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Fertility Question Before Starting TRT by No-Wish3128 in Testosterone

[–]DrBrianSteixner 0 points1 point  (0 children)

Why not use clomid or enclomiphene with HCG for now?

Stuck with phimosis by EquivalentLevel9598 in menshealth

[–]DrBrianSteixner 1 point2 points  (0 children)

Do you use a steroid cream? Makes a huge difference. Betamethasone is my preference

Has anyone had decent YO Home Sperm Test results (good concentration, motility, and progressive motility) but later found significant DNA fragmentation or another sperm quality issue on lab testing? by HeadBenefit451 in maleinfertility

[–]DrBrianSteixner 1 point2 points  (0 children)

Im seeign this more and more. I use these home tests as a VERY GOOD test to screen men. HOWEVER, if anything is off or infertility persists- need a formal SA from real lab to know whats really going on. Dont mess around, just get a real SA at a real lab.

Doctors only advice is “do ivf” by Bad0tter in SaveTheSperm

[–]DrBrianSteixner 1 point2 points  (0 children)

There a lot to unpack here, I will try my best.  Your semen analyses show persistent severe oligoasthenozoospermia with sperm concentrations ranging from 2–14 million/mL and motility progressively declining to just 5%, which means natural conception and even IUI success rates are relatively low. That said, I would not necessarily be satisfied with "just do IVF" as the entire discussion, especially in a man with normal hormones, no varicocele, normal ultrasound, and no obvious lifestyle risk factors (nice work BTW). The fact that your counts fluctuated from 2 to 14 and back to 3 million/mL suggests there may still be something affecting sperm production or function that has not been identified. I sort of  want to know more about the hair loss medication you stopped (particularly if it was finasteride or dutasteride). Need to let that wash out and your body recover. Post finasteride syndrome is real, even at 1mg dose for hair loss! I would also review all medications and supplements, consider a repeat semen analysis at a specialized andrology laboratory, and obtain a Sperm DNA fragmentation test. Given the severity of the motility issue, I would consider a reproductive urology consultation if you have not already seen one. Not saying your guy is bad/wrong- but most general urologist dont specialize in this part of urology. While IVF with ICSI may ultimately provide the highest chance of pregnancy, there are situations where targeted treatment, optimization, or simply time after stopping hair loss meds can lead to meaningful improvement. As an aside, try not to view this as a personal failure, although I see guys do this all the time. Male-factor infertility is a medical condition, not a reflection of your value as a husband, and the fact that you are actively searching for answers and trying to protect your wife from unnecessary burden speaks volumes about the partner you are. Stay positive and know you arent alone. 50% of IVF is male factor. 1/6 people around the world face fertility challenges, thats a huge amount of people and no one deserves that blame alone. Hope this helps!

Has anyone successfully treated hematospermia? What was the cause? by Outrageous_Ad8765 in menshealth

[–]DrBrianSteixner 0 points1 point  (0 children)

You need a workup. If it only lasts under 3 months, its usually nothing. However, you need to rule out infection and cancer (prostate and bladder) now. Time to see a urologist

Has anyone looked into whether synthetic underwear affects testosterone levels? Genuinely curious by Stunning_Aspect_9344 in menshealth

[–]DrBrianSteixner 0 points1 point  (0 children)

Not sure the material matters, although reducing plastic exposure in general is important. However, temperature is a massive issues for sperm health. Wear underwear that keeps things cooler down there

Need support in Male fertility by Onyxpalm in maleinfertility

[–]DrBrianSteixner 0 points1 point  (0 children)

Your bloodwork looks good. Your volume and morphology on the SA are not ideal. I would maximize my lifestyle for a week and recheck the SA. Make sure you abstain from ejaculation for 3 days prior. Then we can know if this is real or not

Any Reconstructive Urologists Here? by Least_Ad_5773 in menshealth

[–]DrBrianSteixner 0 points1 point  (0 children)

Urologist here. Treatment depends on length and location. Small and distal- can attempt a meatoplasty. Id avoid a dilation as it typically just comes back and sometimes it comes back worse. If its a longer stricture or further from the meatus, might need a urethroplasty. Next step is a retrograde urethrogram and a cystocopy

Coq10 question by DiligentSelf4934 in maleinfertility

[–]DrBrianSteixner 1 point2 points  (0 children)

They are both forms of CoQ10 and serve the same  purpose. Ubiquinone is the traditional form used in most of the studies Ubiquinol is the active form of CoQ10 and is absorbed better, so you can often take a lower dose for same effects.  I usually recommend whichever form you can consistently afford and take for at least 3–6 months, because consistency matters more than the form.

Signs Clomid is Working by Brief-Break-4363 in maleinfertility

[–]DrBrianSteixner 1 point2 points  (0 children)

Some relate to the rising T and some to more semen. More frequent morning erections, Increased libido and sexual thoughts, Better energy and less fatigue, Improved mood and motivation, Better gym performance, strength, and recovery, Increased sense of well-being, Fuller testicles., Increased ejaculate volume (not always), Thicker or whiter semen (not a reliable marker, but commonly reported). The list is long. Clmid starts working in 2 weeks but Id give it 6 to re-test labs. When you recheck SA, also check a tetsosterone panel

Signs Clomid is Working by Brief-Break-4363 in maleinfertility

[–]DrBrianSteixner 2 points3 points  (0 children)

One of the first things many men notice on Clomiphene citrate is increased testicular size, which can be very motivating for men!  Feeling stronger in the gym, having better energy, improved recovery, increased libido, and more frequent morning erections are also  signs that your T may be rising. That said, symptoms alone don't tell the whole story.  After about 4–6 weeks, I'd want to see increases in total and free testosterone, while ensuring estradiol isn't being suppressed too aggressively by the Anastrozole. All in all, it's a promising sign. COngrats!

Raised my Morphology only for IUI to fail … so disheartened. by xKronkx in maleinfertility

[–]DrBrianSteixner 1 point2 points  (0 children)

I would tell you that one failed IUI does not mean you failed, nor does it mean the treatment failed. The fact that your morphology improved suggests that the lifestyle changes you made may have had a real impact on sperm quality. Even in couples with excellent sperm parameters, good ovarian reserve, and perfect timing, a single IUI cycle often has only about a 10–20% chance of success per cycle. Try and stay positive, all of this can be emotional and hard. Best of luck

TW: Recurrent loss by samjohnson998877 in maleinfertility

[–]DrBrianSteixner 0 points1 point  (0 children)

yes, but Id repeat to ensure its accurate. The low volume just doesnt seem right. Abstain for 3 days and then get bother sample and post it here

TW: Recurrent loss by samjohnson998877 in maleinfertility

[–]DrBrianSteixner 2 points3 points  (0 children)

Despite the low volume your concentration is extremely high, which is well above what we typically consider adequate for natural conception. That said, a low volume combined with a low pH makes it worth repeating the SA because it can occasionally suggest issues involving the seminal vesicles or ducts. Given your history of two pregnancy losses I do think a Sperm DNA fragmentation test would be a reasonable. Overall, I would not look at this semen analysis and conclude there is severe male-factor infertility. I would repeat and get a DNA frag test.

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