- Articles by Dr.Köhler
Most infertility experts agree that infertility is the appropriate diagnosis when pregnancy has not occurred after a full year of unprotected intercourse. About 1/7 couples will struggle with achieving pregnancy sometime in their lives. Of couple’s who struggle, about 20% of women will seek help from their physician or a female fertility specialist, but only 4% of men will receive a medical evaluation! In general, 50 percent of couples having difficulty conceiving have factors involving the female partner, another 35 percent involve the male partner, and the remaining 15 percent have both male and female factors that together prevent conception. At the SIU Fertility and IVF Center, couples have the unique opportunity to be seen together: Dr. Loret de Mola for the woman, and by Dr Köhler for the male. The opportunity to be seen as a couple, in addition to state of the art fertility technology, over 75 years combined experience in our embryology/andrology laboratory. and our expert, compassionate staff leads to our outstanding fertility success rates. Our take home baby rate for In Vitro Fertilization (IVF) is 74%, which more than doubles the national average success rate of 36%. Seeing Dr. Köhler for fertility problems is an opportunity for often otherwise healthy men to get a medical exam (believe it or not, men ages 20-40 rarely see their Doctor as they should). Patients can expect a thorough medical history, physical exam, and often additional testing. Additional testing for fertility includes a blood draw to assess hormone function and submitting 1-2 semen samples.
Common conditions that affect male fertility that Dr Köhler addresses include:
- Poor Lifestyle
- Low Sperm Count – Oligospermia & Azoospermia
- Hormonal imbalances
- Medical Treatments including those for Cancer (also known as Onco-Fertility)
- History of Vasectomy or other causes of reproductive tract blockage
- Erectile Dysfunction
- Problems with Ejaculation
A heart healthy lifestyle equals a fertility healthy lifestyle. In men trying to father a child, we recommend a tobacco free environment, a diet high in fruits and vegetables, exercise of 150 minutes per week, good sleep habits, an ideal body weight, and minimization of stress (if possible). We also recommend a daily multivitamin, avoidance of excessive scrotal heat (saunas, whirlpools, hot tubs), and avoidance of tobacco or cannabis. Choice of underwear (boxers or briefs), caffeine intake, modest alcohol use and hot showers do not seem to affect fertility in men.
Couples attempting to conceive should utilize ovulation kits, have sex every other day around time of ovulation, and ideally the male should abstain from ejaculation for 3-5 days before having sex when first attempting pregnancy around ovulation.
Websites for overall general health:
Low Sperm Count: Oligospermia (low sperm count) & Azoospermia (zero sperm count)
The majority of men struggling to conceive suffer from a low sperm count. The average man capable of inducing pregnancy with his partner within a year has 72 million sperm per milliliter. Men with less than 20 million sperm/ml will often struggle to conceive via intercourse. Men with < 5 million sperm/ml should undergo genetic tests to rule out chromosomal causes of infertility.
Sperm Extraction Procedures
Men with fertility problems will routinely have testosterone, estradiol and FSH (follicle stiumulating hormone) levels checked.
Although testosterone is the main driver of sperm production, men who struggle to get pregnant SHOULD NEVER TAKE TESTOSTERONE as this causes a counter intuitive DECREASE in sperm counts. Medications such as clomiphene citrate or anastrozole may be utilized to help low sperm counts with or without low testosterone.
Kohler articles in the press:
- What Your Erection Says About Your Health - article by Tobias Kohler, MD - click here
- 8 Things You Didn't Know About Your Penis - click here
- Male Masturbation: 5 Things You Didn't Know - click here
- Are you seeing more younger patients presenting with erectile dysfunction? - click here
- Flem Files: Great Balls of Pain - click here
- Treating Erectile Dysfunction — Without the Little Blue Pill: Non-pharmaceutical alternatives may be more effective - click here
- Erectile Dysfunction Stent Restenosis Rate Disappointing - click here
- PESA (Percutaneous Epididymal Sperm Aspiration) download pre procedure checklist
- MESA/TESE (Microscopic Epididymal Sperm Aspiration) download pre procedure checklist