effect of new intimate moisturizer on sperm motility. American Society of Andrology, March 2003, Phoenix, AZ. (View Abstract).

Ellington JE, Short RA. Prevalence of vaginal dryness in trying to conceive couples. Pacific Coast Reproductive Society Meeting, April, 2003: Rancho Mirage, CA (View Abstract).

Ellington JE, Schimmels J. The effects of vaginal lubricants and moisturizers on computer assisted sperm analysis (CASA) parameters associated with cervical mucus penetration. American Society of Reproductive Medicine, October 2004, Abstract P-28. (View Abstract).

Frishman GN, LucianoAA, Maier DB. Evaluation of Astroglide, a new vaginal lubricant: effects of length of exposure and concentration on sperm motility. Fertil Steril 1992; 58: 630-632.

Kutteh WH, Choe CH, Ritter JO, et al. Vaginal lubricants for the infertile couple: effect on sperm activity. Int J Fertil Meno Stud 1996; 41: 400-404.

Miller B, Klein TA, Opsahl MS. The effect of surgical lubricant on in vivo sperm penetration of cervical mucus. Fertil Steril 1994; 6: 1171-1173.

Ozgur K, Franken DR, Kaskar K, Gabriel LK, Kruger TF. The influence of a mineral oil overlay on the zona pellucida binding potential of human spermatozoa. Andrologia 1995; 27: 155-159.

Tagatz GE, Okagake T, Sciarra JJ. The effect of vaginal lubricants on sperm motility and viability in vitro. Am J Obstet Gynecol 1972; 113: 88-90.

Tulandi T, Plouffe L Jr, McInnes RA. Effect of saliva on sperm motility and activity. Fertil and Steril 1982; 38: 721-723.

Tulandi T, McInnes RA. Vaginal lubricants: effect of glycerin and egg white on sperm motility and progression in vitro. Fertil Steril 1984; 41:151-153.

Wright RW, Ellington JE. Effects of personal lubricants on in vitro fertilization and embryo development. American Society Andrology, March 2003: Phoenix, AZ. (View Abstract).



The Beneficial Role of Arabinogalactan or Related “Bioactive” Polysaccharides on Cells Including Sperm

Dr Ellington’s research includes investigating the use of bioactive plant sugars in products to support sperm and embryo health, particularly via their apparent ability to limit oxidative stress. Example articles of how these plant sugars improve cellular health, including that of sperm, are listed here.


References

Bao X, Wang Z, Fang J et al. Structural features of an immunostimulating and antioxidant acidic polysaccharide from Cussuta chinensis. Plant Med 2002; 68: 237-243.

Ellington JE, Oliver SA, Evenson, DP. Polysaccharides containing arabinose and galactose decrease oxidative damage to sperm in vitro. American Society of Andrology, June 2002, Montreal, Canada. (View Abstract).

Ellington JE, Wright RW, Broder S, et al. A novel one step sperm wash product. Pacific Coast Fertility Meeting 1995, Palm Springs, CA. (View Abstract).

Ellington JE, Oliver SA, Wright RW et al. Use of a plant polysaccharide gradient to wash bull sperm improves fertilization & embryonic development. Int Embryo Transfer Soc, 1996, Salt Lake City, UT. (View Abstract)

Hagmar B, Ryd W, Skomedal H. Arabinogalactan blockage of experimental metastases to liver by murine hepatoma. Invasion Metastasis 1991; 11: 348-355.

Hauer J, Anderer FA. Human medicinal agents from plants. Am Chem Soc Symp Ser 1993; 534:1-348.

Kim LS, Waters RF, Burkholder PM. Immunological activity of larch arabinogalactan and Echinacea. Altern Med Rev 2002; 7: 138-149.

Kohen R, Shadmi V, Kakunda A, et al. Prevention of oxidative damage in the rat jejunal mucosa by pectin. Br J Nutr 1993; 69: 789-800.

Luettig B, Steinmuller C, Gifford GE, et al. Macrophage activation by the polysaccharide arabinogalactan isolated from plant cell cultures of Echinacea purpurea. J Natl Cancer Inst 1989; 81: 669-675.

Sakurai MH, Kiyohara H, Matsumoto T, et al. Characterization of antigenic epitopes in anti-ulcer pectic polysaccharides from Bupleurum falcatum L. using several carbohydrases. Carbohydrate Research 1998; 311: 219-229.

Ye Y, Neethling FA, Niekrasz M, et al. Evidence that intravenously administered alpha-galactosyl carbohydrates reduce baboon serum cytotoxicity to pig kidney cells (PK15) and transplanted pig hearts. Transplantation 1994; 58: 330-337.

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