Are there any sexual positions that you recommend to increase chances of pregnancy?
Typically, the only one that has been shown to make any difference, is after ejaculation, having the woman lie with her legs elevated or propped up on a pillow for about 15 or 20 minutes.

How can a couple tell whether there lack of ability to conceive is caused my the man or the woman?
Since approximately half of infertility problems involve the man, we typically recommend obtaining one or two sperm counts prior to the workup of the woman, unless there are obvious female problems.

Are there any over the counter products that increase fertility?
No. There is a dietary supplement that has been advertised but, to date, there is insufficient evidence to show that it really changes fertility.

How do tight jeans cause a low sperm count?
That is actually a myth. There is very good evidence that shows that tight jeans and tight underwear, as well as all types of clothing do not have any effect on sperm count. There is really no difference in boxers versus briefs, tight jeans versus loose pants.

Can a vasectomy be reversed?
Yes. Vasectomy reversal can be successful. It is dependent upon several factors including the time from vasectomy, the experience of the surgeon, and type of vasectomy reversal performed.

How much time do you usually let go by before testing for a fertility problem?
I leave that up to the couple. The definition of infertility is inability to get pregnant after one year of unprotected intercourse. Some couples want to know before a year, and it is not unreasonable to start with something easy such as a sperm count.

What is retrograde ejaculation, and how can it be prevented?
Retrograde ejaculation is fairly uncommon and is typically associated with a neurologic disorder or previous abdominal surgery. It is not something that can be prevented, but it can be treated. Treatment is based on the specific underlying problem.

Quick question!! I had a tubal pregnancy; after that he had a vasectomy, what are the chances of that failing?
The chances of a vasectomy failing are dependent upon whether or not the man has undergone an adequate test to show that he truly is sterile. Once he has been confirmed to be sterile, the chances of failure are approximately 1 in 4,500.

What causes varicocele, and how does it affect fertility? What can be done to correct it?
Varicoceles are very common and tend to develop during adolescence. 15 percent of all men have varicoceles, but not all varicoceles affect fertility. It appears that decreased fertility is based on increased temperature within the testicles. They can be corrected by surgery or by radiologic placement of coils in the dilated veins. The success rate is fairly reasonable with improvement in approximately 65 to 70 percent of patients and natural conception occurring in approximately 30 to 40 percent of patients.

What is Peyronie's disease, and can it cause infertility?
Peyronie's disease does not cause infertility. It is a curvature of the penis when it is erect. It is typically seen in men between ages 30 and 50. It tends to be self-limited, meaning, it will stop progressing by itself. It does not always need to be treated.

What are the chances of conceiving after a man has a vasectomy?
The chances of conception after a man has had a vasectomy and has been confirmed to be sterile are approximately 1 in 4,500. The chances of conception after a vasectomy reversal are related to several issues including the type of reversal, the age of the female partner, and the sperm count after the reversal.

What causes some men to have fertility problems?
Fertility problems can be related to many factors including varicoceles, blockages, infection, hormonal problems, as well as genetic causes. Seeking help from a male fertility specialist is a good start to determining the problem as well as the answer.

  What causes lack of ejaculate?
That can be due to different causes including infection, blockage, or neurologic problems. It would require evaluation by a urologist or male fertility specialist.

  What are the latest treatments for infertility?
This is a fairly broad question. Much of the treatments now evolve around assisted reproductive techniques such as artificial insemination and in vitro fertilization. However, it is very important that prior to proceeding with these treatments, both partners are evaluated. There are often problems discovered, some of which are medically important when evaluating the infertile male. These should be addressed.

What is the process for in-vitro?
In vitro fertilization is essentially uniting an egg and a sperm in a dish to promote fertilization. The fertilized egg is then placed back inside the woman so that implantation can occur. Typically, the woman is placed on hormonal injections so that she will make multiple eggs for fertilization.

What drugs are best for hypertension if you are trying to have a baby?
The only antihypertensives that would have an effect on the male would be those that would cause difficulties with erection. The physician monitoring hypertension can select a drug that will have minimal effects.

Does the use of marijuana cause infertility or other testicular problems?
Yes. Marijuana is a well-known cause of fertility problems. It tends to cause hormonal problems as well as having a direct effect on the testicles. This can be with long-term as well as short-term use although short-term use tends to be reversible. However, it is important to realize that it takes three months for the testicles to make sperm. Therefore, even after the marijuana is no longer used, it may be several months or more before those effects have been reversed.

What other drugs cause fertility problems?
Many drugs can have an effect on sperm production. Sulfasalazine, a drug that is used in Crohn's disease, is well known to do this. Most hormonal supplements, including anabolic steroids, as well as other street drugs, can have an adverse effect on fertility. Antibiotics, alcohol, and tobacco all have been shown to have some effects on fertility.

What questions should a patient ask before undergoing a vasectomy reversal?
The success rate of vasectomy reversal is dependent upon several factors. Although the time from vasectomy is important, the experience of the surgeon performing the procedure is probably just as important. A surgeon should be able to perform both a vasovasostomy as well as vasoepididymostomy. It is also important that the surgeon uses an operating microscope and performs reversals on a regular basis. Furthermore, it is important to find out that individual surgeon's success rate, not the success rate quoted in the literature. Finally, the pregnancy rates are dependent upon female factors as well. Therefore, women over 40 may have a lower pregnancy rate even if the reversal is technically successful. This information should be readily shared with the patient prior to undergoing a procedure. However, it is also important not to undergo a vasectomy in the first place if you anticipate wanting to become fertile at some future time.

Do hot baths cause a low sperm count or is that just and old wives' tale?
Frequent and regular use of hot tubs can decrease a man's sperm count. Having said that, it probably should not be used as a method of birth control. Couples that are trying to conceive should probably avoid frequent hot tub use.

What other myths would you like to clear up regarding fertility and possibly men's sexual health?
One of the oldest myths is that there are no infertile men, only infertile women. This is obviously not true. Nearly 50 percent of infertility problems involve the male. Furthermore, there is much that can be done to improve male reproductive health, thus improving the couple's chances of conception.

Does smoking or alcohol affect fertility?
Recently several studies have addressed the effects of smoking on male fertility. There is some very good evidence that smoking can have an adverse effect on sperm count, motility, and function. It is always a good idea to quit smoking, particularly when trying to conceive. Alcohol is slightly more controversial. Mild to moderate amounts of alcohol have not been shown to have any effects; however, moderate to heavy amounts can affect sperm count as well as hormone production.

Is infertility often an indicator of cancer?
No. It can be, but this is a rare finding. However, the most common type of cancer in men of reproductive age is testicular cancer. This would be discovered during the evaluation of the man.