Monday, August 4, 2008

Common Cause of Male Infertility Successfully Treated Without Surgery

According to new research, many men who suffer from infertility due to a problem with varicoceles can now be effectively treated with a minimally invasive procedure called retrograde venous embolization.

Varicoceles are abnormally enlarged veins in the scrotum. The condition can cause testicles to shrink and soften. As many as 16 percent of men have this type of varicose vein, which is a common cause of low sperm count. In fact, about 40 percent of men who are infertile have varicoceles, with the traditional treatment being surgery. Why the condition can cause fertility problems in men remains unknown.

Retrograde venous embolization (RVE) is a procedure done with a tiny catheter that works by blocking excessive blood flow into the veins and allowing them to shrink back to their normal size. During the procedure, a radiologist inserts a small catheter through a small incision in the groin and uses an imaging tool to guide it to the affected right or left-sided varicocele. There is a minimal recovery time and according to researchers, most patients can return to work the next day.

Dr. Sebastian Flacke from the University of Bonn Medical School in Germany led the study of infertile men aged 18-50 with at least one varicocele. All of the men had healthy partners who were trying to become pregnant. There was a total of 228 varicoceles in the 223 men who underwent the RVE procedure. Of them, 226 varicoceles were successfully treated while clinical and ultrasound testing revealed that the varicocele was totally resolved in 92.4 percent of patients (206 participants). The procedure significantly improved both sperm count and their ability to move spontaneously and actively (motility), yet the averages were still abnormally low according to the World Health Organization guidelines.

Of all the potential pre-treatment predictors of pregnancy such as varicocele severity, hormone levels, ultrasound findings, and other semen parameters, the researchers found that the only significant predictor was sperm movement.
In follow-up data on pregnancy in partners for 173 of the men, 45 couples or 26 percent, reported a pregnancy with five of them assisted by intrauterine insemination.

The study findings indicate that RVE does improve semen quality, resulting in pregnancy about one-third of the time, which prompted the authors to conclude that fertility benefits seen with this procedure are "similar to those reported after surgical repair," and refer to the treatment as a "useful adjunct to in vitro fertilization therapy."

The authors acknowledged several limitations of the study which included the absence of a control group, the lack of further assessment and grading of female infertility in women without proven infertility, and the relatively short observation period for treatment success. The study and its findings appear in the August issue of Radiology.

Hormone Therapy for Prostate Cancer: Helpful or Harmful?

If you have prostate cancer and you are an elderly man you may want to consider other options other than hormone therapy. A study has shown the one in four U.S. men with early prostate cancer will undergo hormone therapy, but it more likely to more harmful to them than helpful.

The surgery to remove the prostate, radical prostatectomy, is a little too risky for men that are in their 70s and 80s. When these men are found to have the early stages of prostate cancer, they will have three options to choose from.

The first option is they can wait to see whether this usually slow-moving cancer will become a problem. This type of observation is called conservative therapy or watchful waiting. The second option is to undergo radiation therapy and suffer its side effects. The third option is to undergo androgen-deprivation therapy: hormonal drugs such as Lupron, Eligard, Viduar, and Zoladex, or undergo surgery (orchiectomy) that will cut off the production of the male hormones.

Older men that are in the United States often opt for stand-alone hormone therapy, even thought there is really no proof that it is really helpful. One of the hormone therapy's most obvious side effects is sexual dysfunction. According to recent studies, the greater concern now with hormone therapy is linking the androgen deprivation therapies to heart disease, diabetes, bone fractures, and a reduction in muscle mass.

The most recent study on the hormone therapy strongly suggests that this type of therapy offer elderly men no benefit to justify these serious risks. Grace L. Lu- Yao Ph.D., MPH, which is from the University of Medicine & Dentistry of New Jersey, and her colleagues collected data from more than 19,000 mean that have been diagnosed with the early stages of prostate cancer at the average age of 77. Out of these men, none of them underwent surgery or radiation treatment for the early prostate cancer. Nearly 8,000 of the men, however, did decide to go with androgen deprivation therapy.

Lu-Yao said, "The reason patients want this is they want something that will improve their quality of life or their survival. But hormone therapy has a detrimental effect on quality of life. And we cannot find any survival benefit for these men in their 70s with very early-stage cancer."

So now we have to ask, why do so many men choose to undergo this unproven treatment that now seems to do more harm than it does good?

Otis Brawley, M.D. and chief medical officer for the American Cancer Society says that it is because it is just an American phenomenon. One of the problems is that when a man finds out that he has early stages of prostate cancer, both he and his physician feel it is necessary to do something. Unfortunately, the result in the end is that the number of men that should get conservative therapy end up getting some kind of intervention.

Brawley and Lu-Yao both suggest that these elderly men would have done just as well if their cancer had never been found. Brawley also notes that many of these men would have likely underwent continued prostate cancer screenings with PSA tests. The other men probably had possible prostate abnormalities that would have been detected by a urologist.

No matter how they got to their conclusions about their cancers, all of these men must have agreed to undergo prostate biopsies. Also, they may have not have been fully informed and could have come to the wrong decision, says the head of urology at New York's Mount Sinai School of Medicine, Simon Hall, MD.

"You have to have a discussion with an older man before he has a prostate biopsy. You have to ask them, 'Do you really want to open Pandora's Box?' Most patients with localized prostate cancer are not going to die from their disease in the first 10 years anyway. It is a legitimate question whether to screen patients this old, and whether urologists should biopsy older patients based on just a knee-jerk reaction."

Hall also noted that he would only treat a very few men with hormone therapy alone. A lot of the elderly men are at a very low risk and really don't need any treatment at all. It seems that the hormone therapy would make no difference so why put these men through the side effects or cost?

All of these experts have noted that the finding of the current study do not apply to the younger men who might receive androgen-deprivation therapy in combination with radiation or surgery. These such men may actually benefit from this type of hormone therapy.