Transcript
Professional education
In brief
Latest news
Men’s health education for future health professionals One of Andrology Australia’s priorities is the education of health professionals to ensure that they are confident in the management and treatment of male reproductive health disorders. While education of current health professionals continues to be a focus, it is also important to ensure that there is appropriate education of future health care professionals in this area.
core curriculum. The working group will also assist and advise in the development of core curriculum and oversee an extensive consultation process with all Australian medical schools invited to participate in the process.
The working group will provide advice on the development and design of resources, evaluate primary uptake of the curriculum, and assist in the development of strategy to ensure the curriculum package remains current and up to date.
Congratulations to Katherine Cust, Health Promotion Officer at Otway Health in Apollo Bay, and to Bernadette Rey of Belrowes Medical in Queensland! Both were placed in the draw after completing recent online evaluations, winning an iPod 1GB shuffle for their troubles. Thank you to all who provided their valuable feedback.
The aim of the working group is to develop a medical curriculum structure that comprehensively addresses men’s health needs throughout their life. The working group brings together a core consortium of medical schools across Australia to ensure that the consultation process and curriculum that is developed is effective.
Endorsed Provider of health professional education
Members of the Medical Curriculum Working Group (from left to right, top and then bottom row) are Mr Tim Smith (Australian Medical Students Association), Professor Rob McLachlan (Director, Andrology Australia), Professor Ben Canny (Monash University), Dr Megan Cock (Andrology Australia), A/Professor Tessa Ho (University of Sydney) and A/Professor Bu Yeap (University of Western Australia). Not included in the photo is Professor David Wilkinson (University of Queensland).
Research round-up
Andrology Australia is proud to announce its endorsement as a provider of health professional education through the Royal Australian College of General Practitioners (RACGP). Andrology Australia is now qualified to deliver Category 2 Educational Activities for general practitioners. Andrology Australia is also in the process of becoming an Accredited Provider for the RACGP QA&CPD program, which will allow us to develop Category 1 activities.
We need your help! Your support is essential in continuing the important work of Andrology Australia and improving the health and wellbeing of all Australian men and their families.
Promoting good health in the workplace Evidence suggests that lifestyle risk factors such as obesity and living a sedentary lifestyle are linked to both male reproductive health disorders and chronic disease including heart disease and diabetes.
The pilot initially includes focus group meetings with both office and outdoor maintenance staff members, to better understand their current physical activity levels and if any health messages motivate them to exercise.
A pilot program has been developed as a collaborative project between Kinect Australia and Andrology Australia, involving staff working in a metropolitan and a regional Victorian government local council office.
Outcomes of the meetings are currently being collated and will guide the development of the project and education resources to encourage men to participate in physical activity programs.
The program aims to promote physical activity in men by raising awareness of general and reproductive health, through communication of relevant health messages within a workplace environment.
To thank you for your support of Andrology Australia and men’s health, all registrants of the Healthy Male newsletter will receive a 2009 pocket diary with this issue. Only one diary is available per Australian resident.
Winners of evaluation prizes
From a preliminary scoping exercise, men’s health education is generally limited and appears to vary between medical schools across Australia. To address the need for a flexible medical curriculum framework on a range of men’s health disorders in Australia, an Andrology Australia working group has been established.
Project stages will include mapping the current curricula of universities and defining the framework for building the
Diaries 2009
Both of the local councils involved already offer various opportunities and policies to promote physical activity in the workplace. However, these are not clearly known or understood by all staff members.
The pilot is supported by the Australian Government Department of Health and Ageing – Healthy Active Australia: Community and School Grants Program. For more information on the project, please contact Ms Taletha Groves, Education Liaison Officer for Andrology Australia;
[email protected]. edu.au or phone 03 9594 7162.
Donations to Andrology Australia will contribute to our community, professional and research programs in men’s health. Visit www. andrologyaustralia.org or call 1300 303 878 to make a donation.
Do you have Klinefelter Syndrome? Participants needed A major study looking at the personal impact of Klinefelter’s Syndrome (KS) is now underway and is recruiting men diagnosed with KS to complete a questionnaire. To register your interest or for more information, please email your contact details to
[email protected] or call Amy Herlihy on 03 8341 6370.
Agent Orange may be associated with an increased risk of prostate cancer The herbicide Agent Orange was sprayed by the United States in the former South Vietnam during the Vietnam War from 1962 to 1971, and exposed veterans were found to have an increased risk of developing several types of cancer3. However, studies have shown that there was only a weak association between exposure to Agent Orange and the development of prostate cancer specifically. With Vietnam War veterans now entering their 60s, a new study has looked at the link between Agent Orange and prostate cancer4. The authors measured the relative risk of developing prostate cancer amongst 13,144 Vietnam veterans who were noted as either ‘exposed’ or ‘unexposed’ to Agent Orange, and were followed between 1998 and 2006. Differences in patient and disease characteristics including age, race, smoking history, family history, body mass index, prostate-specific antigen (PSA) level and Gleason score, were assessed. The study found that twice as many men exposed to Agent Orange had prostate cancer. Exposed men also developed the disease at a younger age, and had a more aggressive cancer than those who were not exposed. The results suggest that those exposed to Agent Orange should be classified at high risk of developing prostate cancer, in addition to men with African-American heritage and men with a family history of the disease. It is known that during childhood development, exposure to toxic chemicals such as vinclozolin (a fungicide) increases the risk of reproductive problems when older. This new study is interesting because it shows that normal, healthy adult men may still be at risk. Further understanding of the relationship between Agent Orange and prostate cancer, and the contributing factors is needed. Agent Orange is just one of many toxic chemicals that men are exposed to over their lifetime that may affect reproductive health. However, the association between Agent Orange and prostate cancer in the study is strong and should serve to inform both clinical practice and future research about the effects of Agent Orange exposure. 3
Institute of Medicine (IOM) Veterans and Agent Orange, Update 2000. Washington, DC: National Academy 4
Chamie K, deVere White RW, Volpp B, Lee D, Ok J, Ellison LM. Agent Orange exposure, Vietnam War veterans, and the risk of prostate cancer. Cancer; e-pub 29 July 2008
The Healthy Male
Newsletter of Andrology Australia Australian Centre of Excellence in Male Reproductive Health
Editor: Cassy Bezeruk
Andrology Australia C/O - Monash Institute of Medical Research Postal Address: Monash Medical Centre 246 Clayton Road, Clayton Victoria 3168 Street Address: 27-31 Wright Street, Clayton Victoria 3168 Telephone: 1300 303 878 Facsimile: + 61 3 9594 7111 Internet: www.andrologyaustralia.org
Issue 28 – Spring 2008 from The Australian Government Department of Health and Ageing.
Contents 2
Community education Trekking the countryside with Merv Hughes
2
Recent Events Launch of new booklet on preserving male fertility
3
Focus on Your Sperm – and how to look after them!
5
Professional education Men’s health education for future health professionals
5
Research roundup Promoting good health in the workplace
Email:
[email protected] Andrology Australia is administered by
Newsletter of Andrology Australia – Australian Centre of Excellence in Male Reproductive Health
Andrology Australia is supported by a grant
Monash Institute of Medical Research
6
In brief
6
Latest news
Myths of fertility Having a healthy diet, exercising regularly, watching your weight and not smoking are lifestyle choices that benefit your health. But do they improve your fertility? A new study has shown that while young people are aware that negative lifestyle factors can reduce fertility, they falsely believed in fertility myths1. The study, conducted in the UK, surveyed 110 female and 39 male university students to establish their views on what effect a range of health risk factors and myths would have on women trying to get pregnant. Risk factors included smoking, drinking too much alcohol, and being of older age. Fertility myths included not urinating after sex and lying down for 10 minutes after sex, among others. Findings from the study showed a lack of full understanding of the factors that can impact on fertility. Although participants knew about the risk factors for infertility, they were less aware of the factors that had no effect on fertility. Those surveyed
wrongly believed that you can be more fertile by ‘not doing’ something – that not drinking wine will increase your chance of pregnancy. A lack of knowledge about what can and can’t affect fertility may mean that people are unintentionally contributing to their own future fertility problems. For example, they may not understand that being overweight could be affecting their chances of getting pregnant. Also, having false beliefs may lead people to delay seeking treatment such as IVF when having difficulty getting pregnant. This study shows that there is a need to improve people’s knowledge surrounding fertility and the risks and benefits of their lifestyle choices. It is likely that similar issue affects people’s understanding of male fertility, and the authors point to the need for more research to determine the level of knowledge in relation to lifestyle behaviours on male fertility.
1
Bunting L, Boivin J. Knowledge about infertility risk factors, fertility myths and illusory benefits of healthy habits in young people. Human Reproduction 2008; 28:1858–1864
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From the Director Male fertility is often taken for granted when a couple is planning to start a family. By the time the couple make that decision, few men would be aware that they had already been exposed to a range of factors that could impact their ability to father a child. Infections, heat, drugs, age, work environments, sporting and recreational injury, and lifestyle issues such as smoking, alcohol and obesity can all affect fertility in men temporarily or permanently.
child may be better if they pay attention to avoiding injury or infection and to their overall health by exercising regularly, having a healthy diet and watching their weight. This edition of The Healthy Male focuses on how men can protect their fertility and raises awareness of the factors that can impact on fertility in men.
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.
The number of babies born in Australia using assisted reproductive technology such as IVF has tripled in a decade2. In half of all IVF cases, male reproductive complications are either the exclusive problem or a contributing factor. It is estimated that infertility affects 1 in 20 men. While often fertility problems are not preventable, men’s chances of fathering a
Professor Rob McLachlan
2
Wang YA, Dean JH, Badgery-Parker T & Sullivan EA 2008. Assisted reproduction technology in Australia and New Zealand 2006. Assisted reproduction technology series no. 12. AIHW cat. no. PER 43. Sydney: AIHW National
Community education Trekking the countryside with Merv Hughes Merv Hughes has been very busy over the past few months in his role as Andrology Australia Ambassador, travelling across the country speaking at regional community events to raise awareness of men’s health and Andrology Australia. In July, Merv went to Myrtleford in Victoria to speak at two events organised by Alpine Community Health Centre. Almost 300 students from three of the local colleges in the area listened to Merv speak about general health, wellbeing and reproductive health. An evaluation found that almost two thirds of the students said they were more likely to exercise more as a result of Merv’s talk. Over 200 men ranging from 19 to 75 years of age filled the local pavilion in Myrtleford for an evening seminar, with the majority of men going through a Pit Stop program as they arrived. A survey completed by attendees on the night provided positive feedback, such as: “Merv touched on
issues I haven’t previously thought to be important, and his words have encouraged me to be more self aware.” August saw Merv travel to Mackay in Queensland and Rutherglen in Victoria. The event in Mackay organised by the local prostate cancer support group attracted almost 120 men, with funds raised from the night being donated to Andrology Australia. Both Merv Hughes and ‘Crackers’ Keenan spoke at the men’s health event in Rutherglen to around 150 men, and a Pit Stop health check was also available to those attending.
The most recent event had Merv back in Melbourne speaking at the Ferntree Gully Cricket Clubrooms for ‘Secret Men’s Stuff 08: The nuts and bolts of being a bloke’. The event attracted almost 100 people and included a number of speakers, as well as a general expo beforehand with free massages, café bar, basketball and golf putting games with prizes. Andrology Australia would like to thank all those involved in organising these successful events and for their support in raising the awareness of men’s health, in particular, male reproductive health.
Then it was back up to Queensland where the Cooloola Men’s Health Network held a public expo for men to promote their health management in Gympie in September. The event attracted over 500 Gympie and district residents, with stalls from a number of health centres and a Pit Stop health check also being offered.
Focus on: Your sperm – and how to look after them! Author: Professor Rob McLachlan
Why do men need to be aware of their fertility throughout their lives? Whether young or old, with a current partner or not, men need to protect their fertility so that natural conception can happen when they are ready to have children. To start a healthy pregnancy, men need to make large numbers of sperm that are good swimmers, and that ‘know’ how to fertilise the egg when they arrive. Sperm also needs to contain genetic information (DNA) in good condition. Having regular sex also helps! In many cases, there are no treatments to correct poor sperm production, blockages to sperm tubes or when couples have difficulty having sex, which means assisted reproductive technologies such as in vitro fertilisation (IVF) treatment is needed. Whilst there are some causes of infertility that cannot be prevented, there are things you can do to protect your fertility, protect your partner’s fertility and lessen the chances of needing IVF treatments in the future.
What infections can affect fertility? Sexually transmitted infections (STIs) STIs, particularly untreated gonorrhoea and chlamydia, can cause blockages in the sperm tubes so that sperm are unable to move on from the testicles (where they are produced) into the semen and ejaculated. Surgery to fix the blocked tubes is not always possible.
Prostate infection: ’Prostatitis’ The prostate sits underneath the bladder and adds fluid to protect sperm on their journey through the reproductive system. As the sperm move through the prostate into the urethra, prostate swelling may stop sperm from passing through the reproductive system. White blood cells from the infection can also damage sperm. Some STIs can cause bacterial prostatitis, so it pays to use protection!
Merv getting out and about promoting men’s health
Epididymo-orchitis
Recent events Launch of new booklet on preserving male fertility Andrology Australia has launched a new men’s fertility booklet ‘Your sperm – and how to look after them’ at the annual Fertility Society of Australia conference in October. The booklet provides a summary of conditions, behaviours and situations that can affect male fertility and outlines the measures men can take to preserve their fertility potential. Developed in response to an increase in both community awareness about male infertility and in the use of IVF treatments, the booklet encourages men to think about their fertility throughout their life.
“It’s important that there’s a resource available to men outlining how they can best look after their reproductive health and avoid fertility issues when they decide to start a family,” said Prof. Rob McLachlan, Director of Andrology Australia. “While some causes of infertility cannot be prevented, there are others that can be managed or avoided.” “In some cases where fertility may be affected permanently, men also need to be aware of options available to them like sperm storage.”
Epididymo-orchitis (pronounced ork-eye-tis) is usually caused by an infection in the urinary tract. This viral or bacterial infection happens in the tube that carries sperm out of the testicles (epididymis), but also spreads back into the testicle. Epididymo-orchitis can cause permanent blockages and damage to the testicles (and the ability to make sperm), but this is rare.
The booklet was reviewed and endorsed by the Fertility Society of Australia and Access Australia. Andrology Australia wishes to thank all those who took the time to review and provide input to the guide.
Mumps
‘Your sperm – and how to look after them’ is available to order from Andrology Australia in hard copy on 1300 303 878 or via email at
[email protected].
The virus can permanently destroy the tubes that make sperm and stop sperm production. Mild cases will still stop sperm production, but only for a short time of six to 12 months.
A viral infection that can be caught by anyone at any age, mumps is much more dangerous for adult men. Besides causing swelling of the salivary glands, fever and headaches, it can also cause inflammation and pain in the testicles.
Top Tips • Practice safe sex – use a condom to stop transfer of infection to or from your partner • Young boys should be vaccinated against the mumps virus to protect their fertility for the longer-term
Can heat damage sperm production?
Does lifestyle affect fertility?
What medical treatments can affect fertility in men?
To produce top quality sperm, the testicles need to be a couple of degrees cooler than normal body temperature; the scrotum serves as an ‘evaporative air cooling’ system. When it is too hot, the scrotum cannot sweat and the testicles have trouble making sperm. In cases where the scrotum has been too hot for too long, sperm production can be reduced.
Smoking
Vasectomy
Smoking cigarettes can reduce fertility, with heavy smokers producing up to 20 per cent fewer sperm. Smoking may also increase the number of abnormally shaped sperm, making it harder for sperm to fertilise the egg.
One in four Australian men in their forties have had a vasectomy believing they will never want to have children again. A vasectomy should be considered a permanent form of contraception and should not be decided lightly; it is not easy to regain fertility later.
New evidence shows that sperm DNA (genetic material) is damaged by the chemicals in tobacco smoke which may lower the chance of healthy pregnancy and affect your child’s future health.
Surgery and sickness
Top Tips • Avoid regular very hot baths or spas • Wearing loose fitting underwear such as boxer shorts may be good for sperm count: while this is unproven, it seems a reasonable step to take
Alcohol
Can drugs affect fertility levels?
Binge drinking and regular heavy drinking can cause liver problems and affect a whole range of body functions. Sexual and reproductive function can be affected and there may be damage to testicular function.
Treatments for cancer
Obesity
Radiation therapy and chemotherapy can cause long-term problems with sperm production. As radiation attacks and destroys rapidly dividing cancer cells, radiation therapy for cancers in or near the testicles can easily damage sperm-producing cells.
Studies show that obese men are less fertile than men of normal weight, and have lower sperm counts and fewer numbers of sperm that can swim well. Changes in hormone levels and too much heat around the scrotum may play a part.
Prescribed drugs Prescribed drugs such as cyclophosphamide and salazopyrine can cause long-term fertility problems. Antidepressants and sedatives can also negatively affect sexual performance, and may be linked to lower sperm counts.
Diet and vitamins Foods including pumpkin seeds, parsley and vitamins such as zinc, vitamin E and B12 are promoted as improving fertility in men. While there is no strong scientific evidence to show that specific foods or natural therapies improve fertility, having a healthy diet is important for general health and wellbeing, especially when trying to start a family.
Marijuana, cocaine, heroin and other illegal drugs can also affect sperm production as they lower a man’s testosterone levels and sex drive. Not having regular sex can make it more difficult to become pregnant.
Top Tips • Ask your doctor about sperm storage before starting cancer treatments • When taking prescribed drugs that may cause fertility problems, talk to your doctor about using other medications if you’re trying to conceive • Avoid using illegal drugs including steroids because all the risks are unknown
Top Tips • Men planning a vasectomy should consider storing sperm before the surgery • Wait several months after any major surgery or illness with a fever before trying to conceive
What problems with the testicles can affect fertility? Undescended testicles Undescended testicles or ‘cryptorchidism’ is when a man’s testicles don’t move down into the scrotum before or just after birth. Testicles ‘stuck’ in the groin or the abdomen are too warm and the spermproducing tubes can be damaged. Even when surgically corrected in early childhood, there is an increased chance of having fertility problems later in life.
Top Tips • Live a healthy lifestyle by watching your weight, have a healthy diet, exercise regularly, don’t smoke and drink alcohol in moderation • A healthy lifestyle will improve your quality of life and that of your family
Illegal drugs Anabolic steroids taken for body building or competitive sports cause acne, weight gain and mood changes, but also shrink men’s testicles and stop sperm production.
Any type of surgery is a serious medical treatment and any procedure using a general anaesthetic can lower a man’s sperm count for a short time. Sickness with a fever can also reduce sperm production and it can take several months for sperm counts to recover.
Does age play a part in fertility? Research shows that as men approach middle age it may take longer to get a partner pregnant. Having sex less often, erectile problems or other serious health problems may play a role, and the amount of semen, sperm movement and perhaps sperm DNA quality is lower. Taking into account your partner’s age is also important when starting a family as a woman’s fertility levels naturally drop after the age of 35.
Twisted testicle A medical emergency, a twisted testicle or ‘torsion of the testicle’ causes extreme pain and needs immediate attention. The testicle twists in the scrotum and cuts off the blood supply, causing the testicle to swell up and if left untreated can cause the testicle to die. Surgery relieves the pain and saves the testicle.
Small testicles Small testicles often signal problems with fertility or hormone levels. If an adult male’s testicles are roughly the size of a green grape, it could be a sign of low hormone levels or problems getting a partner pregnant.
Top Tips
Top Tips
• Men who had undescended testes as a child should check their testicles regularly for lumps and visit a doctor if anything changes
• Develop a life plan with your partner which recognises that fertility lessens with age and think about parenthood before the age of 35
• If a man experiences extreme pain in the testicle, he should go to hospital immediately
Can your workplace affect your fertility?
• Men need to know what ‘normal’ testicle size is and if they are small, should see their doctor for a full health check, including measurement of the testicles
Exposure to harmful chemicals, pesticides, heavy metals, toxic chemicals and radiation may affect the quality and quantity of sperm men produce and should be avoided. Physical injury at work can also affect fertility, so evaluate your work environment and make sure your fertility is safe.
Top Tips • For men who work in occupations that may affect fertility, it’s important to wear protective clothing and follow all OH&S guidelines
Storing sperm for later Particularly if undergoing treatment for cancer, semen samples may be collected and frozen at a fertility clinic with liquid nitrogen storage facilities. The collected semen may then be stored long-term for use later in fertility treatments such as in vitro fertilisation (IVF).
Community education Trekking the countryside with Merv Hughes Merv Hughes has been very busy over the past few months in his role as Andrology Australia Ambassador, travelling across the country speaking at regional community events to raise awareness of men’s health and Andrology Australia. In July, Merv went to Myrtleford in Victoria to speak at two events organised by Alpine Community Health Centre. Almost 300 students from three of the local colleges in the area listened to Merv speak about general health, wellbeing and reproductive health. An evaluation found that almost two thirds of the students said they were more likely to exercise more as a result of Merv’s talk. Over 200 men ranging from 19 to 75 years of age filled the local pavilion in Myrtleford for an evening seminar, with the majority of men going through a Pit Stop program as they arrived. A survey completed by attendees on the night provided positive feedback, such as: “Merv touched on
issues I haven’t previously thought to be important, and his words have encouraged me to be more self aware.” August saw Merv travel to Mackay in Queensland and Rutherglen in Victoria. The event in Mackay organised by the local prostate cancer support group attracted almost 120 men, with funds raised from the night being donated to Andrology Australia. Both Merv Hughes and ‘Crackers’ Keenan spoke at the men’s health event in Rutherglen to around 150 men, and a Pit Stop health check was also available to those attending.
The most recent event had Merv back in Melbourne speaking at the Ferntree Gully Cricket Clubrooms for ‘Secret Men’s Stuff 08: The nuts and bolts of being a bloke’. The event attracted almost 100 people and included a number of speakers, as well as a general expo beforehand with free massages, café bar, basketball and golf putting games with prizes. Andrology Australia would like to thank all those involved in organising these successful events and for their support in raising the awareness of men’s health, in particular, male reproductive health.
Then it was back up to Queensland where the Cooloola Men’s Health Network held a public expo for men to promote their health management in Gympie in September. The event attracted over 500 Gympie and district residents, with stalls from a number of health centres and a Pit Stop health check also being offered.
Focus on: Your sperm – and how to look after them! Author: Professor Rob McLachlan
Why do men need to be aware of their fertility throughout their lives? Whether young or old, with a current partner or not, men need to protect their fertility so that natural conception can happen when they are ready to have children. To start a healthy pregnancy, men need to make large numbers of sperm that are good swimmers, and that ‘know’ how to fertilise the egg when they arrive. Sperm also needs to contain genetic information (DNA) in good condition. Having regular sex also helps! In many cases, there are no treatments to correct poor sperm production, blockages to sperm tubes or when couples have difficulty having sex, which means assisted reproductive technologies such as in vitro fertilisation (IVF) treatment is needed. Whilst there are some causes of infertility that cannot be prevented, there are things you can do to protect your fertility, protect your partner’s fertility and lessen the chances of needing IVF treatments in the future.
What infections can affect fertility? Sexually transmitted infections (STIs) STIs, particularly untreated gonorrhoea and chlamydia, can cause blockages in the sperm tubes so that sperm are unable to move on from the testicles (where they are produced) into the semen and ejaculated. Surgery to fix the blocked tubes is not always possible.
Prostate infection: ’Prostatitis’ The prostate sits underneath the bladder and adds fluid to protect sperm on their journey through the reproductive system. As the sperm move through the prostate into the urethra, prostate swelling may stop sperm from passing through the reproductive system. White blood cells from the infection can also damage sperm. Some STIs can cause bacterial prostatitis, so it pays to use protection!
Merv getting out and about promoting men’s health
Epididymo-orchitis
Recent events Launch of new booklet on preserving male fertility Andrology Australia has launched a new men’s fertility booklet ‘Your sperm – and how to look after them’ at the annual Fertility Society of Australia conference in October. The booklet provides a summary of conditions, behaviours and situations that can affect male fertility and outlines the measures men can take to preserve their fertility potential. Developed in response to an increase in both community awareness about male infertility and in the use of IVF treatments, the booklet encourages men to think about their fertility throughout their life.
“It’s important that there’s a resource available to men outlining how they can best look after their reproductive health and avoid fertility issues when they decide to start a family,” said Prof. Rob McLachlan, Director of Andrology Australia. “While some causes of infertility cannot be prevented, there are others that can be managed or avoided.” “In some cases where fertility may be affected permanently, men also need to be aware of options available to them like sperm storage.”
Epididymo-orchitis (pronounced ork-eye-tis) is usually caused by an infection in the urinary tract. This viral or bacterial infection happens in the tube that carries sperm out of the testicles (epididymis), but also spreads back into the testicle. Epididymo-orchitis can cause permanent blockages and damage to the testicles (and the ability to make sperm), but this is rare.
The booklet was reviewed and endorsed by the Fertility Society of Australia and Access Australia. Andrology Australia wishes to thank all those who took the time to review and provide input to the guide.
Mumps
‘Your sperm – and how to look after them’ is available to order from Andrology Australia in hard copy on 1300 303 878 or via email at
[email protected].
The virus can permanently destroy the tubes that make sperm and stop sperm production. Mild cases will still stop sperm production, but only for a short time of six to 12 months.
A viral infection that can be caught by anyone at any age, mumps is much more dangerous for adult men. Besides causing swelling of the salivary glands, fever and headaches, it can also cause inflammation and pain in the testicles.
Top Tips • Practice safe sex – use a condom to stop transfer of infection to or from your partner • Young boys should be vaccinated against the mumps virus to protect their fertility for the longer-term
Can heat damage sperm production?
Does lifestyle affect fertility?
What medical treatments can affect fertility in men?
To produce top quality sperm, the testicles need to be a couple of degrees cooler than normal body temperature; the scrotum serves as an ‘evaporative air cooling’ system. When it is too hot, the scrotum cannot sweat and the testicles have trouble making sperm. In cases where the scrotum has been too hot for too long, sperm production can be reduced.
Smoking
Vasectomy
Smoking cigarettes can reduce fertility, with heavy smokers producing up to 20 per cent fewer sperm. Smoking may also increase the number of abnormally shaped sperm, making it harder for sperm to fertilise the egg.
One in four Australian men in their forties have had a vasectomy believing they will never want to have children again. A vasectomy should be considered a permanent form of contraception and should not be decided lightly; it is not easy to regain fertility later.
New evidence shows that sperm DNA (genetic material) is damaged by the chemicals in tobacco smoke which may lower the chance of healthy pregnancy and affect your child’s future health.
Surgery and sickness
Top Tips • Avoid regular very hot baths or spas • Wearing loose fitting underwear such as boxer shorts may be good for sperm count: while this is unproven, it seems a reasonable step to take
Alcohol
Can drugs affect fertility levels?
Binge drinking and regular heavy drinking can cause liver problems and affect a whole range of body functions. Sexual and reproductive function can be affected and there may be damage to testicular function.
Treatments for cancer
Obesity
Radiation therapy and chemotherapy can cause long-term problems with sperm production. As radiation attacks and destroys rapidly dividing cancer cells, radiation therapy for cancers in or near the testicles can easily damage sperm-producing cells.
Studies show that obese men are less fertile than men of normal weight, and have lower sperm counts and fewer numbers of sperm that can swim well. Changes in hormone levels and too much heat around the scrotum may play a part.
Prescribed drugs Prescribed drugs such as cyclophosphamide and salazopyrine can cause long-term fertility problems. Antidepressants and sedatives can also negatively affect sexual performance, and may be linked to lower sperm counts.
Diet and vitamins Foods including pumpkin seeds, parsley and vitamins such as zinc, vitamin E and B12 are promoted as improving fertility in men. While there is no strong scientific evidence to show that specific foods or natural therapies improve fertility, having a healthy diet is important for general health and wellbeing, especially when trying to start a family.
Marijuana, cocaine, heroin and other illegal drugs can also affect sperm production as they lower a man’s testosterone levels and sex drive. Not having regular sex can make it more difficult to become pregnant.
Top Tips • Ask your doctor about sperm storage before starting cancer treatments • When taking prescribed drugs that may cause fertility problems, talk to your doctor about using other medications if you’re trying to conceive • Avoid using illegal drugs including steroids because all the risks are unknown
Top Tips • Men planning a vasectomy should consider storing sperm before the surgery • Wait several months after any major surgery or illness with a fever before trying to conceive
What problems with the testicles can affect fertility? Undescended testicles Undescended testicles or ‘cryptorchidism’ is when a man’s testicles don’t move down into the scrotum before or just after birth. Testicles ‘stuck’ in the groin or the abdomen are too warm and the spermproducing tubes can be damaged. Even when surgically corrected in early childhood, there is an increased chance of having fertility problems later in life.
Top Tips • Live a healthy lifestyle by watching your weight, have a healthy diet, exercise regularly, don’t smoke and drink alcohol in moderation • A healthy lifestyle will improve your quality of life and that of your family
Illegal drugs Anabolic steroids taken for body building or competitive sports cause acne, weight gain and mood changes, but also shrink men’s testicles and stop sperm production.
Any type of surgery is a serious medical treatment and any procedure using a general anaesthetic can lower a man’s sperm count for a short time. Sickness with a fever can also reduce sperm production and it can take several months for sperm counts to recover.
Does age play a part in fertility? Research shows that as men approach middle age it may take longer to get a partner pregnant. Having sex less often, erectile problems or other serious health problems may play a role, and the amount of semen, sperm movement and perhaps sperm DNA quality is lower. Taking into account your partner’s age is also important when starting a family as a woman’s fertility levels naturally drop after the age of 35.
Twisted testicle A medical emergency, a twisted testicle or ‘torsion of the testicle’ causes extreme pain and needs immediate attention. The testicle twists in the scrotum and cuts off the blood supply, causing the testicle to swell up and if left untreated can cause the testicle to die. Surgery relieves the pain and saves the testicle.
Small testicles Small testicles often signal problems with fertility or hormone levels. If an adult male’s testicles are roughly the size of a green grape, it could be a sign of low hormone levels or problems getting a partner pregnant.
Top Tips
Top Tips
• Men who had undescended testes as a child should check their testicles regularly for lumps and visit a doctor if anything changes
• Develop a life plan with your partner which recognises that fertility lessens with age and think about parenthood before the age of 35
• If a man experiences extreme pain in the testicle, he should go to hospital immediately
Can your workplace affect your fertility?
• Men need to know what ‘normal’ testicle size is and if they are small, should see their doctor for a full health check, including measurement of the testicles
Exposure to harmful chemicals, pesticides, heavy metals, toxic chemicals and radiation may affect the quality and quantity of sperm men produce and should be avoided. Physical injury at work can also affect fertility, so evaluate your work environment and make sure your fertility is safe.
Top Tips • For men who work in occupations that may affect fertility, it’s important to wear protective clothing and follow all OH&S guidelines
Storing sperm for later Particularly if undergoing treatment for cancer, semen samples may be collected and frozen at a fertility clinic with liquid nitrogen storage facilities. The collected semen may then be stored long-term for use later in fertility treatments such as in vitro fertilisation (IVF).
Community education Trekking the countryside with Merv Hughes Merv Hughes has been very busy over the past few months in his role as Andrology Australia Ambassador, travelling across the country speaking at regional community events to raise awareness of men’s health and Andrology Australia. In July, Merv went to Myrtleford in Victoria to speak at two events organised by Alpine Community Health Centre. Almost 300 students from three of the local colleges in the area listened to Merv speak about general health, wellbeing and reproductive health. An evaluation found that almost two thirds of the students said they were more likely to exercise more as a result of Merv’s talk. Over 200 men ranging from 19 to 75 years of age filled the local pavilion in Myrtleford for an evening seminar, with the majority of men going through a Pit Stop program as they arrived. A survey completed by attendees on the night provided positive feedback, such as: “Merv touched on
issues I haven’t previously thought to be important, and his words have encouraged me to be more self aware.” August saw Merv travel to Mackay in Queensland and Rutherglen in Victoria. The event in Mackay organised by the local prostate cancer support group attracted almost 120 men, with funds raised from the night being donated to Andrology Australia. Both Merv Hughes and ‘Crackers’ Keenan spoke at the men’s health event in Rutherglen to around 150 men, and a Pit Stop health check was also available to those attending.
The most recent event had Merv back in Melbourne speaking at the Ferntree Gully Cricket Clubrooms for ‘Secret Men’s Stuff 08: The nuts and bolts of being a bloke’. The event attracted almost 100 people and included a number of speakers, as well as a general expo beforehand with free massages, café bar, basketball and golf putting games with prizes. Andrology Australia would like to thank all those involved in organising these successful events and for their support in raising the awareness of men’s health, in particular, male reproductive health.
Then it was back up to Queensland where the Cooloola Men’s Health Network held a public expo for men to promote their health management in Gympie in September. The event attracted over 500 Gympie and district residents, with stalls from a number of health centres and a Pit Stop health check also being offered.
Focus on: Your sperm – and how to look after them! Author: Professor Rob McLachlan
Why do men need to be aware of their fertility throughout their lives? Whether young or old, with a current partner or not, men need to protect their fertility so that natural conception can happen when they are ready to have children. To start a healthy pregnancy, men need to make large numbers of sperm that are good swimmers, and that ‘know’ how to fertilise the egg when they arrive. Sperm also needs to contain genetic information (DNA) in good condition. Having regular sex also helps! In many cases, there are no treatments to correct poor sperm production, blockages to sperm tubes or when couples have difficulty having sex, which means assisted reproductive technologies such as in vitro fertilisation (IVF) treatment is needed. Whilst there are some causes of infertility that cannot be prevented, there are things you can do to protect your fertility, protect your partner’s fertility and lessen the chances of needing IVF treatments in the future.
What infections can affect fertility? Sexually transmitted infections (STIs) STIs, particularly untreated gonorrhoea and chlamydia, can cause blockages in the sperm tubes so that sperm are unable to move on from the testicles (where they are produced) into the semen and ejaculated. Surgery to fix the blocked tubes is not always possible.
Prostate infection: ’Prostatitis’ The prostate sits underneath the bladder and adds fluid to protect sperm on their journey through the reproductive system. As the sperm move through the prostate into the urethra, prostate swelling may stop sperm from passing through the reproductive system. White blood cells from the infection can also damage sperm. Some STIs can cause bacterial prostatitis, so it pays to use protection!
Merv getting out and about promoting men’s health
Epididymo-orchitis
Recent events Launch of new booklet on preserving male fertility Andrology Australia has launched a new men’s fertility booklet ‘Your sperm – and how to look after them’ at the annual Fertility Society of Australia conference in October. The booklet provides a summary of conditions, behaviours and situations that can affect male fertility and outlines the measures men can take to preserve their fertility potential. Developed in response to an increase in both community awareness about male infertility and in the use of IVF treatments, the booklet encourages men to think about their fertility throughout their life.
“It’s important that there’s a resource available to men outlining how they can best look after their reproductive health and avoid fertility issues when they decide to start a family,” said Prof. Rob McLachlan, Director of Andrology Australia. “While some causes of infertility cannot be prevented, there are others that can be managed or avoided.” “In some cases where fertility may be affected permanently, men also need to be aware of options available to them like sperm storage.”
Epididymo-orchitis (pronounced ork-eye-tis) is usually caused by an infection in the urinary tract. This viral or bacterial infection happens in the tube that carries sperm out of the testicles (epididymis), but also spreads back into the testicle. Epididymo-orchitis can cause permanent blockages and damage to the testicles (and the ability to make sperm), but this is rare.
The booklet was reviewed and endorsed by the Fertility Society of Australia and Access Australia. Andrology Australia wishes to thank all those who took the time to review and provide input to the guide.
Mumps
‘Your sperm – and how to look after them’ is available to order from Andrology Australia in hard copy on 1300 303 878 or via email at
[email protected].
The virus can permanently destroy the tubes that make sperm and stop sperm production. Mild cases will still stop sperm production, but only for a short time of six to 12 months.
A viral infection that can be caught by anyone at any age, mumps is much more dangerous for adult men. Besides causing swelling of the salivary glands, fever and headaches, it can also cause inflammation and pain in the testicles.
Top Tips • Practice safe sex – use a condom to stop transfer of infection to or from your partner • Young boys should be vaccinated against the mumps virus to protect their fertility for the longer-term
Can heat damage sperm production?
Does lifestyle affect fertility?
What medical treatments can affect fertility in men?
To produce top quality sperm, the testicles need to be a couple of degrees cooler than normal body temperature; the scrotum serves as an ‘evaporative air cooling’ system. When it is too hot, the scrotum cannot sweat and the testicles have trouble making sperm. In cases where the scrotum has been too hot for too long, sperm production can be reduced.
Smoking
Vasectomy
Smoking cigarettes can reduce fertility, with heavy smokers producing up to 20 per cent fewer sperm. Smoking may also increase the number of abnormally shaped sperm, making it harder for sperm to fertilise the egg.
One in four Australian men in their forties have had a vasectomy believing they will never want to have children again. A vasectomy should be considered a permanent form of contraception and should not be decided lightly; it is not easy to regain fertility later.
New evidence shows that sperm DNA (genetic material) is damaged by the chemicals in tobacco smoke which may lower the chance of healthy pregnancy and affect your child’s future health.
Surgery and sickness
Top Tips • Avoid regular very hot baths or spas • Wearing loose fitting underwear such as boxer shorts may be good for sperm count: while this is unproven, it seems a reasonable step to take
Alcohol
Can drugs affect fertility levels?
Binge drinking and regular heavy drinking can cause liver problems and affect a whole range of body functions. Sexual and reproductive function can be affected and there may be damage to testicular function.
Treatments for cancer
Obesity
Radiation therapy and chemotherapy can cause long-term problems with sperm production. As radiation attacks and destroys rapidly dividing cancer cells, radiation therapy for cancers in or near the testicles can easily damage sperm-producing cells.
Studies show that obese men are less fertile than men of normal weight, and have lower sperm counts and fewer numbers of sperm that can swim well. Changes in hormone levels and too much heat around the scrotum may play a part.
Prescribed drugs Prescribed drugs such as cyclophosphamide and salazopyrine can cause long-term fertility problems. Antidepressants and sedatives can also negatively affect sexual performance, and may be linked to lower sperm counts.
Diet and vitamins Foods including pumpkin seeds, parsley and vitamins such as zinc, vitamin E and B12 are promoted as improving fertility in men. While there is no strong scientific evidence to show that specific foods or natural therapies improve fertility, having a healthy diet is important for general health and wellbeing, especially when trying to start a family.
Marijuana, cocaine, heroin and other illegal drugs can also affect sperm production as they lower a man’s testosterone levels and sex drive. Not having regular sex can make it more difficult to become pregnant.
Top Tips • Ask your doctor about sperm storage before starting cancer treatments • When taking prescribed drugs that may cause fertility problems, talk to your doctor about using other medications if you’re trying to conceive • Avoid using illegal drugs including steroids because all the risks are unknown
Top Tips • Men planning a vasectomy should consider storing sperm before the surgery • Wait several months after any major surgery or illness with a fever before trying to conceive
What problems with the testicles can affect fertility? Undescended testicles Undescended testicles or ‘cryptorchidism’ is when a man’s testicles don’t move down into the scrotum before or just after birth. Testicles ‘stuck’ in the groin or the abdomen are too warm and the spermproducing tubes can be damaged. Even when surgically corrected in early childhood, there is an increased chance of having fertility problems later in life.
Top Tips • Live a healthy lifestyle by watching your weight, have a healthy diet, exercise regularly, don’t smoke and drink alcohol in moderation • A healthy lifestyle will improve your quality of life and that of your family
Illegal drugs Anabolic steroids taken for body building or competitive sports cause acne, weight gain and mood changes, but also shrink men’s testicles and stop sperm production.
Any type of surgery is a serious medical treatment and any procedure using a general anaesthetic can lower a man’s sperm count for a short time. Sickness with a fever can also reduce sperm production and it can take several months for sperm counts to recover.
Does age play a part in fertility? Research shows that as men approach middle age it may take longer to get a partner pregnant. Having sex less often, erectile problems or other serious health problems may play a role, and the amount of semen, sperm movement and perhaps sperm DNA quality is lower. Taking into account your partner’s age is also important when starting a family as a woman’s fertility levels naturally drop after the age of 35.
Twisted testicle A medical emergency, a twisted testicle or ‘torsion of the testicle’ causes extreme pain and needs immediate attention. The testicle twists in the scrotum and cuts off the blood supply, causing the testicle to swell up and if left untreated can cause the testicle to die. Surgery relieves the pain and saves the testicle.
Small testicles Small testicles often signal problems with fertility or hormone levels. If an adult male’s testicles are roughly the size of a green grape, it could be a sign of low hormone levels or problems getting a partner pregnant.
Top Tips
Top Tips
• Men who had undescended testes as a child should check their testicles regularly for lumps and visit a doctor if anything changes
• Develop a life plan with your partner which recognises that fertility lessens with age and think about parenthood before the age of 35
• If a man experiences extreme pain in the testicle, he should go to hospital immediately
Can your workplace affect your fertility?
• Men need to know what ‘normal’ testicle size is and if they are small, should see their doctor for a full health check, including measurement of the testicles
Exposure to harmful chemicals, pesticides, heavy metals, toxic chemicals and radiation may affect the quality and quantity of sperm men produce and should be avoided. Physical injury at work can also affect fertility, so evaluate your work environment and make sure your fertility is safe.
Top Tips • For men who work in occupations that may affect fertility, it’s important to wear protective clothing and follow all OH&S guidelines
Storing sperm for later Particularly if undergoing treatment for cancer, semen samples may be collected and frozen at a fertility clinic with liquid nitrogen storage facilities. The collected semen may then be stored long-term for use later in fertility treatments such as in vitro fertilisation (IVF).
Professional education
In brief
Latest news
Men’s health education for future health professionals One of Andrology Australia’s priorities is the education of health professionals to ensure that they are confident in the management and treatment of male reproductive health disorders. While education of current health professionals continues to be a focus, it is also important to ensure that there is appropriate education of future health care professionals in this area.
core curriculum. The working group will also assist and advise in the development of core curriculum and oversee an extensive consultation process with all Australian medical schools invited to participate in the process.
The working group will provide advice on the development and design of resources, evaluate primary uptake of the curriculum, and assist in the development of strategy to ensure the curriculum package remains current and up to date.
Congratulations to Katherine Cust, Health Promotion Officer at Otway Health in Apollo Bay, and to Bernadette Rey of Belrowes Medical in Queensland! Both were placed in the draw after completing recent online evaluations, winning an iPod 1GB shuffle for their troubles. Thank you to all who provided their valuable feedback.
The aim of the working group is to develop a medical curriculum structure that comprehensively addresses men’s health needs throughout their life. The working group brings together a core consortium of medical schools across Australia to ensure that the consultation process and curriculum that is developed is effective.
Endorsed Provider of health professional education
Members of the Medical Curriculum Working Group (from left to right, top and then bottom row) are Mr Tim Smith (Australian Medical Students Association), Professor Rob McLachlan (Director, Andrology Australia), Professor Ben Canny (Monash University), Dr Megan Cock (Andrology Australia), A/Professor Tessa Ho (University of Sydney) and A/Professor Bu Yeap (University of Western Australia). Not included in the photo is Professor David Wilkinson (University of Queensland).
Research round-up
Andrology Australia is proud to announce its endorsement as a provider of health professional education through the Royal Australian College of General Practitioners (RACGP). Andrology Australia is now qualified to deliver Category 2 Educational Activities for general practitioners. Andrology Australia is also in the process of becoming an Accredited Provider for the RACGP QA&CPD program, which will allow us to develop Category 1 activities.
We need your help! Your support is essential in continuing the important work of Andrology Australia and improving the health and wellbeing of all Australian men and their families.
Promoting good health in the workplace Evidence suggests that lifestyle risk factors such as obesity and living a sedentary lifestyle are linked to both male reproductive health disorders and chronic disease including heart disease and diabetes.
The pilot initially includes focus group meetings with both office and outdoor maintenance staff members, to better understand their current physical activity levels and if any health messages motivate them to exercise.
A pilot program has been developed as a collaborative project between Kinect Australia and Andrology Australia, involving staff working in a metropolitan and a regional Victorian government local council office.
Outcomes of the meetings are currently being collated and will guide the development of the project and education resources to encourage men to participate in physical activity programs.
The program aims to promote physical activity in men by raising awareness of general and reproductive health, through communication of relevant health messages within a workplace environment.
To thank you for your support of Andrology Australia and men’s health, all registrants of the Healthy Male newsletter will receive a 2009 pocket diary with this issue. Only one diary is available per Australian resident.
Winners of evaluation prizes
From a preliminary scoping exercise, men’s health education is generally limited and appears to vary between medical schools across Australia. To address the need for a flexible medical curriculum framework on a range of men’s health disorders in Australia, an Andrology Australia working group has been established.
Project stages will include mapping the current curricula of universities and defining the framework for building the
Diaries 2009
Both of the local councils involved already offer various opportunities and policies to promote physical activity in the workplace. However, these are not clearly known or understood by all staff members.
The pilot is supported by the Australian Government Department of Health and Ageing – Healthy Active Australia: Community and School Grants Program. For more information on the project, please contact Ms Taletha Groves, Education Liaison Officer for Andrology Australia;
[email protected]. edu.au or phone 03 9594 7162.
Donations to Andrology Australia will contribute to our community, professional and research programs in men’s health. Visit www. andrologyaustralia.org or call 1300 303 878 to make a donation.
Do you have Klinefelter Syndrome? Participants needed A major study looking at the personal impact of Klinefelter’s Syndrome (KS) is now underway and is recruiting men diagnosed with KS to complete a questionnaire. To register your interest or for more information, please email your contact details to
[email protected] or call Amy Herlihy on 03 8341 6370.
Agent Orange may be associated with an increased risk of prostate cancer The herbicide Agent Orange was sprayed by the United States in the former South Vietnam during the Vietnam War from 1962 to 1971, and exposed veterans were found to have an increased risk of developing several types of cancer3. However, studies have shown that there was only a weak association between exposure to Agent Orange and the development of prostate cancer specifically. With Vietnam War veterans now entering their 60s, a new study has looked at the link between Agent Orange and prostate cancer4. The authors measured the relative risk of developing prostate cancer amongst 13,144 Vietnam veterans who were noted as either ‘exposed’ or ‘unexposed’ to Agent Orange, and were followed between 1998 and 2006. Differences in patient and disease characteristics including age, race, smoking history, family history, body mass index, prostate-specific antigen (PSA) level and Gleason score, were assessed. The study found that twice as many men exposed to Agent Orange had prostate cancer. Exposed men also developed the disease at a younger age, and had a more aggressive cancer than those who were not exposed. The results suggest that those exposed to Agent Orange should be classified at high risk of developing prostate cancer, in addition to men with African-American heritage and men with a family history of the disease. It is known that during childhood development, exposure to toxic chemicals such as vinclozolin (a fungicide) increases the risk of reproductive problems when older. This new study is interesting because it shows that normal, healthy adult men may still be at risk. Further understanding of the relationship between Agent Orange and prostate cancer, and the contributing factors is needed. Agent Orange is just one of many toxic chemicals that men are exposed to over their lifetime that may affect reproductive health. However, the association between Agent Orange and prostate cancer in the study is strong and should serve to inform both clinical practice and future research about the effects of Agent Orange exposure. 3
Institute of Medicine (IOM) Veterans and Agent Orange, Update 2000. Washington, DC: National Academy 4
Chamie K, deVere White RW, Volpp B, Lee D, Ok J, Ellison LM. Agent Orange exposure, Vietnam War veterans, and the risk of prostate cancer. Cancer; e-pub 29 July 2008
The Healthy Male
Newsletter of Andrology Australia Australian Centre of Excellence in Male Reproductive Health
Editor: Cassy Bezeruk
Andrology Australia C/O - Monash Institute of Medical Research Postal Address: Monash Medical Centre 246 Clayton Road, Clayton Victoria 3168 Street Address: 27-31 Wright Street, Clayton Victoria 3168 Telephone: 1300 303 878 Facsimile: + 61 3 9594 7111 Internet: www.andrologyaustralia.org
Issue 28 – Spring 2008 from The Australian Government Department of Health and Ageing.
Contents 2
Community education Trekking the countryside with Merv Hughes
2
Recent Events Launch of new booklet on preserving male fertility
3
Focus on Your Sperm – and how to look after them!
5
Professional education Men’s health education for future health professionals
5
Research roundup Promoting good health in the workplace
Email:
[email protected] Andrology Australia is administered by
Newsletter of Andrology Australia – Australian Centre of Excellence in Male Reproductive Health
Andrology Australia is supported by a grant
Monash Institute of Medical Research
6
In brief
6
Latest news
Myths of fertility Having a healthy diet, exercising regularly, watching your weight and not smoking are lifestyle choices that benefit your health. But do they improve your fertility? A new study has shown that while young people are aware that negative lifestyle factors can reduce fertility, they falsely believed in fertility myths1. The study, conducted in the UK, surveyed 110 female and 39 male university students to establish their views on what effect a range of health risk factors and myths would have on women trying to get pregnant. Risk factors included smoking, drinking too much alcohol, and being of older age. Fertility myths included not urinating after sex and lying down for 10 minutes after sex, among others. Findings from the study showed a lack of full understanding of the factors that can impact on fertility. Although participants knew about the risk factors for infertility, they were less aware of the factors that had no effect on fertility. Those surveyed
wrongly believed that you can be more fertile by ‘not doing’ something – that not drinking wine will increase your chance of pregnancy. A lack of knowledge about what can and can’t affect fertility may mean that people are unintentionally contributing to their own future fertility problems. For example, they may not understand that being overweight could be affecting their chances of getting pregnant. Also, having false beliefs may lead people to delay seeking treatment such as IVF when having difficulty getting pregnant. This study shows that there is a need to improve people’s knowledge surrounding fertility and the risks and benefits of their lifestyle choices. It is likely that similar issue affects people’s understanding of male fertility, and the authors point to the need for more research to determine the level of knowledge in relation to lifestyle behaviours on male fertility.
1
Bunting L, Boivin J. Knowledge about infertility risk factors, fertility myths and illusory benefits of healthy habits in young people. Human Reproduction 2008; 28:1858–1864
Subscribe Today! Andrology Australia extends an invitation to all to take advantage of the FREE SUBSCRIPTION offer. Call, fax or email us to register on our mailing list and receive this regular quarterly publication and other items from Andrology Australia.
From the Director Male fertility is often taken for granted when a couple is planning to start a family. By the time the couple make that decision, few men would be aware that they had already been exposed to a range of factors that could impact their ability to father a child. Infections, heat, drugs, age, work environments, sporting and recreational injury, and lifestyle issues such as smoking, alcohol and obesity can all affect fertility in men temporarily or permanently.
child may be better if they pay attention to avoiding injury or infection and to their overall health by exercising regularly, having a healthy diet and watching their weight. This edition of The Healthy Male focuses on how men can protect their fertility and raises awareness of the factors that can impact on fertility in men.
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.
The number of babies born in Australia using assisted reproductive technology such as IVF has tripled in a decade2. In half of all IVF cases, male reproductive complications are either the exclusive problem or a contributing factor. It is estimated that infertility affects 1 in 20 men. While often fertility problems are not preventable, men’s chances of fathering a
Professor Rob McLachlan
2
Wang YA, Dean JH, Badgery-Parker T & Sullivan EA 2008. Assisted reproduction technology in Australia and New Zealand 2006. Assisted reproduction technology series no. 12. AIHW cat. no. PER 43. Sydney: AIHW National
Professional education
In brief
Latest news
Men’s health education for future health professionals One of Andrology Australia’s priorities is the education of health professionals to ensure that they are confident in the management and treatment of male reproductive health disorders. While education of current health professionals continues to be a focus, it is also important to ensure that there is appropriate education of future health care professionals in this area.
core curriculum. The working group will also assist and advise in the development of core curriculum and oversee an extensive consultation process with all Australian medical schools invited to participate in the process.
The working group will provide advice on the development and design of resources, evaluate primary uptake of the curriculum, and assist in the development of strategy to ensure the curriculum package remains current and up to date.
Congratulations to Katherine Cust, Health Promotion Officer at Otway Health in Apollo Bay, and to Bernadette Rey of Belrowes Medical in Queensland! Both were placed in the draw after completing recent online evaluations, winning an iPod 1GB shuffle for their troubles. Thank you to all who provided their valuable feedback.
The aim of the working group is to develop a medical curriculum structure that comprehensively addresses men’s health needs throughout their life. The working group brings together a core consortium of medical schools across Australia to ensure that the consultation process and curriculum that is developed is effective.
Endorsed Provider of health professional education
Members of the Medical Curriculum Working Group (from left to right, top and then bottom row) are Mr Tim Smith (Australian Medical Students Association), Professor Rob McLachlan (Director, Andrology Australia), Professor Ben Canny (Monash University), Dr Megan Cock (Andrology Australia), A/Professor Tessa Ho (University of Sydney) and A/Professor Bu Yeap (University of Western Australia). Not included in the photo is Professor David Wilkinson (University of Queensland).
Research round-up
Andrology Australia is proud to announce its endorsement as a provider of health professional education through the Royal Australian College of General Practitioners (RACGP). Andrology Australia is now qualified to deliver Category 2 Educational Activities for general practitioners. Andrology Australia is also in the process of becoming an Accredited Provider for the RACGP QA&CPD program, which will allow us to develop Category 1 activities.
We need your help! Your support is essential in continuing the important work of Andrology Australia and improving the health and wellbeing of all Australian men and their families.
Promoting good health in the workplace Evidence suggests that lifestyle risk factors such as obesity and living a sedentary lifestyle are linked to both male reproductive health disorders and chronic disease including heart disease and diabetes.
The pilot initially includes focus group meetings with both office and outdoor maintenance staff members, to better understand their current physical activity levels and if any health messages motivate them to exercise.
A pilot program has been developed as a collaborative project between Kinect Australia and Andrology Australia, involving staff working in a metropolitan and a regional Victorian government local council office.
Outcomes of the meetings are currently being collated and will guide the development of the project and education resources to encourage men to participate in physical activity programs.
The program aims to promote physical activity in men by raising awareness of general and reproductive health, through communication of relevant health messages within a workplace environment.
To thank you for your support of Andrology Australia and men’s health, all registrants of the Healthy Male newsletter will receive a 2009 pocket diary with this issue. Only one diary is available per Australian resident.
Winners of evaluation prizes
From a preliminary scoping exercise, men’s health education is generally limited and appears to vary between medical schools across Australia. To address the need for a flexible medical curriculum framework on a range of men’s health disorders in Australia, an Andrology Australia working group has been established.
Project stages will include mapping the current curricula of universities and defining the framework for building the
Diaries 2009
Both of the local councils involved already offer various opportunities and policies to promote physical activity in the workplace. However, these are not clearly known or understood by all staff members.
The pilot is supported by the Australian Government Department of Health and Ageing – Healthy Active Australia: Community and School Grants Program. For more information on the project, please contact Ms Taletha Groves, Education Liaison Officer for Andrology Australia;
[email protected]. edu.au or phone 03 9594 7162.
Donations to Andrology Australia will contribute to our community, professional and research programs in men’s health. Visit www. andrologyaustralia.org or call 1300 303 878 to make a donation.
Do you have Klinefelter Syndrome? Participants needed A major study looking at the personal impact of Klinefelter’s Syndrome (KS) is now underway and is recruiting men diagnosed with KS to complete a questionnaire. To register your interest or for more information, please email your contact details to
[email protected] or call Amy Herlihy on 03 8341 6370.
Agent Orange may be associated with an increased risk of prostate cancer The herbicide Agent Orange was sprayed by the United States in the former South Vietnam during the Vietnam War from 1962 to 1971, and exposed veterans were found to have an increased risk of developing several types of cancer3. However, studies have shown that there was only a weak association between exposure to Agent Orange and the development of prostate cancer specifically. With Vietnam War veterans now entering their 60s, a new study has looked at the link between Agent Orange and prostate cancer4. The authors measured the relative risk of developing prostate cancer amongst 13,144 Vietnam veterans who were noted as either ‘exposed’ or ‘unexposed’ to Agent Orange, and were followed between 1998 and 2006. Differences in patient and disease characteristics including age, race, smoking history, family history, body mass index, prostate-specific antigen (PSA) level and Gleason score, were assessed. The study found that twice as many men exposed to Agent Orange had prostate cancer. Exposed men also developed the disease at a younger age, and had a more aggressive cancer than those who were not exposed. The results suggest that those exposed to Agent Orange should be classified at high risk of developing prostate cancer, in addition to men with African-American heritage and men with a family history of the disease. It is known that during childhood development, exposure to toxic chemicals such as vinclozolin (a fungicide) increases the risk of reproductive problems when older. This new study is interesting because it shows that normal, healthy adult men may still be at risk. Further understanding of the relationship between Agent Orange and prostate cancer, and the contributing factors is needed. Agent Orange is just one of many toxic chemicals that men are exposed to over their lifetime that may affect reproductive health. However, the association between Agent Orange and prostate cancer in the study is strong and should serve to inform both clinical practice and future research about the effects of Agent Orange exposure. 3
Institute of Medicine (IOM) Veterans and Agent Orange, Update 2000. Washington, DC: National Academy 4
Chamie K, deVere White RW, Volpp B, Lee D, Ok J, Ellison LM. Agent Orange exposure, Vietnam War veterans, and the risk of prostate cancer. Cancer; e-pub 29 July 2008
The Healthy Male
Newsletter of Andrology Australia Australian Centre of Excellence in Male Reproductive Health
Editor: Cassy Bezeruk
Andrology Australia C/O - Monash Institute of Medical Research Postal Address: Monash Medical Centre 246 Clayton Road, Clayton Victoria 3168 Street Address: 27-31 Wright Street, Clayton Victoria 3168 Telephone: 1300 303 878 Facsimile: + 61 3 9594 7111 Internet: www.andrologyaustralia.org
Issue 28 – Spring 2008 from The Australian Government Department of Health and Ageing.
Contents 2
Community education Trekking the countryside with Merv Hughes
2
Recent Events Launch of new booklet on preserving male fertility
3
Focus on Your Sperm – and how to look after them!
5
Professional education Men’s health education for future health professionals
5
Research roundup Promoting good health in the workplace
Email:
[email protected] Andrology Australia is administered by
Newsletter of Andrology Australia – Australian Centre of Excellence in Male Reproductive Health
Andrology Australia is supported by a grant
Monash Institute of Medical Research
6
In brief
6
Latest news
Myths of fertility Having a healthy diet, exercising regularly, watching your weight and not smoking are lifestyle choices that benefit your health. But do they improve your fertility? A new study has shown that while young people are aware that negative lifestyle factors can reduce fertility, they falsely believed in fertility myths1. The study, conducted in the UK, surveyed 110 female and 39 male university students to establish their views on what effect a range of health risk factors and myths would have on women trying to get pregnant. Risk factors included smoking, drinking too much alcohol, and being of older age. Fertility myths included not urinating after sex and lying down for 10 minutes after sex, among others. Findings from the study showed a lack of full understanding of the factors that can impact on fertility. Although participants knew about the risk factors for infertility, they were less aware of the factors that had no effect on fertility. Those surveyed
wrongly believed that you can be more fertile by ‘not doing’ something – that not drinking wine will increase your chance of pregnancy. A lack of knowledge about what can and can’t affect fertility may mean that people are unintentionally contributing to their own future fertility problems. For example, they may not understand that being overweight could be affecting their chances of getting pregnant. Also, having false beliefs may lead people to delay seeking treatment such as IVF when having difficulty getting pregnant. This study shows that there is a need to improve people’s knowledge surrounding fertility and the risks and benefits of their lifestyle choices. It is likely that similar issue affects people’s understanding of male fertility, and the authors point to the need for more research to determine the level of knowledge in relation to lifestyle behaviours on male fertility.
1
Bunting L, Boivin J. Knowledge about infertility risk factors, fertility myths and illusory benefits of healthy habits in young people. Human Reproduction 2008; 28:1858–1864
Subscribe Today! Andrology Australia extends an invitation to all to take advantage of the FREE SUBSCRIPTION offer. Call, fax or email us to register on our mailing list and receive this regular quarterly publication and other items from Andrology Australia.
From the Director Male fertility is often taken for granted when a couple is planning to start a family. By the time the couple make that decision, few men would be aware that they had already been exposed to a range of factors that could impact their ability to father a child. Infections, heat, drugs, age, work environments, sporting and recreational injury, and lifestyle issues such as smoking, alcohol and obesity can all affect fertility in men temporarily or permanently.
child may be better if they pay attention to avoiding injury or infection and to their overall health by exercising regularly, having a healthy diet and watching their weight. This edition of The Healthy Male focuses on how men can protect their fertility and raises awareness of the factors that can impact on fertility in men.
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.
The number of babies born in Australia using assisted reproductive technology such as IVF has tripled in a decade2. In half of all IVF cases, male reproductive complications are either the exclusive problem or a contributing factor. It is estimated that infertility affects 1 in 20 men. While often fertility problems are not preventable, men’s chances of fathering a
Professor Rob McLachlan
2
Wang YA, Dean JH, Badgery-Parker T & Sullivan EA 2008. Assisted reproduction technology in Australia and New Zealand 2006. Assisted reproduction technology series no. 12. AIHW cat. no. PER 43. Sydney: AIHW National
