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An estimated 2.6 million couples in the United States experience problems with fertility, and numerous factors may be involved in both the male and the female partners. In up to 40% of infertile couples, male factor infertility plays a contributing role. For many years, the evaluation of male infertility has relied on-and been limited to-semen analysis, which measures sperm count and assesses sperm motility and morphology. More recently, new technologies have evolved that measure DNA fragmentation in sperm. Clinical studies have shown that sperm with elevated levels of DNA fragmentation are a strong predictor of reduced male fertility. Many factors-infection, diet, illicit drugs, some prescribed and over-the-counter medications, lack of sleep, stress, high fever, elevated testicular temperature, air pollution, alcohol, cigarette smoking, toxin exposures, advanced age-may result in DNA fragmentation.Now on the market is a dietary supplement called Proxeed?, which has been designed to enhance and support the quality of sperm. This supplement provides ingredients that contribute to the metabolic processes in the cells that manufacture sperm. Clinical data have shown that the ingredients in Proxeed? may potentially optimize sperm motility, speed, count, morphology, and concentration.Recently, Mark Perloe, MD, an endocrinologist and fertility specialist, posed questions to Phillip Werthman, MD, a board certified urologist and fellowship-trained andrologist, on the use of DNA testing of sperm, on the implications of DNA fragmentation, and on the benefits of dietary fertility supplements in optimizing the reproductive health of men. The following is a report of Dr. Werthman’s answers to these questions.

Articles on prostate cancer and colon cancer screening in high-circulation consumer magazines do not offer the necessary information for readers to make an informed decision, according to a recent study in the Journal of General Internal Medicine (2004; 19:843-8).

Howard B. Goldman, MD, has joined the Cleveland Clinic Glickman Urological Institute.

Unimed Pharmaceuticals said it now offers testosterone gel 1% (AndroGel) in a metered-dose pump.

A federal appeals court in Atlanta has confirmed class-action status for a lawsuit alleging that six health insurers had systematically underpaid 900,000 active and retired physicians.

PSA has lost its value as a screening tool for prostate cancer and does nothing more than indicate the size of the prostate gland, according to a study led by Thomas A. Stamey, MD, and published in the October issue of the Journal of Urology (2004; 172:1297-1301).

International Volunteers in Urology (IVU) carried out its second trip to care for children in Mongolia in June.

Prostate Centers of America said its first urologist-owned LLC joint venture using photoselective vaporization of the prostate (PVP) had reached profitability.

Even though men age 56 years and older continue to receive the majority of sildenafil citrate (Viagra) prescriptions, use in men ages 18 to 46 years increased 312% from 1998 to 2002, according to a study in the International Journal of Impotence Research (2004 16:313-8.)

A new study has been launched to compare long-term benefits and risks of three treatments for BPH-transurethral needle ablation, transurethral microwave thermotherapy, and a combination drug regimen of alfuzosin (Uroxatral) and finasteride (Proscar), the National Institute of Diabetes and Digestive and Kidney Diseases announced.

The addition of a short course of androgen suppression therapy following radiation therapy improves survival in men with localized prostate cancer compared with radiation therapy alone, according to researchers from Brigham and Women's Hospital and the Dana Farber Cancer Institute, Boston.

Washington--Legislation designed to help improve patient safety by reducing mistakes in health care settings stands a good chance of winning final approval by Congress before lawmakers adjourn for the November election.

Terminating a patient is more complicated than just refusing to see him or her again.

Salaries, fees, bonuses, taxable fringe benefits, pensions, and retirement pay are subject to withholding if paid as compensation for services.

At some point in our profession, we may want to send videos demonstrating certain procedures to our colleagues, or we may want to include a video with a study that is being published in an online medical journal, where visitors can view the technique in real time rather than try to make sense of an illustration or photograph.

CMS estimates that Medicare payments to urologists will decrease 13% in 2005.

New Orleans--Treatment with the endothelin receptor antagonist atrasentan (Xinlay) significantly delays time to progression in patients with metastatic, hormone-refractory prostate cancer, according to a meta-analysis of pooled data from two large trials.

San Francisco--As a salvage for locally recurrent prostate cancer after failed radiation, targeted cryoablation of the prostate (TCAP) provides a "significantly better overall quality of life" than salvage radical prostatectomy, said Aaron E. Katz, MD, at the AUA annual meeting.

San Francisco--Once infection has been ruled out as a cause of a man's pelvic pain, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the diagnosis. Although a symptom and problem index is available to help clinicians and researchers follow the patient's progress, there is no objective test that helps clinch a diagnosis, define the extent of disease, or measure its progression or regression.

San Francisco--A history of prostatitis is apparently linked to the development of prostate cancer, although it is unclear whether this is simply a compelling correlation or a potential etiology, according to the authors of a multicenter study presented at the AUA annual meeting.

San Francisco--An investigational selective alpha-1 adrenoreceptor blocker improves both the obstructive symptoms associated with BPH and symptoms associated with overactive bladder, according to a Japanese study presented at the AUA annual meeting here.

San Francisco--Interim results from two multi-national European studies show that once-daily treatment with a uroselective alpha-blocker reduces lower urinary tract symptoms and may benefit sexual function. The drug, alfuzosin (Uroxatral), appears to be efficacious in men with co-morbidities such as hypertension, heart disease, and diabetes, and does not seem to significantly interact with medications for those conditions, according to two separate studies presented at the AUA annual meeting here.

San Francisco--Phytotherapy with the saw palmetto extract Serenoa repens (Permixon) appears to be more effective than an alpha-blocker in relieving severe BPH, European researchers report. Their finding is based on a study of nearly 700 patients with symptomatic BPH who received either the saw palmetto extract or the alpha-blocker tamsulosin (Flomax).

San Francisco--Androgens, estrogens, and the development of BPH appear to be related, according to a study presented at the AUA annual meeting this year, but the nature of those relationships and the underlying mechanisms remain unknown.

New York--New disease registries aimed at collecting real-world data on the management of two common urologic conditions in men-BPH and rising PSA following initial treatment for prostate cancer-are currently in the patient recruitment phase. The registries will help to quantify the wide range of practice patterns and outcomes that have not been previously examined, say urologists involved in the initiatives.

San Francisco--Serum BPSA, an antigen enriched in the nodular transition zone tissue in BPH, appears to be a better predictor of clinically significant prostate enlargement than PSA or free PSA. This finding and complementary data, by researchers from the Scott Department of Urology, Baylor College of Medicine, Houston, lay the groundwork for further study that will determine the antigen's potential to distinguish between BPH and prostate cancer.

New Orleans--The amount and velocity of change in PSA during the first few months of chemotherapy can independently predict patients who will survive, according to data from the Southwest Oncology Group (SWOG) and Cancer and Leukemia Group B. The results are among many recent findings begging FDA consideration in the debate about how PSA measurements can be used to more quickly approve prostate cancer drugs.

Hopefully critical analysis of the MTOPS samples will yield useful biomarkers within the next couple of years.