Welcome to The Egg Whisperer Show. Today I’m speaking with Dr. Ramy Ghayda. Dr. Ghayda is an experienced urologist, who has had a long history of working in the higher education industry. His specialties include urology, andrology, and male infertility. He is currently an assistant professor at University Hospitals in Cleveland, Ohio and the Chief Medical Officer at Legacy, a company that is revolutionizing how men and couples store and freeze sperm.
I’m delighted to have him joining me today to talk about sperm, declining fertility rates, and why it’s important to test and freeze your (or your partner’s) sperm.
Dr. Aimee: You hear me say this all the time; it’s always nice to have sperm on ice. Today, I have someone on the show who has made it his career. And he might be wearing a shirt that says that right now. I’m kidding, but he should. I’m so excited to have Dr. Ramy Ghayda to talk to us about sperm, sperm, and more about sperm.
Welcome, Ramy. Thank you for joining us today.
Dr. Ramy Ghayda: Thank you for having me today, Aimee.
Dr. Aimee: Tell us about Legacy. You’re the chief medical officer of this company. What does it do and how did it come about?
Dr. Ramy Ghayda: Legacy is a digital fertility clinic. Traditionally, all these fertility clinics don’t have and are not designed to attend to any men’s needs or the men’s journey. They’re only focusing on the female part. The men were a very small part of the journey for the fertility clinic and the couple. Legacy was created to fill this gap.
Legacy would be with the journey of the clients all along, from an emotional perspective, medical perspective, nutrition perspective, psychological perspective. We look at fertility as a journey and then we’re there to support all aspects of the journey.
First, it started off by providing analysis and the ability to freeze any sperm that’s needed. Then we branched out to provide free telehealth services. Now we have supplements like CoQ10 and multivitamin supplements. We have DNA fragmentation tests, which we are the only at-home kit to provide this service. It was a very big deal to have it because DNA fragmentation is an indicator for the integrity of sperm DNA. Once you have a high DNA fragmentation index, it might mean that you have some problem that can be corrected and improve male fertility. We can test for that.
Dr. Aimee: Can you do it all at once, can you do the semen analysis and the DNA fragmentation off of one sample, or do they have to collect more than one sample to do this?
Dr. Ramy Ghayda: Analysis, freezing, DNA fragmentation, with the same one sample.
Dr. Aimee: This is a dream come true for me, because you know the S of the TUSHY method is sperm. Then I have the BALLS method. Ramy, I don’t know if you know about the BALLS method.
Dr. Ramy Ghayda: I have heard about it.
Dr. Aimee: The B for the BALLS method after you go through the S of the TUSHY is background genetics. Getting your sperm DNA fragmentation test done is something that is really important to me. I feel like it definitely does make a difference to make sure that the sperm is as sparkly as possible before you make an embryo or make a baby. This is so nice that you guys have been able to do this for my patients. So, thank you.
Dr. Ramy Ghayda: You’re welcome. We’ve also partnered with many other companies. Now we have the US Navy Seals that use our services. Our service is included and covered by many insurances in New York. So, we’re even thinking about the financial aspect of fertility and trying to support men, couples, or anyone interested in parenthood to make it as easy as possible and facilitate the whole process.
Dr. Aimee: You talked to us about the products and services that you offer, supplements, semen testing, sperm freezing, DNA fragmentation.
Dr. Ramy Ghayda: Nutrition support, emotional support, free telehealth. One-stop shop for fertility.
Dr. Aimee: I love it. I feel like we should now be able to maybe join forces and do sperm freezing parties. I have egg freezing parties, I have a lot of single ladies that are freezing their eggs waiting for Mr. Right. Maybe you have sperm freezers who are also looking for someone who has frozen their eggs. Don’t you think there might be some sort of collaboration there?
Dr. Ramy Ghayda: I agree 100%. This is an ongoing conversation. We’re trying to break the taboos around infertility and then parenthood. We need to be proactive about it. We need to have strong partnerships and then reach out to people, explain to them, and then try to facilitate the journey.
Dr. Aimee: I love it. Tell us about yourself. What made you go into male fertility, why are you so passionate about what you do?
Dr. Ramy Ghayda: After urology residency, you have to choose between subspecialties. You have oncology, pediatrics, etcetera. I tell you with all subjectivity and bias, male fertility is the best. Being there with your patient, trying to improve their quality of life, trying to facilitate them to have their own biological kid is priceless. The reward you have just by interacting with them, just by being part of their journey is indescribable.
You always talk about the sparkle of the sperm. I think there’s always a spark between the physician and the patient or the couple when you’re there for them, listen to them, be compassionate. This goes well with my personality, this is the thing that I want to do. I think it builds a lifelong relationship with your patients. It’s not like a one-time deal and then they’re gone. They’re always there, it’s always part of their lives, they always send you pictures of their kids. It’s very rewarding.
Dr. Aimee: It is. There really isn’t a word in the English language that can describe it. I can’t find one. Conceivably, it’s the most rewarding job. I use that word on purpose.
Dr. Ramy Ghayda: The other good part of male fertility is it’s such a field that’s new. We only know 50% of what’s happening. The other 50% is just a black box waiting to be discovered. You have research, you have technology, you have new genomics. It’s a field that you have so much potential to be discovered and advanced, and I want to be there when all of the things unravel themselves.
Dr. Aimee: I don’t know if you know this about me, but I really like April Fool’s jokes. I design the joke in a way that it makes people think that it’s real, because I really actually want it to be real. Last year, I went to space and did the first IVF cycle as part of my April Fool’s joke.This year, I talked about implementing ultrasound at CVS.
Ramy, do you think this is possible? I want to maybe put a little tracker on a sperm cell and then have some sort of robot arm where I can show it where to go and take it to the fallopian tube and insert it into the egg somehow. I know I can’t do that without stripping the egg.
Dr. Ramy Ghayda: Probably not in 2022, but this could really happen a couple of years down the line. The advancements in the field, the research, and technology are so great, it’s going at a rocket science speed. I think in a couple of years we’re going to discover more and we’re going to learn more. The more we learn, the more questions we have. This is the beauty of male fertility, and fertility in general. It’s always a field where you have so many questions and so many answers. When you answer one layer of this complexity, you have many more layers to be passionate about.
Dr. Aimee: Yes. Obviously, you’re passionate about educating people about sperm and freezing their sperm. There’s a reason we’re talking about this, because of declining fertility rates, especially in men. Tell us a little bit about that and why you think we’re seeing this decline.
Dr. Ramy Ghayda: Over the past decade, we have a good level of evidence and supporting data saying that there is an actual decline in male fertility. We know that semen parameters, like sperm concentration, volume, motility, the quality and quantity of the sperm are not as good as they were 50 years ago.
We have many landmark studies by Dr. Swann and by many other very famous researchers saying that we are seeing almost a 50% decline in semen concentration. Even though these studies have some backlash because of their design, because they only include developed countries, because of the different techniques of counting sperm at the lab from a technical perspective, still, we know that this is real. I believe that this is real. We don’t know the extent of it. We don’t know if it’s 50% more or less, but there is a trend there that is going downward.
It’s a very complex question to answer. It has many factors. First of all, we have more chronic diseases like diabetes, obesity, hypertension, people are taking more medication, they’re living a poorer lifestyle. The overall health of society is not as good as it was before, so this is one area.
The second possible explanation is environmental factors. In 2021, with everything around us, we are exposed and bombarded by so many chemicals. Every day we wake up, we eat, we interact, we breathe, we touch, and everything around us is made of chemicals. These chemicals might disrupt the endocrine system, they’re called endocrine disrupting chemicals. These EDCs will affect fertility. They will go either to the brain to mess up the level of the hormone, or to the testicle where they can interact and then provide a suboptimal semen production.
It’s a good thing that we know about this trend. It’s a good thing that we can identify some factors. But we are very in the beginning of this chapter of infertility. I think we need years and years before we understand exactly what’s causing this decline. For now, people should be aware about their lifestyle, about anything that might cause a decline in their fertility.
We know that smoking, excessive alcohol consumption, marijuana and any recreational drugs are negatively correlated with sperm production. We know that anything that would increase the temperature of the testicles is also negatively correlated with sperm production and quality. The testicles sit outside of the body for a specific reason, because they don’t want the internal body temperature. Hot tubs, Jacuzzis, saunas, very tight underwear, if you keep your laptop on your lap for an extended period of time, all of these factors will increase the temperature of the testicles and will negatively impact sperm production.
Finally, the third bucket that I think about is anything that’s healthy for you, for your body, for your wellbeing, and is good for sperm production. If you eat healthy, a lot of green stuff, no added sugar, no processed food, no trans fat, if you exercise a couple of times per week, if you sleep around 7 hours per night, if you’re not very stressed, all of these factors will be good for sperm production.
This is a very interesting point because now we know that fertility is an indicator for overall health. They’re talking about fertility as being the sixth vital sign, because studies are showing that infertile men in their 30s and 40s had a higher risk of developing diabetes, hypertension, and hospital admissions. They were at higher risk of dying, 2.5 times more risk of dying than others their age. Really, infertility is not a one-time disease, it’s a continuum of conditions that might affect survival outcome and quality of life.
Dr. Aimee: Before we started the interview, you mentioned that you deal a lot with the emotional side of male infertility and offered to share about rebalancing the conversation and workload for women. Can you tell me more about what that means?
Dr. Ramy Ghayda: As you know and experience every day, infertility is an emotional rollercoaster. You have your ups, your downs, you have expectations, you have the pressure from your family, from society, every aspect of your life is just focused on this one specific ability to conceive or not.
Traditionally, because we live in a very sexist society, let’s admit it, we’re trying to advance and improve, but still it’s a very sexist society, we have a lot of toxic masculinity, we have a lot of misconceptions linking, for example, fertility to masculinity and virility to sexual performance. People and men think if we’re not fertile then we can’t perform and we have some sexual problem, which is not true.
All of these factors are really having a toll on the woman because they traditionally were the one to blame for the infertility problem. We know now that infertility is a very common condition, 15-18% of people in society will suffer from one form or another of infertility. We know around 50% of the factor for this infertility is responsible by men, 20% by the male factor alone and 30% by combined female and male factor.
Really, men are half of the equation. We cannot just blame it on the woman, even though we used to do so and it’s easy for us to say it’s not our problem, let’s just go to a reproductive endocrinologist, I’m sure there’s a problem there. We should change this narrative. We should break these taboos, judgment, and prejudice. It’s the responsibility of the physician, the provider, and healthcare to reach out, educate, do these types of podcasts, working at places like Legacy, to try to facilitate the discussion and try to really be there and understand.
Dr. Aimee: What can men do to participate in this rebalancing that you talk about so well?
Dr. Ramy Ghayda: They have a duty to have an open mind. They need to understand the facts and the science that they are part of the equation, they are part of the problem, and they can be part of the solution.
They need to be involved and they need to be proactive about their health and the sanity of their relationship. The blaming game is not appropriate with fertility. They can do it elsewhere, but for fertility you need to be supportive, understanding, and you need to understand that this could be a problem just caused by you. I have so many patients with only male factor. The female is perfectly fine, no obstruction, everything is working, but there is a problem with the male part.
The good news is that in more than 50% of the cases we can find the solution and we can help. This is a very good thing. They should not lose interest in the whole journey, they should not just try to repress it, as we do so many emotions and duties. We should stand up to it, own it, and then be there for our partner.
We’re not talking only about heterosexual couples. Any couple, gay couples, transgender community, nonbinary, anyone who is interested in parenthood will have their own journey. Men and individuals should be there and should understand that they need to be part of the discussion of medical therapy, and they need to be part of the solution.
Dr. Aimee: If they aren’t, I can tell you, like you said, no matter what type of relationship you’re in, your partner might get a little bitter, and the bitterness will turn into resentment. I always tell my patients to get better, not bitter. I tell the male patients the three questions you need to ask your partner are, “What can I do for you? How can I help you? What do you need?” And she’s always right.
Ramy, is there anything else you want to add before we end today’s interview?
Dr. Ramy Ghayda: I just want to talk a bit about Legacy as a company. We’re a startup, it’s a digital fertility clinic based out of Boston, but now we’re covering most of the US. Legacy was founded and created just to fill the gap in the male fertility space. We know that there is a mismatch between the resources of fertility between the male and female, and we know that most traditional clinics, whether private or academic, didn’t have in mind the needs and the emotional journeys of men in this process.
I can tell you going to an andrology lab and providing a semen sample is one of the most horrific experiences a man can go through. They have these very dark rooms with porn magazines from 1995 and then people are just going by the door, sometimes they’re knocking on the door. Maybe you have someone before you that was in this room, someone is waiting to go into this room to provide a sample after you.
Having a service where you can provide a sample at home is priceless for men. Legacy is there just to support this perspective. They will provide the sample, mail it to one of our labs, and then Legacy can provide analysis, freezing, DNA fragmentation. Then they have a lot of products like nutrition support, vitamins, CoQ10, free telehealth consultations. Now, so many clients in New York have the option to do free services using their insurance. We have partnered with insurance. We’re covering most of the Navy Seals in the US.
Basically, we’re covering everything that has to do from product and services with the fertility journey.
Dr. Aimee: Thank you, Ramy, for coming on. I’m so glad you guys offer this service to my patients. Thank you for all the hard work that you guys are doing to make sperm sparkle everywhere.
Dr. Ramy Ghayda: Thank you. It’s my pleasure and passion.
To find out more about Dr. Ramy Ghayda, and Legacy, visit their website: GiveLegacy.com. You can find 30 guides about male fertility and conception on their site. The Legacy offices are located in Cleveland, and if you are local you can visit their office.
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.
