The Healthy Male. issue 68 CONTENTS. Fertility Week: Healthy you, healthy baby. Spring Fertility Week: Healthy you, healthy baby

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1 The Healthy Male NEWSLETTER OF ANDROLOGY AUSTRALIA Australian Centre of Excellence in Male Reproductive Health Spring 2018 issue 68 CONTENTS 1 Fertility Week: Healthy you, healthy baby 2 From the Medical Director 2 Health spot The verdict is in - the brief on sperm count 3 Focus on Considering a vasectomy? Here s what you need to know 5 Community Development Men s Health Week 2018: It s healthy to talk is a winner 5 Research round-up Immunotherapy breakthrough for advanced prostate cancer 6 In brief 6 Latest News Investigating fertility in men born by intracytoplasmic sperm injection (ICSI) Dell Lovett presents keynote lecture at the National Nursing Forum on sexual health and diabetes Fertility Week: Healthy you, healthy baby This year, Fertility Week is talking about the importance of good health for men and women before trying for a baby. Fertility Week 2018 runs between October and is brought to you by Your Fertility and the Fertility Coalition. Find out more at When trying to have a baby, it is important to know that a man s general health at the time of conception can affect the health of his sperm, which in turn, can impact on his fertility and the long-term health of any child he may have. Being very overweight, smoking, environmental chemicals, alcohol, drugs, lack of physical activity and bad eating habits all pose risks to sperm health and, as a result, to the health of a future child he may help to create. Chronic health conditions such as diabetes and hypertension can also harm sperm health. These environmental factors can alter the setting in which eggs and sperm mature and this can lead to gene changes (epigenetics) which affect the way a baby develops during pregnancy and ultimately the lifetime health of the child. While most research has focussed on the influence of a woman s health before conception, it is becoming increasingly understood that the health of a man before trying for a baby can have a long term impact on the future health of his child. Therefore, wherever possible, men who are planning to become fathers are encouraged to be in the best possible health before actively trying to conceive. As a member of the Fertility Coalition, Andrology Australia has developed a new factsheet for men to get information and guidance on looking after their preconception health. The new factsheet will be available during Fertility Week and later on our website.

From the Medical Director WITH THE changing seasons and Spring on the doorstep, there is a feeling of renewal and optimism as we look forward to taking new challenges and directions.

Together, we are developing new information resources on men s preconception health that will be available to GPs to hand to their patients and help to start important conversations.

Andrology Australia is pleased to be assisting the Commonwealth Department of Health and the Minister for Health, the Hon Greg Hunt, in the development of a National Men s Health Strategy 2020 30.

Andrology Australia supported a Roundtable discussion held at Parliament House, Canberra in early August. The draft Strategy will be available for public consultation in October.

2 From the Medical Director WITH THE changing seasons and Spring on the doorstep, there is a feeling of renewal and optimism as we look forward to taking new challenges and directions. In this issue of The Healthy Male we highlight Andrology Australia s involvement in the Your Fertility Coalition. Together, we are developing new information resources on men s preconception health that will be available to GPs to hand to their patients and help to start important conversations. Our Health Spot article looks at new evidence on underwear choice and sperm quality; an easily achievable lifestyle change for most men! Andrology Australia is pleased to be assisting the Commonwealth Department of Health and the Minister for Health, the Hon Greg Hunt, in the development of a National Men s Health Strategy The current National Male Health Policy was produced in 2010; the National Strategy will build on this and provide a framework for taking action. Andrology Australia supported a Roundtable discussion held at Parliament House, Canberra in early August. The draft Strategy will be available for public consultation in October. If you have a stake in men s health, I urge you to submit any comments at We hope that you enjoy this Spring edition of The Healthy Male. Professor Rob McLachlan AM Health spot The verdict is in - the brief on sperm count A MATTER OF debate for some years, whether wearing tight fitting underwear affects the quality of sperm has finally been answered. In the largest study of its kind, a team from Harvard University studied sperm health in 656 men attending a fertility clinic with their partners from The men (average age 35) self-reported if they wore lose-fitting boxers or tight-fitting briefs. They then had their sperm health and reproductive hormone levels scrutinised. In short, men who wore boxers came off better. Compared to brief-wearers, boxer-wearers had 25% higher sperm concentration, 17% higher sperm counts, and 33% higher total sperm motility (movement). Men who reported wearing briefs, had 15% higher levels of follicle stimulating hormone (FSH), a reproductive hormone released in the brain. This makes sense as in many types of testicular problems, FSH goes up when sperm production and sperm counts fall. The researchers' theory is that the brain attempts to compensate for heat-related injury to the testicles by increasing the hormonal drive for sperm production. But other reproductive hormones, including testosterone, were not altered by underwear type. Before you rush out to purchase new underpants the men included in this study were recruited from a fertility clinic and may not represent the general population it s not clear if the reduction in sperm count is enough to actually make a difference to pregnancy rates if you re thinking of making a wardrobe switch this is a relatively easy and inexpensive lifestyle change. Sperm take around 90 days to mature, you can do this 3 4 months before you start trying for a baby. Reference: Mínguez-Alarcón L, Gaskins AJ, Chiu Y-H, et al. (2018) Human Reproduction: dey259. (

Focus on: Considering a vasectomy? Here s what you need to know Vasectomy is a surgical operation that cuts the tubes (vas deferens or the vas ) that carry the sperm from the testes to the penis.

3 Focus on: Considering a vasectomy? Here s what you need to know Vasectomy is a surgical operation that cuts the tubes (vas deferens or the vas ) that carry the sperm from the testes to the penis. The goal of a vasectomy is to make a man sterile, that is, unable to father children naturally. It is a very effective, safe and permanent form of contraception. In the no-scalpel technique, a sharpened instrument pierces the skin over the vas deferens, giving a skin opening of about 1 cm. In both techniques, once the vas deferens are located by the doctor, they are cut and a small piece of tissue removed. The ends of the vas deferens are then sealed with a stitch or using diathermy (heat). In some cases additional steps are done to minimise the chances of vasectomy failure, such as placing some surrounding tissue (fascia) in between the two ends of the vas deferens. The recovery time from scalpel and no-scalpel techniques is the same. What should I expect after the operation? After a vasectomy, sperm are still made but are stopped in the epididymis where they are reabsorbed. A vasectomy does not interfere with a man s ability to get an erection, have an orgasm or ejaculate. There is no evidence that vasectomy alters a man s sex drive or testosterone levels. It is important to note that vasectomy does not protect against sexually transmitted infections (STIs). What are the risks of vasectomy operations? Vasectomy is safe but carries a small risk (1 2%) of infection or significant bleeding. A small proportion of men have longterm pain or discomfort in the scrotum and some have pain with ejaculation; it can t be predicted before the vasectomy which men will have ongoing pain. Some medicines can help with pain or, in very rare cases, other surgery is needed. How quickly does vasectomy work? It can take a few months after a vasectomy for the sperm to clear out of the ducts. Over this period, it is useful for a man to perform about 20 ejaculations to help clear the tubes from residual sperm. A semen analysis is done around three months after a vasectomy to check there are no live sperm in the semen. About 4 in 5 men will have no sperm present, but for others, more tests are done every 1 2 months until they are clear. You should use another method of contraception until your doctor says there are no live sperm in the semen. Can vasectomy fail? Even after an initial negative sperm count, rarely sperm may reappear months or even years later. It seems that in some men, new passages for sperm to bypass the vasectomy site form ( recanalisation ). The risk of pregnancy after a vasectomy is small (1 in 2000). Why is it important to think about sperm storage? Even though only a small fraction of men who undergo vasectomy want another child, some men store sperm before a vasectomy just in case. This may prevent the need for a vasectomy reversal in the future; however, when using stored sperm, the female partner will still need some form of assisted reproductive technology (ART) to fall pregnant. There are also costs involved with sperm storage. The sperm journey AFTER SPERM are made in the testes, they leave the testes through the epididymis, a highly coiled tube that lies at the back of each testis and connects it to the vas deferens, a muscular tube about 30 cm long. When released from the testis, the sperm spend 2 10 days passing through the epididymis where they become fully mature and ready to fertilise a woman s egg. Sperm then pass through the seminal vesicles and the prostate gland, before being ejaculated through the urethra during orgasm. How common is vasectomy? Each year, around 30,000 men have a vasectomy in Australia. About 1 in 4 men over the age of 40 have had a vasectomy. Is vasectomy right for me? Vasectomy may be right for you if: you and your partner are sure you have completed your family you want to take responsibility for family planning you want an effective, permanent method of contraception that does not need ongoing treatment. Vasectomy may not be right for you if you are: relatively young and do not have any children not in a relationship, or you have recently separated or divorced having relationship or marriage problems. Who performs a vasectomy? Vasectomies can be performed by specialists (e.g. urologists, general surgeons) or some general practitioners (GPs). A referral (usually from a GP) is needed to see a specialist. A vasectomy is performed in a hospital or in a doctor s private rooms under a general or local anaesthetic, and takes minutes. Are there different techniques for vasectomy? A vasectomy can be done using a scalpel or a no-scalpel technique. In the scalpel technique, a small cut of 1 2 cm is made on each side of the scrotum to access the vas deferens. VASECTOMY REVERSAL What is a vasectomy reversal? About 3% of men who have had a vasectomy will think about having more children, for reasons such as a new relationship, either by having a vasectomy reversal or by using ART. Vasectomy reversal involves re-joining the cut ends of the vas deferens usually by microsurgery (using an operating microscope). The operation is much more complex than the original vasectomy and is usually done under general anaesthetic by a specialist and can take several hours. How successful is a vasectomy reversal? In expert hands, in 80 90% of vasectomy reversals, sperm return to the ejaculate. The chance is lower if: there has been a long time between the vasectomy and the reversal; after years, the chances fall significantly a large amount of vas deferens was removed originally, or it was cut near the epididymis other blockages have developed in the epididymis. Even after technically successful surgery, pregnancy is not guaranteed. After vasectomy reversal, only about 40 70% of couples achieve a pregnancy over the next 2 3 years of regular sex. The chance of pregnancy is lower when the woman is older or has other fertility issues. Sperm problems may contribute if there is a lower sperm count, poorer sperm function if the epididymis has been damaged, or because of sperm antibodies which may develop. What are sperm antibodies? Sperm antibodies happen when the immune system reacts to the man s own sperm as if it were foreign tissue. About 4 in 5 men develop sperm antibodies after vasectomy. How is vasectomy reversal affected by sperm antibodies? In most men sperm antibodies do not cause any problems and will not affect the chance of a pregnancy, so testing for sperm antibodies is not needed before a vasectomy reversal. However, in a few men, sperm antibodies can interfere with the ability of sperm to swim, and to attach to and penetrate (get into) the woman s egg. This can stop fertilisation happening, even if the vas deferens is successfully re-joined. ASSISTED REPRODUCTIVE OPTIONS When is ART used after vasectomy? Men who have had a vasectomy reversal but their partner has been unable to become pregnant can seek ART. Some couples decide not to have a vasectomy reversal and go straight to ART depending on the couple s individual circumstances. Sometimes the choice is easy but often it needs in-depth discussion with a specialist to decide what is best. Factors that affect this choice include: the time since vasectomy the age and fertility of the female partner the couple s desire to have only one or many children the availability and cost of surgical and ART services. How is ART used after vasectomy? Sperm can be collected from the epididymis or testis using a fine needle under local anaesthetic. These sperm can then be injected one by one into eggs collected from the female partner in an ART process called intracytoplasmic sperm injection (ICSI). The success of treatment depends mainly on the age and health of the female partner. For women in their 30s, pregnancy rates around 40% per cycle are typical. For more information speak with your doctor, urologist or sexual health and family planning clinic.

Community Development Men s Health Week 2018: It s healthy to talk is a winner INTERNATIONAL MEN S Health Week (MHW) provides a platform for Andrology Australia to support an increasing number of

During MHW 2018 (11-17 June), we supplied almost 50,000 MHW themed resources to a variety of organisations, and partnered with the Australian Men s Shed Association and Men at Work Communications to

4 Community Development Men s Health Week 2018: It s healthy to talk is a winner INTERNATIONAL MEN S Health Week (MHW) provides a platform for Andrology Australia to support an increasing number of organisations servicing men s health needs by providing evidence-based information resources and materials for men s health promotion. During MHW 2018 (11-17 June), we supplied almost 50,000 MHW themed resources to a variety of organisations, and partnered with the Australian Men s Shed Association and Men at Work Communications to deliver targeted health promotion. Andrology Australia invited MHW 2018 participants to complete a survey aiming to evaluate the impact of our men s health information resources. The results are in! The theme It s healthy to talk was regarded extremely highly with 93% of respondents providing a rating of good or very good. The majority of respondents rated MHW resources highly for raising the awareness of men s health issues to their target audience. In particular, 80% of respondents rated the MHW brochure as useful or very useful. MHW resources were distributed right across the country, with 41% hosting activities in a major city/suburb, 38% in regional areas and 24% in rural or remote Australia. Workplaces were the most popular setting for holding a men s health activity, followed by In my local community (e.g. shopping centres, gyms). This year, there was a 10% increase in the number of GP clinics displaying MHW resources in their waiting rooms. Andrology Australia s men s health messages also reached over 543,000 people via social media. An overwhelming 86% of respondents believe that the MHW resources were a valuable source of quality men s health promotion resources and all respondents would like Andrology Australia to continue using It s healthy to talk messaging in the future. If you are running a community event or would like to promote men s health in primary care, MHW themed It s healthy to talk resources are now available without campaign dates. Resources can be downloaded directly from our website or ordered for mail-out. (www. andrologyaustralia.org/mens-healthweek/) Research round-up Immunotherapy breakthrough for advanced prostate cancer NEW TREATMENT hope for specific types of advanced prostate cancer could be on the horizon. A study recently published in the science journal Cell, discovered a new subset of advanced prostate cancer, which contain a special genetic signature making these cancers more likely to respond to new therapies. These new therapies, called immunotherapy, work by helping the body s immune system detect cancer cells and then kill them. In some cancers, immunotherapies are very effective treatments because those cancers are easily detected by the immune system. Most prostate cancers have a genetic signature not very detectable by the immune system, so immunotherapy is not particularly beneficial. University of Michigan researchers looked closely at the genetic signature (DNA sequences) of hundreds of advanced prostate cancer cases and found that 7% of the tumours had a defect in a gene called CDK12. This defect causes the tumours to behave in a unique way to other prostate tumours, including producing protein fragments that can be detected by the immune system. This is an exciting finding because it means that these prostate cancers could be candidates for immunotherapy. Early observations show that some patients with a prostate cancer containing the CDK12 gene defect have extremely beneficial responses to immunotherapy. Clinical trials are needed to assess the true significance of this promising discovery in a large number of patients with advanced prostate cancer. Reference: Wu YM, Cieslik M, Lonigro RJ, et al. (2018) Cell. 173(7): e1714.

In brief Andrology Australia staff update Andrology Australia extend a heartfelt thank you to Taletha Rizio, our Education Liaison Officer who left in August to begin a new role.

relationships. We wish Taletha all the best for her new role. We d like to introduce and welcome Carmen Broadhurst, our new Communications and Marketing Coordinator, who joined us in August.

Carmen is looking forward to assisting in strategy development over the next 12 months, and increasing awareness and recognition of reproductive health issues with all age groups of men.

5 In brief Andrology Australia staff update Andrology Australia extend a heartfelt thank you to Taletha Rizio, our Education Liaison Officer who left in August to begin a new role. Over the past 12 years, Taletha has proficiently managed our GP education and training modules and worked closely with hundreds of health professionals and community groups to build lasting relationships. We wish Taletha all the best for her new role. We d like to introduce and welcome Carmen Broadhurst, our new Communications and Marketing Coordinator, who joined us in August. Carmen s background is in executing national promotional campaigns, developing local area marketing strategy, advertising, branding and digital marketing. Carmen is looking forward to assisting in strategy development over the next 12 months, and increasing awareness and recognition of reproductive health issues with all age groups of men. GP survey closed In collaboration with Your Fertility, Andrology Australia recently ran a survey exploring GPs knowledge, attitudes and practice relating to male fertility health promotion. The survey is now closed. A huge thank you to the 304 GPs who responded. We heard from GPs in each State and Territory, both urban and rural regions, and a range of clinical settings. The results of the survey are being analysed and will be shared in the coming months. Latest News Investigating fertility in men born by intracytoplasmic sperm injection (ICSI) INTRACYTOPLASMIC SPERM injection (ICSI) is a method of assisted reproduction used in couples where the male partner is infertile due to low sperm quality or sperm count. Unlike in vitro fertilisation (IVF) where a semen sample containing thousands of sperm is mixed with the woman s egg, in ICSI a single healthy sperm is selected by medical staff and injected directly into the egg. While ICSI has similar success rates to IVF, it is not known whether selecting the sperm and bypassing natural selection has an impact on the health and fertility of the child. Dr Sarah Catford, a PhD student at the Hudson Institute of Medical Research (Melbourne) and ex Andrology Australia Fellow, is leading a study to answer this question. Funded by the NHMRC, the study is part of a research program Ms Dell Lovett sits on Andrology Australia s Primary Health Care Nurse Reference Group and has an extensive background in nursing, men s health, and diabetes in primary health care settings. Dell is also a member of the Global Action for Men s Health (GAMH) and the Australian Men s Health Forum. Representing Andrology Australia, Dell was invited to give a keynote presentation at the Australian College of Nursing s (ACN) National Nursing Forum 2018, August, in the Gold Coast. supported by Monash IVF Group, Melbourne IVF, the Victorian Assisted Reproductive Treatment Authority (VARTA), the Fertility Society of Australia (FSA) and Access Australia. Dr Catford presented a progress report on the study at the Fertility Society of Australia (FSA) Annual Conference, 9 12 September in Melbourne. Results from the study will be made available next year. Dell Lovett presents keynote lecture at the National Nursing Forum on sexual health and diabetes Dell presented a talk that focussed on sexual and reproductive health problems, including erectile dysfunction and the link to cardiovascular disease. Andrology Australia thank the ACN organisers for the opportunity to present at this forum and the inclusion of men s health in the program. Subscribe Today! FREE SUBSCRIPTION Register on our website or call to receive this quarterly publication and other items from Andrology Australia. NEWSLETTER OF ANDROLOGY AUSTRALIA Australian Centre of Excellence in Male Reproductive Health The Andrology Australia project is supported by funding from the Australian Government Department of Health, and is administered by Monash University. Andrology Australia Postal Address: School of Public Health and Preventive Medicine 553 St Kilda Rd, Melbourne, Victoria 3004, Australia. info@andrologyaustralia.org Telephone: Web: Facebook: AndrologyAustralia DISCLAIMER: This newsletter is provided as an information service. Information contained in this newsletter is based on current medical evidence but should not take the place of proper medical advice from a qualified health professional. The services of a qualified medical practitioner should be sought before applying the information to particular circumstances.

A USER S GUIDE WHAT EVERY MAN NEEDS TO KNOW

A USER S GUIDE WHAT EVERY MAN NEEDS TO KNOW 1. Why men need to know more Good health is vital for a happy and full life. But, with work and family responsibilities, men often overlook their own health