My wife and I are attempting to conceive by means of in vitro fertilization. I have been told that my sperm may be a bit "lazy" and ICSI may be used. Is there anything that I personally can do to assist the mobility of my sperm, such as wearing boxers or observing longer periods of abstinence? This is an expensive proposition and I would like to do anything possible to better our chances.

George

I always chuckle when physicians choose to use terminology that suggest that eggs or sperm fail to meet and form a lasting relationship because of a character defect. If only it was as easy to address sperm problems! There are no reform schools or boot camps to get "lazy" sperm -- or, for that matter, "juvenile" sperm or "hyperactive" sperm -- to work up to their potential.

Fat serves as the major energy source for sperm. This energy is released inside cellular structures called mitochondria; this makes motility possible. Rarely is a person's diet deficient in carnitine. However, studies have suggested that carnitine levels may be lower in the semen of men with low motility.

Initial European studies have suggested that supplementation with Proxeed for a period of three to four months may improve motility and sperm counts. It is too early to say whether these early clinical findings are valid. Hopefully, placebo-controlled clinical trials in the United States will confirm these findings.

As you suggest, your physician is probably referring to sperm motility -- the ability of the sperm to move and swim. When we do a semen analysis, we look at several factors, including the sperm count (the number of sperm in each milliliter of seminal fluid), the volume of semen, the percent of sperm that are motile (moving), and the sperm morphology or "handsomeness" (whether they look normal). A more careful analysis includes a description of specific motility characteristics such as speed, straight-line swimming or "hyperactivity" (a wildly gyrating swim pattern). These factors will be noted by most andrology labs, which specialize in fertility evaluation. Unfortunately, many people seeking answers to fertility problems are directed to the major "we do everything" laboratories, which rarely provide the degree of information we need to accurately assess your fertility potential.

Semen analysis is not the only step in evaluating a man's fertility. You should also have a physical examination. A urologist (a specialist in male organs) will review your medical history and check your prostate, testicles, epididymis and vas deferens to look for signs of infection, blockage or malformation. Blood tests or an ultrasound examination of the prostate may be necessary. Even so, we rarely identify a correctable problem that can affect sperm motility.

That's not to say there are no ways to improve motility, however. Before ejaculation, sperm generate the energy they need for motion primarily by burning fat. After ejaculation, sperm rely on the sugar fructose that is found in the seminal fluid. This energy production occurs just below the sperm head, in the sperm mid-piece. This portion of the sperm is filled with mitochondria, tiny furnaces that burn sugar and fat to generate energy for the "big swim." Just as with the old coal-burning steam locomotives, the mitochondria require someone to stoke the fire. In the case of sperm, that help comes from two proteins, called L-carnitine and acetyl-L-carnitine, which facilitate transfer of fatty acids into the mitochondrial furnaces.

Rarely is a person's diet deficient in carnitine. However, studies have suggested that carnitine levels may be lower in the semen of men with low motility. Recent studies in the United States and Europe have shown that dietary supplementation with Proxeed, a combination of these two proteins, may improve sperm motility in a large percentage of males with motility problems. A three- to six-month trial may result in significant improvement, making it possible to conceive either naturally or with insemination, rather than IVF.