Hillary: You are listening to Episode 76 Fertile Minds Radio, and I'm your host, Hillary Talbott Roland.
Dr. Turek: I have to say that the more we know about sort of transcriptomics, genomics, metabolomics, and epigenetics, the deeper we dive into the genetics of infertility in sperm, the more that the most basic things matter like lifestyle, choices, diet, and things like that. It's remarkable. It's just remarkable because when I entered the field, we couldn't explain a lot of male infertility. It was really unexplained, a half of it. And then the Y chromosome was found as to have deletions by Renee Reijo Pera, and all of the sudden 7 to 10% of infertility is explainable. So one region of a chromosome and all of the sudden 10% of the field has an explanation. So that the impact of genetics was clear to me that it's gonna be large. And then now we're learning that even on unexplained cases, epigenetic issues loom large, and it's probably more male than you think.
Hillary: If you are looking for holistic wisdom and a plan to reclaim your fertility, to help you create a healthy family for generations to come, you're in the right place. This is Fertile Minds Radio. And that excerpt was an interview with Dr. Paul Turek we did last year. To date, I think it's one of the most important episodes we've done because it really gets into specifics about the rather elusive subject of male fertility. We originally entitled that episode "Is IVF Good for Men's Health?" Because we were joking before recording that it might be one of the only times a male goes to the doctor. If you are one of the many that has had issue getting your man to the doctor, I invite you and your partner to listen to this refurbished episode. Dr. Turek is a wealth of knowledge and a guy's guy. I would say on average, I refer a male client to him weekly to work with him virtually for a second opinion to what exactly is going on with his reproductive health. So, grab your partner and have a listen because after all, it still takes two to tango.
Dr. Turek is actually a world-renowned reproductive urologist. He's probably one of the top three urologists in the world. He has clinics in San Francisco and Beverly Hills. He advises the ABORM board that I'm a fellow of. He graduated both Yale and Stanford University. He's taught at Yo San University. He has countless studies that he's both authored and advised. And aside from being a Western medical doctor that really gets complementary medicine, like Chinese medicine, he's a soulful clinician. He manages to connect with one of the most difficult patient populations- dudes that don't want to talk about their potential fertility issues. The first time that I heard him speak at the International Infertility Symposium, in Vancouver, I was blown away. He was so intelligent and generous with his ideas and research that he was really the first person that made male fertility issues relatable to me. For three years running, he was one of my favorite speakers, and since I wasn't able to attend this year, I had to get my fix, and I invited him on the show. So, I'm sure that you'll be just as enamored with him as I am by the end of this. His ideas are both provocative and backed by science. So, without further ado, welcome to the show Dr. Turek.
Dr. Turek: Hillary, thank you very much. Who are you talking about?
Hillary: We need to get you a mirror, right? You just listen to that.
Dr. Turek: I want to meet that guy.
Hillary: No, truly, I mean, I think that your generosity with your ideas is and they've been, you know, pretty groundbreaking. Decades ago, you've been in this field since the 90s, and you're really at the forefront. So, I think there's a lot to learn from you.
Dr. Turek: It's interesting, I entered the field because it was a dearth of research. You know, I said, this is a very interesting field, male fertility reproductive urology because it's great surgery. So, it's microsurgery and you have to have a skill set for that, which I found myself drawn to. But then I looked at the science in the field and compared to something like an oncology, there was really very little I mean, it's a very young field. I'm probably the second generation of person in it, you know, in terms of its age. But it's come along beautifully, I think, and it still got a long way to go, though.
Hillary: Yeah, I mean, it's, for eons, it's always been the woman's fault, right? We never even looked at the men.
Dr. Turek: And that's an interesting cultural bent, but what happens is women are generally more proactive about their care, and women also have a cycle to judge their health by and men don't. So that's my next 20 years is where can we get the men's ovulatory cycle? What can we replace that with men that might be just as effective? And is it semen analysis? Is it waist circumference, the fifth vital sign? Is it testosterone levels? There will probably be something coming on board, where we can say, "Hey, and while you're young, be aware that this is where you're headed."
Hillary: Yeah, I mean, I've heard you advocate several times that, you know, fertility, semen analysis, waist circumference should all be bio-markers for male health and yet the semen analysis is pretty archaic, right.
Dr. Turek: It's about 60 years old, and it had several normal ranges that change every 10 or 15 years. And yeah, I'd say among the things I think about when I see men for infertility, it's probably the least important thing, unless of course it's zero, then it becomes the most important thing.
Hillary: Right, and you just lectured on this at the symposium and you were relating it in the semen analysis to a deck of cards.
Dr. Turek: Yeah, I'd say the blog I wrote is called Reading Your Cards on Turek blog is searched turekandmenshealth.com or Turek blog on Google. I basically took the four components of a semen analysis and view them as cards in your hand in a game of cards and what do they mean independently of each other and what do they mean when you take them as a whole? So, for instance, count, sperm concentration has values, especially if it's not zero, but not predictive value because it varies so much. So, I showed a graph of a man, that was published in our World Health Organization guidelines for semen analyses fourth edition, that took semen samples every week or twice a week from a man for a year, and they were all over the map. The sperm concentrations were all over the map from zero to normal to high and they hovered around 20 million or so but they never really sat there very long. And so, you're really looking at a moving target with sperm concentration because it is a biological process much unlike a glucose level, you know. So, there's a lot of variation between individuals, there's a lot of individual-- each individual varies by season. So, if you look at sperm concentrations, they're basically highest in the winter. I just did an interview for a magazine about this - “why are sex drive so high in the spring?”, and I'd say it's probably because people were stuck-- you know like bears. We've stopped hibernating we're looking upward and outward again, as opposed to downward.
However, sperm counts are highest in the winter and births are highest in the summer. With other animal species, there's a lot of seasonality. Some of you even have ruts where there's no sperm most of the year and there’s only sperm when ovulation occurs once or twice a year, like in walruses. I had a nice paper with Holly Morocco from Six Flags because the walruses, coming from the Arctic, were in Napa, and Vallejo. They weren't reproducing and she figured out that the female was ovulating once a year off-cycle in the fall and the male is rutting in the spring. So, it's an incredible biological process but very different between men and women. So, count alone is you know, it's a moving target. Motility even worse and I think of motility is kind of a toxin light like something's going on when the motility is not normal. That's toxic in some way like pot or social-- how their social habits, alcohol, obesity, things like that. If it's not a huge hit, then you get to the account a motility problem. If it's a larger or longer hit, then you get account problem. It takes more to knock account down than it does your motility and motility recovers faster.
Volume is a third one. And that is probably the most significant one for finding something. If someone has a low ejaculate volume, you will certainly find something if you look hard. So, that is one of those setting stone abnormalities. If the volume is high it's probably meaningless. If the volume is low, you can almost always find something a blockage, something missing and a testosterone problem. Retrograde ejaculation is a list of five things that will always be something on that list. So, that's nice to have something a reference point that matters. And then there's four, progression, which is less relevant. But there's also morphology, which I don't give a lot of credence to, which is firm shape because I always think about walking in a bookstore and finding you know, a book with a really nice cover and then not reading it bringing it home and finding out it's not very well written. I think morphology similar to that. So that's sort of dissecting it out. And you know, I kind of held up the semen analysis as a cube and sort of walked around it and describe what I feel about it. The bottom line is that it has a little relevance to man's fertility. I'd rather know more about his history and physical exam. If the semen analysis shows anything, I mean, a good hot bath will drop you down. If you do hot baths 20 minutes, three times a week for a month, you probably be zero.
Dr. Turek: So, it would bounce right back. Yeah. So, it's pretty sensitive marker of things. That's why I like the bound marker concept. Flu season this year was rough because there were several flus. They weren't covered, influenza A wasn't covered well by that vaccine. So, I remember seeing men who had, "Oh, I was yeah, I was feeling uncomfortable for about a week Doc. Took a couple days off headaches and pains, but I didn't have a fever.". But you know, when they have aches and pains, and when they have myalgias, men typically have a low-grade fever. So, I said, "Well, let's look at your semen. It's like zero, right? It's zero. And it was normal two months ago, and it's going to be normal in two months again.”
Hillary: Yeah, men are so lucky that way, right? They're meant to bounce back.
Dr. Turek: Yeah. And so, the other main concept about the semen analysis is you're meant to run hard. So, the semen analysis is not something men say, "How can I make? How can improve my semen analysis or how can I improve my count?” You run it full tilt. If everything's healthy, you're running at maximum RPM, and all you can do is bring it down. So, it's-- right? So, you’ve given everything so that's why it's valuable because if it's running at half speed, you got to look at why. And usually, you can figure it out. When I entered this field, we usually couldn't figure it out, but it wasn't a lot of conceptual differences going on. But I think with the attitude that why isn't his motility normal? And why is this count low? What is going on in his life? What is he eating? What is he doing? Whether is recreational drug use? What's his lifestyle like? What's his stress like? What's his weight doing? All that stuff matters. And that's really interesting to me. That falls in collusion with other things that we're learning about, for instance, epigenetics. So, the other point of the talk was that the whole story is not on the semen analysis. You have to dive deeper into sperm and look at more of their function, and the two. Morphology does that a little bit, but I'm not a real believer in it. Sperm DNA fragmentation is another measure of quality and performance, sort of, and then sperm epigenetics. Now we know after there's been an essay on the market for about a year to that sperm epigenetics is probably the new evolution. That's how we're evolving. That's what we're handing off to kids. You can have abnormal expression of markers on your DNA because you're obese. If you lose weight, those change on sperm and change the quality so it's quite dynamic, a process. Even on a genetic level or epigenetic level, it's constantly changing, and it makes sense because evolution isn't really a generational thing over 1,000 years. It's really happening every day, and this is the everyday evolution is epigenetics. So my mind is very captivated by the deeper dive with sperm, which appears to be explaining why a lot of unexplained infertility what causes because if you look at a couple to try for a year, and everything looks normal, extensively normal, if you dive deeper in sperm you may find that the genetic issues or sperm fragmentation issues or whatever the next thing might be, but there might not be a next thing because epigenetics appears to be probably the new bottom line, I think.
Hillary: Well, I think, you know, as a TCM practitioner, I feel like I was taught about epigenetics, just with different languaging. You know, our jing in our essence, being affected by our lifestyle, dictating what we passed down. 10 years ago, that seemed like an obscure concept to Westerners, but now you're saying science is actually proving that, right?
Dr. Turek: Absolutely. I, as an advisor to the epigenetics company, that's my disclosure, I have to say that the more we know about sort of transcriptomics, genomics, metabolomics, and epigenetics, the deeper we dive into the genetics of infertility and sperm, the more that the most basic things matter, like lifestyle choices, diet, and things like that. It's remarkable. It's just remarkable because when I entered the field, we didn't know a lot about, we couldn't explain a lot of male infertility. It was really unexplained, a half of it. And then the Y chromosome was found, has to have deletions by Renee Reijo Pera and all of a sudden 7 to 10% of infertility is explainable. So, one region of a chromosome and all of a sudden 10% of the field has an explanation so that, you know, the impact of genetics was clear to me, it's going to be large. And then now we're learning that even in unexplained cases, epigenetic issues loom large, and it's probably more male than you think. So, it's shifting over from 25% to maybe 50% of unexplained might be male-related and it's not female. So yeah, women might take the hit, but actually men should take the hit. And then if you look at the solutions for that, it's gonna be how you live your life. That's what Eastern medicine does beautifully. We're terrible in Western medicine at lifestyle. 12-minute visits do not get into the details in a medical practice of how a man lives his life. I love it because when I get acupuncturist's referrals, guy with a low sperm count, I've tried everything for six months and it's still low. I generally find something anatomical that I can fix, which is pretty interesting, because everything else is sorted out. The man's stress is under control. His diet's good. He's got a good balance in life, exercising, and all that stuff's handled. And that's the stuff that Western medicine is terrible at, but it all, and so I am a firm believer in the role, the complimentary role of Eastern and Western medicine in treating infertility. It's more powerful than ever and yes, you should hang your hats on epigenetics because that's the value to Eastern medicine as you're making big changes. Those changes are transmissible to other generations. So, they're really important.
Hillary: So, would you describe, just so that I'm clear and our listeners are clear, you know is when you're talking about epigenetics, when you're talking about the difference between single-gene mutations versus chromosomal gene mutations?
Dr. Turek: Right. So, epigenetics isn't really a mutation story. It's really a… it's the marks on your DNA. So, it's not mutations. It's not chromosomal. It's if you look, so there's blog is called "Epigenetics: The Reason You Are Who You Are", it's the reason a nose is a nose and an ear is an ear, despite the cells being the same. It's a reason why we're different than bananas, even though we share 50% of the genetic material of the banana. It's a reason why, you know, individuals are individuals despite being 99% genetically identical. So, it's not explained in the genes themselves. It's explained in which genes are turned on and which are turned off. So which pages in the book can be read and which pages can't be read if you have different pages that are read differently for each person. So that's epigenetics. It's really the expression and a non-expression of various genes to make different organs and different people and different functions. So, we all have the template of, we all have the whole book, but we don't express the whole book.
Hillary: And so, the test that you helped develop, that's Episona, right?
Dr, Turek: Yeah. And that test tells you if there's a pattern of epigenetic marks on certain genes, that might explain your semen analysis or your fertility. So, it could explain impaired natural fertility. So that might be in, you know, at home, at time the intercourse would fail or inseminations might fail IUI. And then there's another part of the test that looks at the sperm dynamics and interaction with the embryo, and it could explain why IVF would fail. So, sperm can be… sperm are a big contribution to IVF success. We're not talking about fertilizing an egg, we're talking about post-fertilization events. I call it, “dissolving embryos syndrome”. I have a lot of patients who come in, normal semen analysis, normal female evaluation and go to IVF. And their embryos don't make it in a dish. They just dissolve on day 2, 3, 4, whatever and I call it, “dissolving embryo syndrome”. I think epigenetics of sperm, a lot of it drives early embryogenesis, and those genes have to be the right genes have to be working at the right time and if they're not, it's a contribution to failure. Before knowing more about sperm epigenetics, we used to think that about 5% of poor embryo development in IVF might be due to sperm issues. With the development of epigenetics, it's looking like it might be around 45%. So, all of a sudden, in the last couple years, the whole new light being shown on sperm quality as a driver of IVF success, and a lot of epigenetics we know is lifestyle mediated. So, it's all kind of coming together like the Mediterranean diet for health, you know or paleo. It's sort of that kind of collusion of information, it’s all making sense now.
Hillary: Right. So, what you were speaking about in terms of the dissolving, you know, the embryo, it fertilizes but then they just kind of implode on themselves. You know, I've heard that oftentimes blamed on DNA fragmentation of the sperm, which would be toxicity, right?
Dr. Turek: Right. Lockshin species and oxidants, right.
Hillary: And so oxidative stress is that's supposed to be around 30 to 80% of the cause of male infertility, right?
Dr. Turek: Yeah, that's, I mean, it's hard to prove, but that seems reasonable. But this may be epigenetics may be a downstream event of oxidative stress, and the epigenetics predispose you to that. So, it's going to be related somehow. We don't know that relationship yet. I think that epigenetics will assume the field of oxidative stress or be a byproduct of it, or somehow related to it.
Hillary: Okay. But it's not necessarily DNA fragmentation. That's just one thing that can like a symptom that can show up, right?
Dr. Turek: Correct. I think that the downstream event, probably.
Hillary: Okay. So, with that in mind and oxidative stress, and that, you know men are kind of traditionally, not all, but some are poor eaters and, you know, some lifestyle choices… Do you think men should take a prenatal?
Dr. Turek: Absolutely, I mean, the data for prenatals for men, it's sort of pre prenatal, is very strong from the Cochrane Reviews. And that was my talk at IFS a couple years back about should men be on a prenatal. And they did, you know there are about 20 studies done using antioxidant supplements in men. And the nice thing was that they were controlled, and they used IVF, as the result, the IVF findings. That's as about a controlled situation for pregnancies you can get. Funny the big complaint when you do natural fertility studies is how do you know that the- that the pregnancy is his. When you publish a paper it's always the question because you can, how do you know it's his?
Dr. Turek: Very-- I never-- just an odd criticism from editors, but that's what you get. But having an IVF setting is much more controlled, so. They showed about a three-fold increase in pregnancy rates at IVF and a three-fold decrease in miscarriages among women whose partners who are taking an antioxidant supplement compared to controls. And published it, I don't know 2011, and then in the Cochrane Reviews. And then they probably didn't believe it so they did it again with 40 studies, and they came up with the same numbers three years later, maybe 2013. The criticism of all of it is that garbage in garbage out, the studies weren't large and well-powered and they were all small, but they all kind of show the same thing. So, it may not be the best data but the government was so taken by this, the NIH, that they started a Moxie trial. So male antioxidant supplement trial a couple years back, and I was on the review committee called the RMM for that, but I'm not now. So, I don't know what's happened to that trial. But typically, what happens when you try to recruit men to a randomized controlled trial fertility is if they don't accrue very well, so there's a lot of trouble keeping them the men and keep them compliant and getting them to join. So, I'm not sure what the results are. But that's how impressed the government was they're saying, listen, if you're recommending-- if this data is real, then mentioned be on a prenatal, if we de-prove that in a prospective trial, because that's a big statement, because women have been on prenatals for 35, 40 years, for similar reasons, prevent miscarriages and birth defects. And it's been very effective. This is probably as effective. It's probably just as important that men be on a prenatal.
Hillary: Yeah. And you actually took a step further and developed one of your own. How is that different from what a female would take versus a male?
Dr. Turek: I know it's true. It's doses of things like those a lot of related products and female, there's some in male, more antioxidants. We have some sort of an antioxidant, mineral, herbal supplement, it's organic, and we had one called it's called Essential Beginnings XY, we also have one called XX which is female. The key thing was for both they were had organic fillers. So, you can put a vitamin in anything you want, but your body may not see it. It may not be available to you, and any vitamin supplement can be put on the market saying this is in it, but what are you actually seeing? And so, a cancer nutritionist whose job is to get nutrients into cancer patients who have terrible digestion and habits and you know, because of disease. So, we used very highly organic fillers that are highly absorbed and had great reviews of it. For instance, the iron in the female prenatal, you know often upsets women's stomachs because, you know, gets absorbed pretty quickly and it's kind of iron is heavy on the stomach and you can get upset but the natural fillers are a little more-slow release. So, women were tolerating that a lot better. With men, we add tribulus, astragalus and maca root. Some of the well-established herbals that have the best data and it was all it's more scientific. I'd say it's kind of like a smart vitamin.
Hillary: I love that, that you added the herbs to it especially the tribulus and the maca.
Dr. Turek: Yeah. And we had L-Carnitine and the usual, you know, and CoQ10 and ubiquinol and things like that, resveratrol, stuff that really made sense.
Hillary: And so, do you like you ubiquinol over CoQ10? Because I know a lot of people look at me, and I try and have them take the ubiquinol instead of the CoQ10. Because it's more cost-effective than the pathway before and all the studies are seemingly done on CoQ10.
Dr. Turek: Yeah, I think a lot of it depends on absorption. I mean, if you get nothing of one of them, it's the other one is better. So, you choose the one you want. It's how it's delivered that matters, right? You can buy all the gifts you want, but if you don't give them to the person who's intended, it's worthless. So, we're all about delivery. In fact, the NIH chose our supplement to model their supplement that they were gonna provide in the trial because they were impressed with the way it was thought through.
Hillary: I agree. I mean, it's definitely complex. What I like most about it is your delivery. You've put all these things together in one pill because if you start trying to make a man take, you know, a handful of pills every day, that's gonna last maybe three days, right? You've got it in one or two.
Dr. Turek: Well, that's another whole problem is compliance with men, I mean, we're thinking a chewable is probably really good, but it's too many calories for 35 to 50 calories a pill, you know, great for kids, probably not good for men, but they probably even toss it up there. You know, because a lot of these antioxidants are water soluble. They don't last very long. So, you do have to dose twice a day. It's hard to do anything once a day with antioxidants and get any persistent levels, you know with vitamins C and E. So, it's complex, but the news is that we've been bought out. It's probably gonna be improved this year, hopefully. And that's all I can tell you. But I'm very excited.
Hillary: That's great. And that's definitely in line with what I've observed about you and your ability to try and make things as easy as possible on the men. You know, your practice model, unless it’s changed, it's a very lengthy questionnaire, but they only have to see you once and then the rest is done by phone, right?
Dr. Turek: It's all Telehealth. So now I can even do, I'm even starting mobile care where I will, I won't even require the guy to come to the office. So, I'm in San Francisco and LA. And they're both pretty heavily trafficked cities. I like the idea of seeing them and IVF programs when they hit the door, because you don't have many opportunities to connect with men ever. So, it's just the way the culture is. So, asking them, I mean it's amazing that they fill out that questionnaire, but that's so valuable. I mean, you'll never get it, you'll never get the information ever again unless there was-- you know the partner says, “get in there and get that done and get in to see him.” You got one opportunity so you got to take maximum advantage of it. Once you've got it, you've seen it, get everything you can done, and try to make that connection with men. Because if you don't, you'll never see him again. I mean, I most of my patients have seen the urologist before can't remember their names. I have a simple thing I say to them, “I want to give you care that's so good that you'll remember my name.”
Hillary: I think that's great. And I think that's so needed, you know, men don't get cared for. I think that that's You're right. If they're willing to go to IVF like what if you could get them right then and there? Oh, my God, what if you could get them before that?
Dr. Turek: Right. So before, that is almost impossible, but because they're- they're basically taken care of by their partners, but I am, you know, my bigger mission in life is not cure infertility, it's to have men live longer. You know that the stark fact and the stark truth in America is that the richest man in America lives five to seven years, less than or shorter lifespan than the poorest woman. So, they are certainly under served for a variety of reasons. Some of its self-inflicted, some of that inflicted on them, some of its provider, cultural norms, and but it is a shame that men just have such a short lifespan in America, regardless of their socioeconomic status. It's a little bit about the immortality complex, but my attitude is let's find a bio-marker and then let's engage men because they love numbers, right? So, if you throw them a number, they'll try to fix it, right? The try to get, I'm gonna get that number better, and they'll do things. So, you got to get them engaged. And if you don't show your personality, and you don't commit yourself to them to walk the walk, you're not gonna get them, they have to trust you.
Hillary: Well, I love your blog for that. I send men to it all the time, or I tell wives just to have their husbands go there, Turek on Men's Health, because it's, you know, like you speak. It's a lot of information in a short time. Like you get to the point. Here, here it is.
Dr. Turek: Nuggets. They're called nuggets. Nuggets, right. I'm aiming at guys, it's 80% read by women, but I want men to just start the blog, and then not- they have to finish it, they can't put it down. That's the idea. Because you know, again, you only have one shot. So, you have to have a hook. It's not written like other blogs. You don't answer the question right away. You bring up some social situation where everyone finds themselves and somehow bring it down to their health.
Hillary: Now, it's definitely interesting in that way, for sure.
Hillary: So, when I… you're pretty light-hearted physician, right? You've got a good sense of humor and connection, but on one of the years in the symposium, I heard you talk about advanced paternal age and the sobering reality of it. It really made me tune in because I had observed and kind of suspected that there was some advanced paternal age problems and couples in my clinic, but I really didn't have any proof of it. This kind of urban myth, another myth that males can be fathers at any age, which you know, they can. There's been some very old fathers in the course of history, but your work is around the epigenetics and everything is kind of saying, "Hey, there are some issues with advanced paternal age." And I think that that was really illuminating, especially even some of it that pointed and said, "Hey, you know, like, infertility is not always the cause of the woman. There is some issues with advancing age in men, right?
Dr. Turek: Absolutely. So we actually just published a nice review in a journal of assisted reproductive genetics, called reproduction of the genetics in the aging male, and it'll be available open access, probably in a couple months. Alex Yatsenko Y-A-T-Z-- Yatsenko is a geneticist at University of Pittsburgh who co-authored it with me. It's really the most update review on this topic. I think it's pretty legible talks about epigenetics and all the newest stuff to the month. So, it'll be available open access if you search my name on Google, it should come up in about three months. It's pretty dense reading, but it's I think it's concise. So, the issue is, the most interesting thing to me is that advanced paternal age never existed until about 1960, two generations ago. There was no such thing as advanced paternal age because we didn't live that long. So, it's a recent problem to have an advanced paternal age issue. And a lot of the problems that we're noticing arising among offspring is recent, like autism. We think schizophrenia, bipolar, things like that seem to be going up, increasingly. So, there have been associative studies trying to look at epidemiologically at the relationship. There have been correlations between age and neurodegenerative diseases in offspring so bipolar, autism, schizophrenia, dyslexia. And there's some correlations showing up but no biological basis, and it looks like it might be epigenetic. So, the kinds of things you see in advanced paternal age… so what is advanced paternal age? That was the biggest argument on the paper, with the reviewers and the editors. It's what's the definition? And the answer is there isn't really one. Remember, it's a new field because in 1900, we lived 38 years on average. In 1950 we lived 50 to 60 years. 1980 we live 75 years, right?
Dr. Turek: Very few people 50 to a 100 years ago or older, had any kids at age 40. I mean, the average age of an American male at first child or first paternity is 30 now, used to be 26 about a generation ago. So that's pretty significant. That's a 10, 20% increase in age. So, I think the issues are new and they're large, and we're just learning what they are but as men age the miotic machinery that makes sperm tends to fail. So, you spin out in this monumental stem cell on the testicle, that's the driver of all sperm, you spin out-- you divide that thing once a year for 13 years. You hit puberty, and then you're doing it 10 or 15 times a year. So, you've you schooled up the problem. And then at by the age of 60, the machinery is getting old, and the quality control is getting a little sparse. And so advanced paternal age 40 would be the kind of a general definition, 50 for sure. And that's, you know, that's what we're talking about sort of age 50 and beyond. And if you compare 25 to 50-year-old men, you'll see that there's more miscarriages, there's more early fetal deaths, there's about one-- a little over 10-20% more birth defects, congenital birth defects. And if you go to 60, think of it as a hockey stick shaped curve. It's sort of flat for a while, and then it starts rising dramatically like the blade of a hockey stick. And that probably that position where it changes that flexion point is probably around age 60, where it really starts to go up dramatically in, DNA fragmentation is a classic age-related issue. It's about 3% per year increase over age 40. So, talking 3 times 10 is 30% per decade or 20% per decade change in sperm DNA fragmentation just because of age.
Epigenetically, it changes dramatically. Great study by the Utah Group, Doug Carroll took men who had bank sperm in their 20s, 30s. And then again, got a sample in their 40s, 50s and shut-- and so they had these samples at about 17, 20 years apart. And they looked at the epigenetic profile, and there was a dramatic shift in the in the epigenetic marks on sperm in the same men samples over age, and they all tend to group around the neurodegenerative diseases. So that means you would expect the expression of genes around the diseases we talked about, to be changed, and altered. And so, it's again, kind of coming all together. Chromosomally men don't change that much. That's not one of the systems that fails but yet trisomy 18, and Kleinfelter syndrome XY are two of the kind of hot spots in men that could contribute to issues with kids later in life. And the biggest and well-known, most well-known are single gene mutation. So, when women age they have chromosomal issues. And those are detectable on prenatal testing. And they're also usually lethal, causing miscarriages. So that's good, I guess that they are lethal, it's a quality checkpoints. In men, they're single gene mutations. So, they're just little nicks in the DNA that tend to pass through quality control mechanisms and persist, and come out of an offspring and they're the source of, I would call, highly disfiguring and rare diseases like, retinoblastoma, tuberous sclerosis, and Lesch–Nyhan syndrome, lots of odd sort of diseases.
And luckily, they don't-- they're not that frequent. They're more frequent and older men, but they're not that frequent in general. So, this stuff, if you look at it carefully, is very, very alarming. And right now we consider about 20% of autism appears to be paternal age related, not all of it. That mean, that's probably a conservative number based on the best science, but it's definitely related. And I always tell men, because when I-- some men bank, their sperm, you know, while they're in their 40's, or 30s, because there's no relationship in the future, near future. And they want to know what they're headed for and you give them this data, and they usually bank their sperm. But I would say, though, that to put in perspective, if you just ask men, "If you have a child with a partner, do you know what the birth defect rate is, you know, the chance of having a birth defect in that baby is, you know, all comers, all ages?", and they usually say, No, they don't know. And it's-- so it's not on their radar. And the answer is about 3%. Is a 3% chance, so men usually don't-- aren't too alarmed below 5%. Once you start getting 5%, 10%, they start taking notice. It's just a risk aversion thing. But that's about the same rate you're seeing with the combination of issues with men with age. It goes from less than 1% to about 3%. So, it runs in the same order of magnitude is birth defects in general. And so, I leave them with that statement because that puts it all in perspective. And then they can decide whether they should need to worry about it or not. There's nothing you can test for with these issues. So, the problem is, you can't do prenatal testing easily. There are no genes identified for these conditions right now. And it's really-- it's an open risk. It's an open faced, what risk. And the other thing is, these are sometimes diseases and adult offspring. So, you won't even see them at birth or early on. You have to wait for a lot of them three to five years, and sometimes up to, you know, beyond purity, to see any issues. So, it's a concern, and it's a new issue. So how you handle it, no one's ever dealt with it before in history.
Hillary: It is a lot to make you think about our biology and what happens as we age for sure. So, bring up what happens later in the offspring and things that you may not even see until much later. And, you know, this kind of makes me think about when I was first learning about reproduction in grad school, and the concept of ICSI of the intracytoplasmic sperm injection where, you know, the sperm is selected and put into the egg during IVF. And I remember just kind of being somewhat horrified like, "Oh, my God, we're taking natural selection out of the process.”, and, “Is this a good idea?" Like, "Do we really know better?" And you know, and now 10 years later, I have, you know, these walking children that are a product of ICSI that probably wouldn't be here without it. And they're seemingly healthy. But sometimes I wonder about, like the long-term implications on their health and their ability to reproduce. And do we have any data on that? Because ICSI hasn't really been around that long, right?
Dr. Turek: Right. There's not much but it was an interesting player, is, when I first entered the field in the early 90s, you know Gianpiero Palermo and Van Belgium - who's now at Cornell started it. And I sat with him in 1998 at a play at ASRM in San Francisco called-- I forgot what it's called. But it was about a woman who was in the lab and got some sperm and got her own eggs out and was ICSI-ing her own eggs. And it was just-- everything that can go wrong with the technique. Was done by Carl Djerassi-- An Immaculate Misconception I think it was called the play. It was premiered at the ASRM in 1998. And I sat with the inventor of ICSI at the thing. It was pretty interesting, but you know, it was an accident. So, there was no science behind ICSI. Someone Gianpiero , and basically and Belgium were doing-- trying to get sperm closer to eggs for male factor issues. Putting them between the egg and the egg shell, and sub-sona insertion and that-- it wasn't working well. And then he made a mistake, and he stabbed the egg. Maybe-- he said he made a mistake. But maybe they he did it intentionally. But he did it four times. And then he just watched those, and they fertilized. And then he told Van, "Start again." That what he had done, and that they gone phone he said, "We're going to have to follow this carefully." So, they have tracked their ICSI kids in Belgium ever since day one. And you know, there's a lot of debate about the health, because you are removing barriers to natural selection. And I had a conference at a resolve meeting where I took all the embryologist from the major programs at San Francisco. I had a minute panel session with a microphone in front of each of them. And I-- the audience was patients. And I said, "Meet the embryologist, because patients want to know who's selecting my sperm. Who's collecting that sperm?"
Dr. Turek: What kind of person is selecting my sperm? What do they believe in? What are they-- You imagine the questions these guys got about, you know, do you have kids? What-- Do you-- Are you religious? You know, it's interesting, how you-- Culturally it's a big change, right? And then, of course, scientifically, what does it all mean? And you are removing barriers. But a couple things impress me that sperm-- that things still work pretty much the same, even by removing those barriers, there's so much quality control in the process, that it's still quite intact. And you can debate whether there are higher birth defect rates with ICSI. But there probably is, but it's probably very small. So, in a point of like, point 1.2% increase, there's probably some conditions that are more likely to occur that are very rare, imprinting disorders and things like that, but again very rare. And we don't know about the unnatural environment of ICSI, because you have to be under a microscope with light and neither of our gametes normally see any light. So, there can be epigenetic alterations. And there's from feeling from power and all those research at UCSF that there might be epigenetic alterations going on. Two, the culture medium is a little unnatural, that kind of stuff. So, sort of much, some of that IVF, but it's constant.
So, the best data out of Belgium recently is men, couples in whom there's male factor with low sperm counts, they now have the sperm counts of the sons, and only about 50 or 60 couples. So, they had IVF exceed for low sperm counts have children, and the boys are now men, and the men have low sperm counts. So, it looks like a lot of the male, low sperm counts in men might be genetic or epigenetic and it's being passed on. That's the ideas a lot of it is being passed on whether you can define the genetics or not. But I've been also impressed on how little is coming-- How little difference we see, for instance, I have cancer survivors with 20 sperm in their testicle after chemotherapy. And published in mobile transplant literature, some of the most extreme cases of being treated and cured for cancer and they have a couple of sperm and you know, those sperm were in testicles that were exposed to lots of chemo and radiation. And those kids have no, you know, no issues and it's pretty impressive. But I think you could of course, long term follow-up is still needed. One of the biggest problems all these studies is birth defect rates. Birth defects are defined differently in different countries. Some of them are defined as, something needing a surgery to fix, some have defined as, you know, an abnormal look. So, it's hard to compare. It is apples and oranges among groups. So, you'll see conflicting data and we know nothing about cancer risk later in life, which is of some concern.
So, it is a bit interesting. I feel the same way as you do and still, and I am working with Demirci, who's a Stanford professor and we just published a paper on using a chip that will allow the sperm to swim under a microfluidic chip to imitate the cervical path that they take going to the cervix, there's grooves in the human cervix. And only really sperm can make it through that cervix, like an obstacle course. So, we're creating an obstacle course like it. And we're comparing the integrity, build quality of sperm before and after running that the gauntlet there. And we're finding that they are, they're better looking, better moving certainly, better looking morphology. They have four to five full, less fragmentation, and they have an epigenetic profile that's altered, probably better favorably. So, it looks like we're able to help reproduce what sperm have to go through to get to fertilize an egg. And when I first saw his data, he's a fluid physicist who just loves sperm, because they have motors on them, like they're little particles with motors on them. And he was publishing physics journals. And I read the things I said, "This guy is such a cuk, I mean, he's publishing all this fluid physics with sperm." And I called him up and got and met him and said, "He's so much fun." But I said, "Look Tom", I said, "You know what you're doing here, you're reproducing the cervical path." And then I said, "This is a path that has been preserved in mammalian species, land and sea from million years." So, for a million years, sperm had to do this work to get to the egg, they don't-- the egg just doesn't sit at the cervix. And as soon as you make it through the cervix, you're in or even closer. You have to go and have human six, eight inches, which is like crossing an ocean. And that's why, you know, 40 million start and 100 make it but there's something about the path. And I said, "And you're making the path." And I said, "I need to be part of this. And I need to help out." So, he had me write the introduction to the paper, about the reservation of the you know, the cervical path issue, the urine path issue for a million years. So, I think they're-- what I'm comfortable-- now they have a product. It's a fertile chip. It's available in Europe. It's now FDA approved in America, as of last month. So, another disclosure, I'm part of that company called DX Now, and they named it Zymotchip Z-Y-M-O-T. Horrible name I'm gonna get it changed.
Dr. Turek: But it's a chip, that's literally a microscope slide, and you put sperm on one and you drop it in, there's no processing, and you pick it up at the other end, 20 minutes later by the clock. And you should have a sperm that is more naturally selected, than if an embryologist did it, you know, at 9 am with a cup of coffee and then in the other hand.
Hillary: I've got a name change for you. I think that you have created the Darwinian Obstacle Course.
Dr. Turek: Yes, that's right. That's the idea. But you know, it's been bothering me for 20 years. Maybe you for 10 or 5, but it's always been a little-- I'm a little bit of a Darwinian but not really. And I'm also religious. So, it's complicated, but--
Hillary: Right. Oh, very much, so yes. Well, and like I said, you know, that it's such a something, I wonder and now we're seeing it and like you, you're saying that there's really not-- Yes, they're passing on this the low sperm count. But to me, that's just information of like, "Hey, son, you might want to freeze your sperm earlier before you have this, you know, the steep increase in DNA fragmentation on top of the low sperm count." Right?
Dr. Turek: That's right, because those things are probably occurring in all men, and may be exaggerated in men with abnormal semen analysis. We don't know.
Dr. Turek: It's the kind of science I hope the field that had when I joined it, but now it's happening. And I'm glad to be a part of the hard science coming out. Because it has more relevance than ever, I think. You know, for me maybe the treatment for ICSI is not to use it, maybe just go to IVF, right? Maybe IVF, the worry is that it will fail to fertilize. But we're not seeing that. So the whole even Jamie Grifo is work from NYU looking at, if you don't use morphology, which has been a classic reason to do ICSI. Poor morphology means poor fertilization with IVF, so go to ICSI and avoid the problem. If you just don't use that criteria and stick sperm, and without looking at morphology the failure to fertilize rate is 101 and 250. So, it becomes almost noise. So, I don't think that criteria matters. And there's one group at San Francisco that stopped using it and they're doing-- instead of 70 to 75% ICSI nationally, they're doing about 40 to 45%. They don't see failure to fertilize. They don't see that issue at all. So, I think there's going to be a bold move to keep it more natural and IVF is, you know, inseminated eggs and sperm and let them do what they normally do. It's not the cervical path, but it's still a lot of the process. So, I like that concept of maybe going backward a little bit.
Hillary: Yeah, just you know, we don't know what we know until we know it. And your research is helping us to know those things. And I mean, that chip, that's like the golden ratio basically. If all mammals have that ratio of that six-inch path that we have as humans to the cervix, right? You just kind of recreated that.
Dr. Turek: Yeah.
Hillary: That's amazing.
Dr. Turek: Yeah, if you look at-- if you do research, I mean, we did research on the path itself and the micro groups and stuff like that. And he put obstacles in the way and there was this video that was so telling-- I haven't shown it nationally yet, but, and he's a mathematician. So, he calculated in fluid physics, if you put pillars in the way, put obstacles in the way, at a certain distance. If you take a normal shape sperm, morphologic than normal sperm and put it through this obstacle course, it sails through. So just on fluid physics principles, a nicely shaped sperm sails through. If you put it, a sperm has a bent neck or a big head, it'll never make it. So, what's interesting is, I'm not been a big believer in sperm shape as a driver of sperm health, right? A book by its cover. But I am totally convinced that Sperm Morphology matters in the path. Because if it's aerodynamically brilliantly shaped it will do better. So, in the real world, morphology probably matters to success with intercourse and success with IUI, because of shape, not because of nuclear material. But once you get to the, so you know, the more important thing with ICSI nuclear material, because shape doesn't matter that much.
Hillary: It is and that's such a clarification, I think that people need to understand about, you know, their sperm analysis, and then what plans do you have going forward, right? So, if you want to do all natural, but you've got morphology issues, then you know, maybe there is an issue. Especially if you combine that with like cervical mucus production issues, where there's not efven the cervical mucus there to help those sperm get that six inches of the way.
Dr. Turek: Right. And I think, you know, you're talking at the edge of theoretical considerations here, because the study just came out. And these are just my preemptive thoughts about it, so, I don't think you can say anything yet. But if you see these videos, you're going to say, even the mathematical experimental videos, so they can-- he has, you know, videos of mathematically what would happen based on the sperm shape as it goes to the course and then he has the actual, what happens to sperm that are real sperm, but-- and they're identical. So, his mathematical modeling is identical to reality. So I know it's true. But it's just fascinating because it gave morphology new meaning to me. It actually does matter. Because if you're not absolutely perfectly shaped sperm, least in a from a fluid dynamics point of view, you're probably not going to make it.
Hillary: Well, I have to say, this is one of the things I love about you. You publish all this research and you're involved in it yet you are very careful to say, what is theory still and what is-- what is fact, right?
Dr. Turek: Now, I have a blog on, when does fact become fact, right? It starts out as theory and we published a paper about the semen analysis being a bio-marker for prostate cancer and testis cancer 10 years ago. And, you know, it was an epidemiologic study, and it was large and it was very prominent. It was published in a general medical journal that, you know, men who are infertile have higher rates of cancer later in life, if they have low sperm count. It was based on molecular biology data, and we went straight to epidemiology, which is like the opposite end of the spectrum. And it was done by my fellow Tom Walsh, an epidemiologist and urologist at University of Washington. And, you know, took 10 years. And now I believe it's true. I mean, even though I did the paper, because it's epidemiology, but enough people have reproduced it. And the government is now putting grants out to study the issue, which is a-- for me a bucket list thing. Because, you know, being at the meeting, where we're talking about it and NIH, and they're saying, Dr. Turek inspired this meeting, and like, Oh, that's nicest. So, it's a very nice compliment, but I think, it takes time for theory to fbecome fact. And this is now theory. I think it you know, it's always that way, in science. It could be disrupted at any point. But I think there's enough cumulative evidence looking at the bio market concept and fertility that it's true. I don't know if there's enough evidence that what I'm saying today is true about sperm. But--
Hillary: Well, I'm glad you brought that up, because that ties into our title, Is IVF Good for Men's Health, because I do believe, you know, I kind of look at reproduction and fertility issues. This is what was most fascinating to me. I didn't mean to choose this as a specialty, but it's kind of like almost the ultimate disease, right? If we're put here to eat, sleep and procreate. And there's an issue with that what else could that tell us about our health, right? Especially around chronic disease.
Dr. Turek: Yeah.
Hillary: And so, the fact that now this work is being used to kind of show you know, again, not fact, but some correlation with later stage cancer being an issue, I think, is huge. Because so many men don't want to do that sperm analysis, but if you can put it in statistics, where you can say, "Hey, this can actually show you how healthy you are inside."
Dr. Turek: Yeah, I mean, I-- every day, on an everyday level, if I see a guy with a normal semen analysis, I know some things are true. He can't be doing too much bad, because it would lower his sperm count. So, he's living a good life, probably. He's, you know, probably got a normal testosterone level, because you can't really generate-- You can't bloom a plant without enough water. So he's got the right combination. So, you can say pretty good things and I-- So knowing what I know, I did a study where men came in and they had normal sperm counts, and the woman had no issues and they were infertile. And they were unexplained. And I said at the end of the visit, based on my complete evaluation that I thought he was cleared, and I said, "I think you're cleared; I don't think you are part of the problem." And that's based on everything I know. And so, most of those couples went home and went online and said, Turek couldn't figure out what was wrong with us. And I got a little upset with that, because I didn't say that. I said, Honestly, I think, look harder elsewhere. I mean, I don't take care of women, and I don't make recommendations. But I said, look in the partner a little bit more and then you'll probably have to go down the path of the technology or to other alternates. But I think you're doing great, and I think you're fine. So, they said that, and I said, yeah, nobody said. So, I put a little-- I put my back into it. And I got USC involved, the resident USC. A year after I met them, I called-- I had this resident call them all up in an IRB, you know, to study. And I had them-- I had him ask a couple five questions. How to go last year? Dr. Turek told you to try harder and this and that. And all these guys had varicoceles and they were doing things and they had toxins and I gave them advice about stuff. I did not give them a pill. I did not operate on varicoceles. I just advised and said, "You know, try this, and you know, maybe an antioxidant supplement, etc." So, it wasn't no care. But it was just basically advice. And I thought they were doing fine. And so, to my surprise, 65% of those couples conceive naturally the year after I met them.
Dr. Turek: So, they follow the rule. And these are 35-year-old women for a year and a half of infertility and 65% conceive naturally. Another 20% conceived with IUI or IVF. So, at the end of the year 85% had kids or had pregnancies ongoing. And I said, "So it's true." I mean, basically what I said was true. So, I'm writing this up as a paper and I'm not writing as, "See, I told you I was right." I'm writing it as a lifestyle paper. So, all I did really was give lifestyle advice.
Hillary: That's amazing. Somebody needs to show that in the literature, for sure.
Dr. Turek: Yeah, that's going to be hard to publish, because it's hard to publish when-- You're most effective when you don't do anything as a doctor. Or, I'm on a lot of journals. I'm associated or two, I review for 20. And honestly, I know it's not going to be a big hit. It's not a controlled trial. It's not this, it's not that. But if you look at what a doctor is best at doing, sometimes it's just holding your hand sitting there and being at your side and walking the walk with a little more knowledge and giving you good advice. I mean, that's-- 500 years ago, that's what doctors did. And it may have happen today, because if you-- If they're paying the money to see you and you're telling them, you got to eat better, you got to stop smoking, you got to cut down your alcohol, you got to, maybe, stop these pills taking antitoxins and supplement. Maybe it's just the antitoxins supplements, who knows? But that's a tremendous pregnancy rate. And that told me, until I'm trying to publish the papers, you know, a lot of unexplained infertility can be cleared. Men can be cleared of it by a simple evaluation in the office, one visit.
Hillary: I think that's great. And I… it's amazing that you're doing Telehealth. I think that's just going to open it up to even more men. So, you know, if you're listening to this, and you've been trying to get your male partner in to be seen, you know, he makes it as easy as possible. He can do it at home, a persona test, he can see you via Skype or phone, I think that's incredible. There's going to be some, hopefully, some big changes in the ways that males perceive getting a sperm analysis and getting checked out and hopefully kind of treating it like socialized countries where they do it in the beginning, you know.
Dr. Turek: Correct.
Hillary: You can put a dollar amount to it, then they're more up to go, right?
Dr. Turek: Right. And I think it's a lot cheaper to see a man once and get it all done. I mean, I like to package it so that-- So I offer basically free calls for couples to see if it's a good fit. And then you can get the background stuff, and then have them come in and have the first and last visit. And everyone thinks, "Well then that's it. I'm all done with him." No, that's the start of the care. I mean, my cares is all Telehealth. So, I want-- I'm with you to the kid, but you don't have to come see me. But if you want my opinion about stuff or you, you know, you're taking something new, is this medication safe? Those are really good questions. Someone should answer those questions. I just got diagnosed with this, this is what I'm on, Is this safe for-- I've changed so many blood pressure medications from calcium channel blockers to other things, and bam pregnancies occur. It's so, you know, that's the way you have to deal with men. You have to-- they're not women, they're not that good about care on general. And it's a cultural shift. And you have to I think you have to adjust to the way they need their care, and not trying to treat them like everyone else. And, you know, having them travel across two bridges, and two hours to get there. And then for a 15-minute visit, for what you are 20 minutes late. It's not worth it. It's not the way to do it.
Dr. Turek: You're hitting productivity or making them weak where they shouldn't be weak, and it's already a problem that's embarrassing. And then if you explain it and-- So I just work with the organism the way it is. That's the idea. To work with the organism. Look at what you have.
Hillary: I love that. And I have one more question for you. You mentioned that you don't always treat varicoceles surgically. So, can you explain to our listeners what the prevalences of those. The cause and how they're treated?
Dr. Turek: Yes. Varicocele are the most common diagnosis in infertility. It's probably 40% of men are trying to have their first child and then can't. It's up to 60 to 80% of men who are trying to have a second child and having trouble. And they're a bag of veins in the scrotum. And they occurred as a result of us standing up in an evolution. So, I think the bloggers call it, What Happened When We Stood Up?
Dr. Turek: Probably the worst thing that men could have done in life was to stand up, because the varicoceles basically drainage of the testicle, the blood supply to the body. And if you stand up, it goes up hill and your fighting gravity and the veins aren't made for it. So, they tend to go backwards and the blood goes the wrong way. And unfortunately, that blood from the body going down to the testicle the wrong way, is warmer. And that heats up testicles like a hot tub. And I know-- I did the hot tub study and I know how sensitive testicles are too hot-- to heat. But like I said in the beginning, you know, three days a week for a month, you can be zero. So, you can really turn things off. And so, heats up the testicle, affects both sides and causes probably the largest single correctable cause of male infertility. But they're found in 15% of high school athletes. So, it's also a disease of athletic young people, thin people. So that's also important. And so, some of them are pathologic and some of them aren't. And you just-- we don't have a good test to know which is which right now. Epigenetics, maybe a test down the line, but it'd be nice to have a way to figure out in whom it's a problem. I use metabolomics. Initially, I was looking at the metabolomics of the testicle and a grant 20 years ago from NIH, but my co-investigator took all my money and got no data out of it. So, I was kind of burned by that. But that would have been a way to put them in a scanner and see if there's a certain decrease in function of the testicles that much between side to side that might mean there's relevance and then and then fix it and then scan them again and get recovery. So, but right now, if you fix it, you can either fix it non-surgically with radiology or you can fix it surgically with microsurgery, it's probably the best way. It's an hour of surgery. It's pretty quick. Two or three pain pills down for a weekend back to work on Monday on a Friday case. And you just tie off the veins so it doesn't do that anymore. Sometimes men are having discomfort feel better. That's a pretty high rate. And about 70% of the time you'll get improvement and semen analysis, and if primary infertile couple probably we run a 45% pregnancy rate over the next year naturally.
Hillary: That's amazing. All because they just got checked.
Dr. Turek: Right. So, that's the thing that I find when acupuncturists see patients and have screened everything else in their lifestyle, and have perfected them as best they can be, that's what I find. I find a lot more varicoceles, and I have to figure out-- I'm going to work with a postdoc on a doctoral student on how to do that study. Patients referred from IVF programs versus patients referred from acupuncturists. What's the rate of finding correctable causes of infertility in men, I think it's going to be much higher.
Hillary: Awesome. I can't wait to read that and see the video on the mathematics of the fluid of the sperm. I'm such a nerd. That's great.
Dr. Turek: The coolest video it is. It changed my life to see that.
Hillary: Okay, well I will definitely be stocking your blog looking for that then so I can link it to the show notes which is ladypotions.com/episode30. So, people can find you at turekonmenshealth.com for blog work, they can find you at turekclinic.com if they want to schedule something. And they can also get that test on episona.com. And if you're in the San Francisco Bay, you're also part of a free clinic called, Clinic by the Bay. Yes?
Dr. Turek: Yes. We just had our fundraiser yesterday. It was Fiesta themed and raised $200,000 for free clinic for the working poor. It's called Clinic by The Bay. Love to donations on Facebook or social, it's fabulous. Would take care of the working the uninsured, the hard-working people that can't afford insurance in San Francisco, immigrants, Catholic Charities, everything's free. It's fabulous. It's not fertility. It's general medical care.
Hillary: It's amazing. And so they can donate to you on Facebook. And then you're also doing a Facebook Live covering semen analysis a little bit more in depth, right? They can find that on your Facebook?
Dr. Turek: Yeah, a whole series on Facebook Live weekly.
Hillary: Awesome. Well, I'm not going to keep you any longer. I'm so grateful to you. I know you are a busy, busy man. All right, well, thank you so much.
Dr. Turek: Good bye, Hillary.
Hillary: And I'm sure our listeners will enjoy it. Thank you.
Dr. Turek: Continue doing your good work.
Hillary: So there you have it. IVF could be the best thing for your man's health, if it's what actually gets him into the doctor to be evaluated. What if you could save a ton of money and heartache by being evaluated by a holistic physician, the beginning of your fertility journey? Remember, we are more than our lab test values and our DNA. We are the product of what we think, what we eat, what we are exposed to, even the exposure of the care of our physicians. If you'd like to work together, find me over at ladypotions.com and click on the work with me tab to see options that are currently available. Bye for now.
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