Defining Male Infertility with guest Dr. Paul Turek

Do men have a biological clock?

The short answer is, yes! Absolutely.

I don’t claim to be an expert on men’s reproductive health, but given it is 50% of the equation when it comes to getting pregnant, I care a great deal about it.

I get questions all of the time from patients about their partner’s sperm. My trusted go-to person for the latest information on those little swimmers is Dr. Paul Turek, who I like to call, “The Sperm Whisperer.”

Dr. Turek was a recent guest on The Egg Whisperer Show. Here’s what you need to know about our chat, and answers to some of your most common questions.

It’s time for a men’s movement in preventative healthcare

Men are medically underserved. The typical man leaves a pediatrician and then in some cases doesn’t see a doctor again (absent of illness) until he is in his 40s or 50s.

When it comes to men’s reproductive health, they differ from women in that they they don’t have a monthly cycle that keeps them in tune with their bodies. There is no motivation to see a doctor until there is a problem.

If couples experience infertility both should get care.

Yet, only 1 in 5 men do. Women typically get the care because they are proactive.

A man struggling with infertility may get a semen analysis, but that’s not care.

“We can find things if we see them, but we can’t if we don’t,” he says.

Dr. Turek advocates taking a moment to look under the rock of men’s fertility.

What’s been hiding? What more can be discovered to then be solved and to give men the same level of care women seek and get?

He described men’s fertility like an old Maserati. It won’t bend or make noise when it starts to fail, it will just break down.

So how do men get more regular with their care? What can they do to be proactive with their health?

“When your wife’s period starts, think of me,” says Dr. Turek.

Q & A:

Here are the questions I’ve received from people like you and Dr. Paul Turek’s answers.

1. How old is too old for a man to have a baby?

This field is new. Men never lived long enough to be considered older fathers. 50 is older, and in many cases, so is 40. As a medical and scientific community, we haven’t even defined what old paternal age means!

Male fertility is like a hockey stick. Flat (stays the same) for a long time and then drastically curves, or begins to change.

I would say 60 is the age when you wouldn’t freeze sperm any longer. 40 is advanced sperm age.

The average age for a man to become a first time parent is 30.

The whole concept of what’s old is just so new.

What we do know is that advanced paternal age has been linked to disease and the health of the sperm.

As men age their sperm incur more problems. One is DNA fragmentation; another is that they have more single gene mutations, which may lead to debilitating diseases in their children.

Epigenetics (the study of gene expression) helps us understand that the way DNA is marked on a sperm changes with age. These sperm DNA markings are instrumental in fertilization, embryo quality, miscarriage, and probably a lot of the neurodevelopmental diseases in children like autism, schizophrenia, dyslexia and bipolar disorder.

Episona (an epigenetics data company) is coming out with a second-generation test which will give men the chronological age of their sperm. This test won’t outline specific risks, but it’s intended to assign an age to your sperm. So for instance, you may be a 40-year-old male, but because of how your genes are expressed (likely due to your lifestyle) you may have the chronological age of sperm much older or younger.

The bottom line is for men to seek out information to determine if they would be wise to freeze their sperm.

2. What can a guy do to improve his sperm profile?

Lifestyle, lifestyle, lifestyle.

Take care of yourself for a longer period of time to change sperm for 3–6 months (See Trimester Zero: Strategies for Your Best Preconception Health) before getting pregnant just as women do in preparing their body for pregnancy. Think about a fertility supplement like Essential Beginnings.

It’s not about numbers and semen analysis. It’s not about volume or count. We are going deeper into the sperm’s health. Quality is more important than quantity.

3. Can good egg quality overcome high DNA fragmentation of sperm?

Yes. Think of it as a dance. You need at least 2 legs out of 4 to make it happen otherwise you’ll fall over. If both you and your partner have a problem then you may not finish the dance. However, if one of you is strong it may be enough to make it work.

The sperm introduce errors in their DNA as they meet the egg. Eggs meet those sperm and spend time fixing those things. Then the egg will make the decision if things will be a go after fertilization.

4. If ICSI is unsuccessful is it the egg or sperm quality?

Note: ISCI stands for Intracytoplasmic Sperm Injection and is an in vitro fertilization procedure in which a single sperm cell is injected directly into the cytoplasm of an egg.

Many of the logistics in embryo development are sperm driven. There is a 45% chance sperm are causing the problem.

Obesity is a classic reason for low sperm count along with anything that lowers testosterone like social drugs, chronic stress, marijuana and hot tubs.

Our bodies (and sperm) are not built for chronic stress or to be chronically connected to a device (our phones).

5. Are there any medications a guy can take to improve sperm count and quality?

Not really. Sperm want to run hard and all you can do is bring it down. So if the sperm are down you need to determine what’s keeping them down and reverse it.

If you’re smoking, stop smoking.

Typically the healthiest body is one that has no medicine in it.

A great diet may help too.

Sleep well.

Take care of yourself.

Losing 25 pounds changes the epigenetic profile of your sperm a year later.

Changing lifestyle can change fertility for a man.

6. Does quality of sperm effect successful fertilization with ICSI?

Fertilization is independent of sperm quality.

But the events after fertilization are very dependent on sperm quality.

7. How often do you see no fertilization with ICSI?

1 in 200 cases and the most common reason is dead sperm.

8. If the sperm count is normal how can sperm DNA fragmentation be abnormal? Do they correlate?

You can’t judge a book by it’s cover or a sperm by it’s shape, size or quantity.

It’s not about the count. It’s about the quality.

9. What is the best prep for a guy for an IUI?

Note: Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization.

The most important thing is to understand why IUI is being done.

If you have a long abstinence period the count will go down and the fragmentation will go up. This is a new concept. The sperm is old that’s being ejaculated. Have regular intercourse or ejaculation for the month leading up to it along with a 2–3 day abstinence period immediately prior to giving the sample.

10. What about guys with ED (erectile dysfunction)?

Most of the time it is stress related. Sperm last a day or two in the uterus. Tell your guy to decompress.

Catch more of me and topics like this through The Egg Whisperer Show. Episodes are live-streamed on YouTube, Facebook, Twitter, IGTV and Apple Podcasts. Sign up to get my newsletter. Sign up for The Egg Whisperer School.