Male Health

About one in 500 women either have no uterus or problems so severe with it that it can’t carry a child. Until recently, these conditions had no medical treatment.

In Fertility and Sterility, Mats Brännström and a team of surgeons at the University of Gothenburg in Sweden report uterus transplantation in nine women, eight of whom who were born without a uterus, and one who had it removed for cancer. Two of the women had complications that required surgical removal of the transplanted organs, but seven women made it to six months with their transplants.

The ultimate test of these transplanted uteri remains: whether they can carry babies. If they can, this would be a great advance for the millions of women afflicted worldwide by problems with their uteri so severe that pregnancy is impossible.

I had the pleasure of meeting Dr. Brännström last month at a conference in Brisbane, Australia. These surgeries are not easy, requiring up to six hours to remove the uterus from the donor and up to 13 hours to transplant it into the recipient. It’s a rare kind of surgeon that puts such great effort into coordinating complex care and developing new techniques in a careful and methodical way. Thanks to his efforts, we may be closer to a time when a woman without a womb isn’t hopeless if she wants to carry her child.

I gave a radio interview to Outside the Loop Radio discussing some of the topics that I recently discussed on this blog. For those interested, you can hear the interview here.

An article in press in Fertility and Sterility is getting a lot of media attention. The study connected men seeking infertility care to a cancer registry in the State where the clinic was located. The researchers found that men with infertility had almost twice the chance of getting cancer and almost three times the chance if the man had no sperm in his ejaculate.

The authors of the study have a few theories about why cancer and male infertility may be connected. Cells need to divide just right to make sperm in the testes, and problems with division could lead to both problems with making sperm and the kind of bad division that makes cancer. It could also be that toxic substances in the environment may lead to both infertility and cancer.

Whatever the reason, we’re beginning to understand that problems with male fertility are just a tip of a much bigger iceberg that involves health in general. It’s more than just about the testicles.

I was quoted in Time Magazine in an article on “Frontiers of Fertility“. For those interested, it’s a nice read.

As I’ve written before in this blog, clomiphene is an effective if off-label treatment for men with low testosterone who want to preserve their fertility. If used directly, testosterone itself actually decreases the making of testosterone and sperm in a man’s testis. Clomiphene increases testosterone production in the testis by increasing the pituitary hormones that tell the testis to make testosterone.

In the March issue of Fertility and Sterility, a journal that I co-edit with Dr. Antonio Pellicer, Drs. Kim and co-authors review the published medical literature on treating low testosterone with clomiphene and other drugs besides testosterone. They conclude that clomiphene is a safe and effective treatment for men with low testosterone and note that less than one year of treatment with testosterone is usually reversible if a man wants his fertility to return. Unfortunately, we don’t know all that much about longer treatments with testosterone, and many men who have been on testosterone for several years do not have sperm return even with other forms of treatment.

Drs Kim and co-authors give us a nice review that supports the use of clomiphene for men with low testosterone who want to preserve their fertility.