Latest / You Call This Normal? The Root Cause Fertility Podcast / Episode 14: Roughly Half of Infertility Involves Male Factor. So Why Are You Doing All the Work?

Transcript

Episode 14: Roughly Half of Infertility Involves Male Factor. So Why Are You Doing All the Work? · You Call This Normal? The Root Cause Fertility Podcast

• 0:00
  SPEAKER_00: Okay, quick thing before we get into it.
• 0:02
  SPEAKER_00: If you are listening to this going, we have looked at me every which way, backwards, upside down, and nobody has looked at him, that's what a first move call is for.
• 0:13
  SPEAKER_00: It is 60 minutes, just you and me.
• 0:15
  SPEAKER_00: And I look at both sides of the picture with you.
• 0:18
  SPEAKER_00: You don't have to prep anything.
• 0:19
  SPEAKER_00: I record it, you get a summary email afterwards, and you walk away with an actual next step instead of two of you guessing.
• 0:28
  SPEAKER_00: It's$250.
• 0:30
  SPEAKER_00: And if you enroll in a send within seven days, it goes towards that.
• 0:34
  SPEAKER_00: DM me the word first move on Instagram.
• 0:37
  SPEAKER_00: I'm at Neurishista.
• 0:39
  SPEAKER_00: Okay, let's talk about the other half today.
• 0:43
  SPEAKER_00: So I want you to do something with me for a second.
• 0:46
  SPEAKER_00: Think about however long you've been trying.
• 0:50
  SPEAKER_00: And now think about just how much of the work has landed on you specifically.
• 0:56
  SPEAKER_00: The supplement taking, the tracking, changing how you eat, all of the blood work, the appointments, the research that has you worried and up way past when you should be in bed at night.
• 1:10
  SPEAKER_00: The mental health math every single cycle.
• 1:13
  SPEAKER_00: Okay, now how much of that has been pointed at your partner?
• 1:18
  SPEAKER_00: The mental math every single cycle.
• 1:20
  SPEAKER_00: And it's not like you're doing it during ovulation and then when your period is supposed to arrive or not arrive.
• 1:28
  SPEAKER_00: You're doing it every single day.
• 1:30
  SPEAKER_00: Let's be honest.
• 1:31
  SPEAKER_00: Okay, now how much of that has been pointed at your partner?
• 1:35
  SPEAKER_00: I'm not asking you to go home and start a fight.
• 1:37
  SPEAKER_00: That's not what this episode is, but I am asking because I see this so consistently that it would be kind of dishonest of me to not say it out loud.
• 1:48
  SPEAKER_00: Women come to me having done everything, like everything.
• 1:53
  SPEAKER_00: I ask about the partner every single time.
• 1:56
  SPEAKER_00: And when I ask what's been looked at on his side, the answer is almost always the same.
• 2:01
  SPEAKER_00: He's maybe had a semen analysis and it came back fine, and that was the end of the conversation.
• 2:07
  SPEAKER_00: He's not to blame here.
• 2:09
  SPEAKER_00: I'm also not blaming your doctor, but I am saying there is a piece of this that usually gets closed way too early.
• 2:18
  SPEAKER_00: So I'm here with the key.
• 2:20
  SPEAKER_00: I want to open it back up.
• 2:21
  SPEAKER_00: So here's the number.
• 2:23
  SPEAKER_00: So here's a number I want you to hang on to.
• 2:26
  SPEAKER_00: Roughly half of infertility cases involve male factor, sometimes on its own, and sometimes it is alongside something going on on your side.
• 2:37
  SPEAKER_00: And that's coming from research.
• 2:39
  SPEAKER_00: I will put the source in the show notes.
• 2:42
  SPEAKER_00: So when you put that number next to who's usually doing all the investigating and the changing and the supplementing, there's a gap, a really big gap.
• 2:52
  SPEAKER_00: So let's talk about what a standard semen analysis looks at.
• 2:55
  SPEAKER_00: Because once you know what's on it, the air quotes here, it came back fine, starts to mean a lot less.
• 3:04
  SPEAKER_00: It looks at count.
• 3:06
  SPEAKER_00: So how many sperm are there?
• 3:08
  SPEAKER_00: It looks at motility, which is how many are moving and how well are they moving, and morphology, which is the shape, and then it looks as at volume.
• 3:19
  SPEAKER_00: Those are good numbers.
• 3:20
  SPEAKER_00: I want those numbers, but that's just the surface of everything.
• 3:24
  SPEAKER_00: What the standard analysis does not look at is DNA fragmentation.
• 3:29
  SPEAKER_00: And that is the integrity of the genetic material inside of the sperm.
• 3:33
  SPEAKER_00: And I am sorry, but this piece I see missing the most.
• 3:37
  SPEAKER_00: And it's one of the pieces that matters most when you're a couple and you're trying to figure out why things are not working.
• 3:46
  SPEAKER_00: So when you have a count that looks totally normal, motility's in range, morphology is fine, and he can still have high DNA fragmentation, which means the sperm that are there that are swimming that look okay on paper are carrying damaged genetic material.
• 4:03
  SPEAKER_00: Now, fertilization can still happen with high fragmentation.
• 4:08
  SPEAKER_00: This part is why I think it slips by, but embryo development can struggle.
• 4:13
  SPEAKER_00: So early loss can be more common here.
• 4:16
  SPEAKER_00: Implantation can be all over the place.
• 4:19
  SPEAKER_00: And all of those outcomes look like they could be about her eggs or her uterus, right?
• 4:26
  SPEAKER_00: So the investigation still stays pointed at her.
• 4:30
  SPEAKER_00: More labs, more protocols, more supplements.
• 4:34
  SPEAKER_00: And that fragmentation piece, it just kind of sits there and nobody looks at it.
• 4:39
  SPEAKER_00: And I've watched that happen more times than I can count.
• 4:43
  SPEAKER_00: And it's so frustrating.
• 4:46
  SPEAKER_00: Not because anybody's being neglected.
• 4:49
  SPEAKER_00: You can't blame, you can't blame them for that.
• 4:53
  SPEAKER_00: But the standard workup was built to catch the obvious stuff.
• 4:56
  SPEAKER_00: A really low count, motility that's clearly off.
• 4:59
  SPEAKER_00: It was never made to catch sperm that look fine and aren't doing well at a cellular cellular level.
• 5:06
  SPEAKER_00: Okay.
• 5:07
  SPEAKER_00: And then there's the part that changes this whole conversation.
• 5:10
  SPEAKER_00: Sperm is not static.
• 5:12
  SPEAKER_00: It takes roughly 74 days to make and to mature sperm.
• 5:19
  SPEAKER_00: So whatever's going on in his body right now is shaping the sperm you're working with about three months from now, which completely changes what one analysis means.
• 5:30
  SPEAKER_00: One sample is one snapshot of that window.
• 5:33
  SPEAKER_00: It reflects things like his sleep, his stress levels, his drinking, his metabolic health, how much heat was he sitting in all the weeks before he gave that sample.
• 5:44
  SPEAKER_00: It's not a permanent picture of his fertility.
• 5:47
  SPEAKER_00: And this is where the, but it worked before thing falls apart.
• 5:52
  SPEAKER_00: I hear it all the time.
• 5:54
  SPEAKER_00: He got me pregnant before.
• 5:56
  SPEAKER_00: So his side is fine.
• 5:58
  SPEAKER_00: And I get why that feels like a solid thing or you need proof in your mind.
• 6:03
  SPEAKER_00: I don't know.
• 6:04
  SPEAKER_00: I get it.
• 6:04
  SPEAKER_00: I do.
• 6:05
  SPEAKER_00: But a past pregnancy tells you what was true about his sperm back then.
• 6:11
  SPEAKER_00: It doesn't tell you what is true now, especially if the last few years have looked very different.
• 6:17
  SPEAKER_00: He has more stress, he's working in a different environment, he's sleeping less, there's been some weight gain.
• 6:24
  SPEAKER_00: Maybe he's drinking more, he has a new job where he's sitting still more often.
• 6:28
  SPEAKER_00: Spoon, spoon.
• 6:30
  SPEAKER_00: Sperm moves with his life.
• 6:33
  SPEAKER_00: That last pregnancy does not freeze it in place.
• 6:38
  SPEAKER_00: Okay.
• 6:39
  SPEAKER_00: The hopeful part, and I mean this, when sperm quality is off for these kinds of reasons, a lot of it is modifiable.
• 6:48
  SPEAKER_00: I won't say it's easily changeable because changes is hard no matter what it is.
• 6:54
  SPEAKER_00: But you're working with a system that renews itself about every two to three months.
• 6:59
  SPEAKER_00: So what he does now can show up in the sperm you're working with in a few months.
• 7:07
  SPEAKER_00: And I find that so incredibly encouraging, but only if someone opens the door to that conversation.
• 7:15
  SPEAKER_00: So let me get specific about what I look at on his side.
• 7:18
  SPEAKER_00: The first thing is oxidative stress.
• 7:21
  SPEAKER_00: I know that sounds very clinical.
• 7:22
  SPEAKER_00: It's basically the balance between free radicals and antioxidants in the body.
• 7:27
  SPEAKER_00: And the sperm are especially vulnerable to oxidative damage.
• 7:31
  SPEAKER_00: Their membranes are fragile and the DNA inside is packed in tight without a lot of protection.
• 7:37
  SPEAKER_00: Oxidative stress goes up with poor sleep, a lot of alcohol, if he's smoking or vaping, a diet that's light on colorful produce and heavy on processed foods, any chronic stress, if he's carrying extra body fat.
• 7:55
  SPEAKER_00: The antioxidant side of this is that the better researched areas in male fertility, vitamin C, vitamin E, zinc, selenium, CoQ10.
• 8:07
  SPEAKER_00: And I'm not talking about some random supplement a guy on Reddit swore by.
• 8:12
  SPEAKER_00: There's a real body of research on how these protect sperm.
• 8:16
  SPEAKER_00: So food first, that is my like hand on the Bible, hill I will die on.
• 8:22
  SPEAKER_00: Food first, always, and then supplements that make sense for him, ideally with somebody looking at his labs, not just a random men's fertility blend grabbed off of a shelf.
• 8:33
  SPEAKER_00: The second one is heat.
• 8:34
  SPEAKER_00: And this one is so simple.
• 8:36
  SPEAKER_00: Sperm production works its best a little below core body temperature.
• 8:41
  SPEAKER_00: I mean, that's why the testicles hang outside of the body.
• 8:44
  SPEAKER_00: They're trying to stay cool.
• 8:46
  SPEAKER_00: So a regular sauna session, hot tub time, a laptop on his lap in the evening if he's, you know, doing some work from home, long stretches of sitting, all of that bumps up the temperature and affects production.
• 9:02
  SPEAKER_00: So it's such an easy thing to change.
• 9:06
  SPEAKER_00: It just never comes up because who's asking?
• 9:09
  SPEAKER_00: The third one is metabolic health.
• 9:11
  SPEAKER_00: And I mean insulin resistance very specifically.
• 9:15
  SPEAKER_00: I talk about blood sugar constantly for women.
• 9:18
  SPEAKER_00: And guess what?
• 9:19
  SPEAKER_00: It matters for men too.
• 9:20
  SPEAKER_00: It just takes a little bit of a different path.
• 9:23
  SPEAKER_00: Insulin resistance affects testosterone and the signaling that supports sperm production.
• 9:30
  SPEAKER_00: So men with metabolic syndrome tend to have a lower count and poorer motility.
• 9:35
  SPEAKER_00: And this develops so quietly, he can feel completely fine and still have this kind of humming along in the background.
• 9:43
  SPEAKER_00: And the fourth one is alcohol.
• 9:45
  SPEAKER_00: And I find this to be a tough one for people.
• 9:48
  SPEAKER_00: And I'm not talking about heavy drinking.
• 9:52
  SPEAKER_00: I'm talking about just the regular, a drink most nights, maybe the stuff that just it gets shrugged off as nothing.
• 10:02
  SPEAKER_00: The research on daily drinking pretty consistently links to lower testosterone and changes in semen quality.
• 10:09
  SPEAKER_00: Now, occasional drinking, that's a lot less clear.
• 10:12
  SPEAKER_00: That's a blurred line.
• 10:13
  SPEAKER_00: And I'm not trying to make anybody feel guilty about a beer.
• 10:17
  SPEAKER_00: I'm just saying that this is a lever that we can pull.
• 10:20
  SPEAKER_00: And if things aren't moving, it is worth pulling for a few months just to see what happens.
• 10:25
  SPEAKER_00: Am I right?
• 10:27
  SPEAKER_00: Okay, now I want to talk about the emotional part too, because you cannot pull it apart from everything else.
• 10:35
  SPEAKER_00: You can't.
• 10:36
  SPEAKER_00: It's it's in the same bundle.
• 10:38
  SPEAKER_00: There is a reason male factor doesn't get investigated as thoroughly, and it isn't only the medical system.
• 10:45
  SPEAKER_00: Fertility for so long has been treated like a woman's issue that it just almost kind of baked in.
• 10:52
  SPEAKER_00: And I feel like people have the awareness of that, but it's so baked in that we still lean towards it, even subconsciously.
• 11:03
  SPEAKER_00: For doctors, for partners, and for a lot of women who have absorbed this message that it's their job to make this happen.
• 11:10
  SPEAKER_00: It we feel the pressure.
• 11:12
  SPEAKER_00: So the investigation always lands on her or you.
• 11:16
  SPEAKER_00: And asking him to step in further can feel like a very loaded thing to do.
• 11:24
  SPEAKER_00: You're adding something vulnerable to a relationship that's already carrying a whole heck of a lot.
• 11:30
  SPEAKER_00: And what I see is a lot of women carrying this by themselves.
• 11:33
  SPEAKER_00: And a lot of the time it's not because their partner wouldn't engage.
• 11:36
  SPEAKER_00: He absolutely would.
• 11:38
  SPEAKER_00: Nobody gave her the words for the conversation.
• 11:41
  SPEAKER_00: Or she tried to have the conversation once, it went sideways and she let it drop.
• 11:47
  SPEAKER_00: And it's exhausting.
• 11:49
  SPEAKER_00: Doing all of this while quietly wondering if his side is really as fine as everyone keeps saying, you deserve to have that part looked at, not assumed that that door is closed.
• 11:59
  SPEAKER_00: You've checked that box.
• 12:00
  SPEAKER_00: And if you're wondering how to even bring it up, bring the information, not an accusation.
• 12:06
  SPEAKER_00: Something like, hey, I learned the standard semen analysis, doesn't test everything.
• 12:12
  SPEAKER_00: And I want us both to know that we've looked, we've looked thoroughly because it's both of you.
• 12:19
  SPEAKER_00: Two people made this plan.
• 12:22
  SPEAKER_00: Two people get looked at equally.
• 12:25
  SPEAKER_00: So here's the question that I would bring to your partner, to your doctor, to your specialist.
• 12:30
  SPEAKER_00: And if you're driving or out on a walk right now, don't worry about writing these down.
• 12:34
  SPEAKER_00: I'm going to put them in the show notes.
• 12:36
  SPEAKER_00: Has DNA fragmentation been tested?
• 12:38
  SPEAKER_00: That's your first question.
• 12:39
  SPEAKER_00: It's a separate test, and it usually doesn't get ordered unless somebody asks for it specifically.
• 12:45
  SPEAKER_00: It's especially worth asking about after failed cycles, early loss, if that's recurrent, especially, or embryos that are not developing well.
• 12:55
  SPEAKER_00: Has the analysis been repeated?
• 12:57
  SPEAKER_00: Because one sample in one snapshot of time, it can it can swing with things like being sick, stress levels, sleep, or even a fever that you had a couple months prior.
• 13:11
  SPEAKER_00: So we need to keep that in mind.
• 13:13
  SPEAKER_00: We need to keep retesting.
• 13:15
  SPEAKER_00: Just like the woman would come in and get a lab, and maybe it says, oh my gosh, your ferritin's low.
• 13:21
  SPEAKER_00: Three to four months goes by.
• 13:23
  SPEAKER_00: We're getting her ferritin retested to see what it's doing, where it's going.
• 13:29
  SPEAKER_00: And has he been seen by someone who specializes in male reproductive health?
• 13:33
  SPEAKER_00: So a urologist or an andrologist with a fertility focus, that's much deeper look than a standard workup that you'd get from your regular doctor.
• 13:44
  SPEAKER_00: Okay.
• 13:45
  SPEAKER_00: And if you're already the one cooking for your house and you want the food side of this handled for both of you, that's what Nourishta does.
• 13:55
  SPEAKER_00: It builds your meals around your cycle and your labs, and you tell it how many people you're feeding.
• 14:01
  SPEAKER_00: It's 67 a month for founding members.
• 14:04
  SPEAKER_00: If you pop over to Instagram and DM me the word nourish, I will send you the link and I will also put it down in the show notes.
• 14:12
  SPEAKER_00: And hey, send this one to him and I will see you next week.