Latest / Cry It Out Loud: Navigating Infertility, Miscarriage, Stillbirth, Infant Loss & Pregnancy After Loss / Male Infertility Explained: Sperm Health, Genetics & Why Couples Struggle to Conceive

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Male Infertility Explained: Sperm Health, Genetics & Why Couples Struggle to Conceive · Cry It Out Loud: Navigating Infertility, Miscarriage, Stillbirth, Infant Loss & Pregnancy After Loss

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  Crying Out Loud, a podcast by Chasing the Rainbows with your
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  host Bernice Quisenberry. Today we're diving into a topic
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  that is often overlooked in fertility conversations but is
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  responsible for nearly half of infertility cases, and that's
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  male factor infertility. Joining us today is Doctor
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  Russell Hayden, a urologist who specializes in male infertility
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  and microsurgery at the Center for Male Fertility at Shady
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  Grove Fertility. Doctor Hayden's path to
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  reproductive medicine began during his graduate studies in
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  biomedical engineering at Johns Hopkins University, where he
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  became interested in the intersection of technology,
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  precision medicine, and creative problem solving.
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  He went on to earn his medical degree from Harvard University,
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  followed by residencies in general surgery and urology at
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  Massachusetts General Hospital. He then completed a fellowship
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  in reproductive medicine and microsurgery at Weill Cornell
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  Medicine, one of the leading training programs in male
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  fertility. His work focuses on diagnosing
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  and treating complex male infertility conditions,
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  including sperm retrieval procedures, advanced
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  microsurgical procedures that often involve operating under
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  magnification as high as 25 times finer than a human hair.
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  Doctor Hayden is a member of several leading medical
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  societies, including the American Urological.
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  Sorry, as I butcher that association, the American
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  Society for Reproductive to Protect the Medicine and the
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  Society for Male Reproduction in Urology and his he has published
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  research on a range of topics related to reproductive and
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  health. And Doctor Heaton, thank you so
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  much for being here and shedding light on part of fertility that
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  many families don't fully understand but plays a crucial
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  role in building a family. My pleasure, happy to answer any
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  questions you have. Fantastic.
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  Yeah, we have a lot from our listeners, from our lost
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  parents, so we'll just dive right in.
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  Many people, you know, still assume infertility is primarily
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  a woman issue. From a medical standpoint.
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  How often is male factor infertility contributing to
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  difficulty conceiving? Oh, it's much more common than
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  we all originally anticipated. And I always like to say it
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  takes 2 to tango. Each person is contributing 50%
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  of their DNA. There is definitely a factor of
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  sperm quality that goes into embryo development.
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  I am a firm believer in that and I think it's reasonable to say
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  that male factor is going to be 50% of cases.
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  Absolutely. Well, even, you know, between
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  the two, right, between the partners as well, you know, 1/3
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  it's female, 1/3 it's male. But then when they come
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  together, how that does play a role as well?
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  Yeah, we're seeing a lot of dual factors, so to speak.
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  A little bit of inefficiency on the male side in terms of sperm
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  counts can really compound any issues on the female side and
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  make it really challenging to get pregnant.
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  Absolutely, yeah. And, you know, understanding,
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  too. So this is a big part of it is
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  understanding semen analysis. But what, you know, don't fully
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  understand is what those numbers actually mean when we get them
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  back and things like that. So can you walk us through sperm
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  count, morphology, DNA fragmentation, and what they
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  actually tell us about the fertility potential?
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  Absolutely. So the first thing I tell my
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  patients is expectations. The semen analysis is a crude
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  test. It remains the cornerstone of
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  how we assess a male's fertility potential, but it doesn't do a
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  great job telling us things like sperm quality, whether or not
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  the sperm work or not. It's essentially best used as a
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  lottery ticket counter, which matters because humans are
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  inefficient reproducers by their nature.
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  You need a lot of lottery tickets to have an efficient
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  chance to routinely hit the egg during that ovulation window, so
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  I primarily use the semen analysis as a lottery ticket
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  counter. Your total modal sperm count is
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  the most important number on that entire report sheet.
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  That being said, when there's isolated deficits, say you have
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  a normal count but no motility, that's a big deal.
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  And that could be other issues related to plumbing or how the
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  factory makes sperm and that that requires a little bit more
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  of a subtle eye. Sperm morphology is not a good
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  test, and I don't want anybody being super anxious over sperm
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  morphology. They only count 200 cells
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  typically from the millions that are there to create that number.
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  It is interuser dependent, meaning if you sit a different
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  andiologist down at that microscope, it may be a
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  different number that they generate.
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  Additionally, you Google this stuff, the most inflammatory old
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  studies that weren't done well are going to come up right off
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  the bat and this is where a lot of anxiety is created in my
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  couples. I don't like it.
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  The newer data that's done properly with large cohorts of
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  patients demonstrates that morphology, even when it's 0%,
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  essentially has very little impact on time to conception
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  compared to normal IUI, pregnancy rates, birth defects
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  are the same. That doesn't increase.
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  And even with IVFXC, if that's what you have to do, it appears
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  that the outcomes are about similar comparing 0% morphology
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  to normal. So for most individuals, I tell
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  them to completely ignore morphology altogether.
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  It sounds scary. It just didn't turn out to be as
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  useful as we all thought it would be 40 years ago.
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  Now DNA DNA fragmentation is a is a tougher topic.
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  There is a lot of mixed data out there and your head will spin if
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  you Google this lot of conflicting reports.
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  There have been some some findings that have been readily
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  reproduced that I think we can hang our hat on at this point.
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  You can have a normal semen analysis but be completely out
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  of whack on your DNA fragmentation.
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  So we've seen that it's rare, but occasionally we'll we'll
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  find that's the problem. DNA fragmentation sounds, it
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  sounds important, like it's all about the DNA, but in reality,
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  it's just a measure of sperm damage.
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  We measure the DNA because the assay is easier to do it on
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  that. But if there's holes blown
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  through the DNA, there's holes blown through the tail, through
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  the membrane, through the motor. That global damage of the sperm
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  cell is really what we're assessing with DNA
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  fragmentation. The findings that have been
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  reproduced are that if you're excessively high on DNA
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  fragmentation, it is much harder to achieve a successful
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  pregnancy by natural conception. And in line with that,
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  intrauterine insemination is tough as well.
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  I always call IUI natural conception with a sperm Uber.
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  It's the same Physiology. A lot of men with elevated DNA
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  fragmentation may ultimately require IVF, and for most of
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  those guys they are going to have almost equivalent outcomes
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  to their normal counterparts. But occasionally we will have to
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  do something fancy, such as retrieving sperm directly out of
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  the testicle from the factory, where we know the DNA frag is
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  less if we're not doing well at IVF.
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  Interestingly, we now know that every sperm and every man has
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  damage. It is up to the egg to repair
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  that DNA damage before the embryo develops.
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  So if you do invest in adna fragmentation test, it's not
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  going to be 0, OK? It's going to be somewhere in
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  the low range hopefully. Yeah, that's so interesting.
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  And what so with sperm DNA fragmentation?
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  How might it contribute to also recurrent pregnancy loss?
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  Yeah. So I look at recurrent pregnancy
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  loss as recurrent miscarriage, right, exactly that's how you
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  would say it. So, but I also look at couples
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  who have essentially normal testing who are not getting
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  pregnant. I wonder if they're making
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  embryos, but they're passing and looking like a period, right.
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  So I I also think there's a an overlap there of recurrent
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  pregnancy loss or recurrent miscarriage.
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  Yeah. We have found this is another
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  finding that you can hang your hat on, increase DNA
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  fragmentation. It's got to be pretty high, can
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  definitely increase your risk of miscarriage.
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  So I routinely send these in my RPL recurrent pregnancy loss
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  patients. Yeah.
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  Wow. Thanks, Russ, for that.
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  Yeah, because you know, one of the frustrating things, Well,
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  one. Yeah, like you were saying,
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  Google deep dives, right? When we're in an infertility
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  journey, we do that. So we're gonna research
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  everything from male factor, female factor, you know, all the
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  things. And when this stuff is coming
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  up, it's really scary because like you're saying, it's old
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  studies that are being found, the things that were clicked on
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  the most over the last 40 years. You know, all that is really
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  what's gonna show. And, you know, having things
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  available to us. Yeah, it's good, you know, if
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  you educate, to advocate for yourself, but if you do it with
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  the right things and the right knowledge and having it, that's
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  power, you know, versus finding those old things that make you
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  almost more high anxiety going into these situations with your
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  doc and going in like this is what we need to do.
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  And realistically, these tests aren't always needed.
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  No, they're not. In fact, the guidelines say the
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  DNA fragmentation should be considered optional.
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  We don't know where to put it yet.
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  Yeah. But I definitely think it plays
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  a good role in the evaluation for your recurrent miscarriage.
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  Yeah, for your unexplained, sometimes that's the right test
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  to obtain. But yeah, you got to be careful
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  with Google. It's driven by clicks.
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  And if an older study only has 10 patients in it, that's not
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  good data. No, absolutely not.
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  No. And thanks for pointing that
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  out. You know, something that's
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  really frustrating for couples, and we talk about this too, is,
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  yeah, they go home to Google, but also those, like, normal
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  results which still lead to infertility, you know, and when
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  couples are really struggling to conceive, what hidden or
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  advanced male factors might not show up on just basic testing?
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  There's a tremendous amount and honestly medicine has been slow
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  on the male side in terms of developing better tests.
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  DNA fragmentation has been around for a few decades.
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  It's probably the the most used fancy sperm test, I would say.
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  But the semen analysis, like I said before, is crude.
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  It's somebody looking through a microscope with their naked
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  eyeball. They can't tell you much beyond
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  the visual appearance of those cells and whether or not they're
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  moving. You know, the sperm has a lot to
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  do. It has to hone to an egg, so you
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  need progressive motility. It needs to fuse with the egg
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  fertilization, and that process also is dependent upon the egg
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  itself. There's newer reports that the
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  egg has to allow the sperm in, so to speak.
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  After that, sperm DNA is actually packaged completely
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  uniquely compared to every other cell in your entire body.
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  It is packaged tight. This is one of the smallest
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  cells we make that has to be unpackaged for the embryo to
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  develop. And we do see correlations in
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  terms of how DNA is packaged with male factor fertility.
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  I wouldn't say that I wouldn't invest in any commercial tests
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  right now for that specific type of testing, but there are newer
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  tests coming online trying to assess the functional aspect of
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  sperm, not just how they appear. That's exciting.
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  But we are in very early days, and I caution my patients about
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  purchasing these fancier sperm tests.
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  They're hard to interpret without the depth of history
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  declaring their normal values. Yeah.
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  Absolutely and you know, one of the devastating along with a
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  lot, you know, when they're going, when a couple is going
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  through infertility is getting that diagnosis when there's no
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  sperm found in the ejaculate. You know, what are some main
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  causes of that and and what options exist today that many
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  patients might not realize are possible?
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  Yeah, it's not over, not yet. OK, This is one of my what I
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  specifically trained for. There are two causes.
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  Let's keep it simple. Either the factories online, but
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  the highways are down blockage, OK, or the highways are wide
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  open but the factory is down production.
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  OK, so we either have a production problem or a highway
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  problem, obstruction. You can usually determine which
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  one of the two it's going to be through a physical exam and a
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  basic hormone evaluation. We are pretty good at predicting
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  that. Both require slightly different
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  surgeries. If it's blockage, you're in much
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  better shape. Those are typically fantastic
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  sperm. Doesn't take much to get them
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  out. A blind man can hit the side of
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  a barn. OK with the rock.
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  You're chock full of it. We just got to get them out.
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  Unfortunately. You have to understand that
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  surgically retrieved sperm across the board only works with
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  IVF. It will not work with an
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  intrauterine insemination type deal.
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  OK, we learned that in the early 90s and until ICSI came on board
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  in 1997, surgical sperm never worked.
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  OK. Now if it's a production
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  problem, the factory is down, then we'd have a lot more work
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  to do. I need to rule out some
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  chromosomal abnormalities that are common.
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  We can still find rare sperm in some of those men, but the
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  prognosis is much more guarded. It's tough.
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  It's a tough journey. The name of the surgery for that
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  is called a microtessie. And essentially what we're doing
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  is combing through attempting to find ultra rare pockets of sperm
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  production. What we don't understand is why
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  they exist in the 1st place. Presumably the genetics are the
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  same throughout the entire testicle, but for some reason
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  most of the factory is off with the lights down and every once
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  in a while you'll come across a pocket where the factory is
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  going hog wild and completing fully mature sperm.
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  Realistically, I would have to see a patient before I gave them
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  a percent chance of of finding sperm, but it's about 55% for
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  most men based on prior literature.
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  So it's tough. I spend a lot of time with those
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  couples discussing donor backup as an option and talking to a
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  reproductive urologist in terms of donor sperm, I think is
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  useful. You know this, this is hard for
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  men. It's hard for couples to accept,
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  but sperm don't make the dad at the end of the day.
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  No, that's such a good way of putting it, Ross.
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  Absolutely. I know going into the donor
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  discussion, I can't imagine how tough that is to, you know,
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  enter with the couples as the physician.
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  Yeah, it's important to respect their autonomy.
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  You give them the data and I tell them you have homework to
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  do. Take the weekend and call me
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  back and tell me what you want, but I'm not going to force you
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  to use donor sperm. Yeah, yeah, absolutely.
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  Yeah. I mean, the whole aspect of
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  everything along this, you know, and getting those, you know how
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  it's delivered, having a physician like yourself who's
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  compassionate, caring and giving everything up front like this is
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  what we're seeing. It's so important because, you
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  know, infertility in and of itself is the complex trauma
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  'cause it's like loss after loss and just you feel like your
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  bottoms just keep getting lower and lower in this journey and
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  like, oh, we're going to try this next.
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  We're going to do this next, you know those things.
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  So having someone that is clearly transparent with you in
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  those moments is so vital and crucial so you can feel like I
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  can make the best educated decision as a couple.
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  You know, what we can do for our family planning and what that
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  looks like and what we're comfortable doing and what we're
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  not, you know, based off of that and the studies.
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  Yeah. I, I think it's important as a
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  physician to you don't hold anything back as transparent and
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  sometimes as brutal as possible is what you need.
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  You need the data to make your decisions and the data is either
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  good or bad, but you need it. And and so I think that
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  physician patient relationship is especially important in
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  fertility. And finding the one that you
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  relate the best with and and has that open communication like
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  you're saying, Ross, because they're alongside you the whole
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  time with your family planning and it.
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  And it takes a long time, yeah, going into fertility treatments
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  it it always takes longer than you expect.
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  Yeah, absolutely. Well, and having these
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  conversations is so vital up front and and earlier the
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  better, you know understanding that as well, you know, and the
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  the next question I was going to ask was about the testing.
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  So I'm really glad that you went into that.
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  So thank you for that, Ross. And, you know, on top of
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  understanding the factory or the highways, you know, those
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  things, you know, with production or distribution of
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  the sperm, what other, you know, lifestyle and environmental
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  factors really play a role in sperm health that, you know,
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  might be easier to change or, you know, help with this, like
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  toxins exposure, heat exposure, alcohol, cannabis, sleep, stress
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  and nutrition. You know, they're always the big
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  top ones I feel like we hear about all the time.
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  Yeah, so I always say the lifestyle of male reproduction
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  is the lifestyle of moderation. As long as you're not too
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  extreme on any end of the spectrum, you want to be in the
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  middle. That's where your body is happy.
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  So, for instance, going on a crash diet is a bad idea.
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  So if you need to lose weight, you should do it.
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  Low and slow crash diet is a controlled famine.
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  Humans do not reproduce during famine, That's on purpose.
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  Alcohol probably matters, but I typically need to see pretty
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  heavy drinking before it starts really impacting the semen
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  analysis. In general though, I'd like to
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  keep my patients below 4 to 5 drinks spaced out in a week.
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  Smoking is the worst you can do. This is probably the most
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  impactful lifestyle factor that you can change to improve your
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  sperm. Nicotine effects sperm, but it's
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  really all the other stuff that's coming out of the
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  combustion of that plant that is highly damaging to sperm.
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  And we know that it increases DNA fragmentation.
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  We've measured OK Cannabis is the same thing.
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  I don't care about the THC as much as the other stuff coming
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  out of the burning plant. It's like 3 unfiltered
• 20:37
  cigarettes now. There are THC receptors down
• 20:41
  there. We don't know what they do.
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  It's probably a minor effect in terms of the active chemical,
• 20:47
  but I still tell my patients, remove variables, cut that stuff
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  out, OK. In terms of diet, it's tough to
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  move the needle. You know you'll read these
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  studies, but the effect size is very small.
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  The truth is in Western society, we are all macro and
• 21:07
  micronutrient sufficient. And I have guys who disappear on
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  me for six months and they go live the perfect lifestyle.
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  They hit the gym everyday, perfect Mediterranean diet,
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  taking their supplements, They come back, they repeat their
• 21:24
  semen analysis. It's exactly the same.
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  And so it's very, yeah, it's tough to move the needle when
• 21:32
  you're already doing OK. It's there are prescription meds
• 21:39
  that can influence sperm production.
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  If you Google any prescription Med I guarantee you you will
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  find some sort of random animal study or vague human study that
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  links it to sperm. I don't want you to get too into
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  it until you talk to somebody like myself, but there are a few
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  bad players and I don't know if this is one of your future
• 22:04
  questions, but testosterone replacement therapy is a
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  nightmare that is essentially going to be a male contraceptive
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  for most men. It turns sperm production off
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  and it can take a long time to get you back online.
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  Some men, it took me a year. So that is become,
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  unfortunately, very, very common.
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  It's being pushed on our population.
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  And you're not always counseled before you start testosterone
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  replacement therapy that it affects your sperm count.
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  And so a lot of folks are getting kind of bamboozled into
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  a difficult fertility situation. Absolutely and a year and
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  infertility is a long time when you're trying to and see if.
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  Yeah, anabolic steroids are the same thing.
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  If you're using those, it's like testosterone on steroids, no pun
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  intended. Wow.
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  That was a big question. Did I miss any of those
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  segments? How about this is always a big
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  one, You know, everybody says like, just relax, you know, if
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  you didn't have stress. But it's hard not to stress when
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  you're in an infertility journey.
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  But how does stress and sleep really associate with it too?
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  Yeah, again, loose correlations. OK.
• 23:27
  Every patient is hoping it's the stress.
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  It's not the stress. Yeah, you have very little
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  control of your sperm counts and we all live stressful life
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  lifestyles these days. I do think a severe event can
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  temporarily affect your sperm counts, such death of a close
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  loved one for instance. Now sleep is interesting.
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  I think sleep's very important. We none of us have good sleep
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  hygiene it seems. But remember, the testosterone
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  axis is the, it, it, it cycles day-to-day.
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  If, if your days are different every single day of the week,
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  your body's having a hard time regulating that testosterone
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  cycle that kind of follows your sleep wake cycle.
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  So if not for general health, I think it's nice to review remove
• 24:27
  that variable. I preach a lot of sleep hygiene
• 24:30
  for my patients. I think it's very important.
• 24:33
  Yeah, that's good to know, Ross. I mean, you don't hear about it
• 24:36
  as often as you hear about the others that we discussed.
• 24:39
  I feel like, you know, the alcohol, the cannabis, the
• 24:42
  nicotine, they always get all the, you know, attention out
• 24:45
  there. But, you know, sleep that
• 24:47
  routine and having a really healthy sleep pattern, yeah.
• 24:50
  Exactly. You got to sleep and.
• 24:52
  That's something you can fix, you know, like that's something
• 24:54
  you can do on your own, you know, figure it out and what
• 24:57
  works for you. Yeah, right.
• 24:59
  Yeah, taking that variable out, you know, what's interesting is
• 25:03
  too something that, especially from the female perspective, is
• 25:05
  our biological clock, right? And we're like, eggs are on a
• 25:09
  timer, for lack of a better way of saying it.
• 25:10
  But male age is discussed less frequently.
• 25:14
  How does male age impact, you know, sperm quality, genetics
• 25:18
  and pregnancy outcomes? Not very much as we as you would
• 25:22
  expect, but it does matter. But the correlations are are are
• 25:27
  pretty soft. It's just not like a huge change
• 25:30
  occurs through 510 years, but there is a progressive drop with
• 25:35
  age with testosterone and sperm counts.
• 25:40
  The as you get older and older, there is concern that some of
• 25:45
  these polygenetic diseases, like autism for instance, may
• 25:50
  slightly increase with male age. In terms of risk, I think it's
• 25:56
  reasonable to assume that that makes sense, but I wouldn't say
• 26:00
  that that should significantly influence your decisions because
• 26:05
  the relt, excuse me, the absolute risk remains pretty
• 26:08
  low, comparable to everyone else.
• 26:12
  But This is why you see much older men able to start
• 26:16
  pregnancies. Yeah.
• 26:18
  Absolutely. That makes sense, you know, for
• 26:20
  some men, infertility also has a genetic 'cause, you know, what
• 26:26
  does types of genetic conditions or chromosome abnormalities
• 26:32
  affecting the sperm production. When you see that, Ross.
• 26:35
  Yeah. So again, the science is
• 26:38
  limited, but what I can tell you there's something in the
• 26:43
  genetics that's affecting you if you're having significant
• 26:48
  diminished sperm counts or motility, OK.
• 26:52
  We have spent millions upon millions in research through the
• 26:56
  NIH, etcetera trying to identify these genes.
• 26:59
  It is an extremely complex system and we've just scratched
• 27:04
  the surface. It takes hundreds of genes to
• 27:07
  make a sperm as unique individuals.
• 27:11
  We have a unique variant in each one of those genes.
• 27:14
  These genes come from far outstretches of your family
• 27:18
  tree. You get some of them from great
• 27:20
  great grandma on one side, great granddad on the other side.
• 27:24
  It's the it's the unique mixture of these gene variants, your
• 27:28
  hand of cards that matters and is going to affect what I call
• 27:33
  your factory efficiency. How much product can you make
• 27:37
  right? That being said, there are a few
• 27:41
  you you, if you Google this, there are some genes that have
• 27:45
  been identified, but they're typically only applicable to
• 27:47
  very small groups of people, very, you know, very specific
• 27:52
  families that have a very specific problem.
• 27:55
  The only real good genetic testing we have, and that is
• 27:59
  pretty old and dated at this point, but we still use it, is
• 28:02
  the chromosome analysis, AKA karyotype and the Y chromosome
• 28:08
  micro deletion test. If you have asospermia, no sperm
• 28:12
  in the ejaculate or you're or you're shooting very low sperm
• 28:16
  counts, I will order these tests.
• 28:18
  We need to rule them out. It will detect chromosome
• 28:22
  rearrangements, Klinefelter syndrome, and loss of that
• 28:26
  specific spot on that Y chromosome.
• 28:30
  Think of your chromosomes like the Encyclopedia Britannica.
• 28:34
  They're divided into volumes. As long as you have all the
• 28:37
  text, you can be a totally normal human.
• 28:41
  But if part of five is stuck to six, it makes it very difficult
• 28:46
  to produce sperm because you got to split these chromosomes into
• 28:49
  separate cells so you can have that.
• 28:53
  Klinefelter syndrome is a syndrome where you have an extra
• 28:58
  X chromosome so you have XXYI believe it's far more common
• 29:02
  than we all initially anticipated.
• 29:07
  For most men you can't tell the difference until your
• 29:10
  infertility diagnosis. Those men typically require a
• 29:14
  microtessie if they have a shot to find sperm.
• 29:17
  It needs to be ruled out if you're having zero sperm in the
• 29:20
  ejaculate. the Y chromosome microdeletion is interesting.
• 29:25
  This is not typically passed down because you typically don't
• 29:28
  have any sperm or very low amounts of sperm so in the past
• 29:33
  you would have been totally infertile.
• 29:35
  It is a it is a hot spot on the Y chromosome that tends to fall
• 29:41
  out easily and it happened right at conception when egg and sperm
• 29:46
  meet and This is why it's not carried down in families yet.
• 29:51
  However, if I find sperm in a guy with AY chromosome
• 29:55
  microdeletion and we make an embryo that's a boy, now it will
• 30:00
  be passed down because he's going to get your Y chromosome.
• 30:04
  So it's still a relevant measure because in some cases those
• 30:09
  couples may gender select. Yeah, absolutely.
• 30:13
  No. Lots to consider and think about
• 30:16
  that. You have to in these instances.
• 30:20
  Absolutely. Wow.
• 30:22
  And you know, with that and with a couple who is on an
• 30:27
  infertility journey or feel like they've been trying to conceive
• 30:30
  for months, maybe even years, when do you feel like, 'cause
• 30:35
  obviously many couples focus first testing on the female,
• 30:39
  even though it is easier to test in the male, right?
• 30:43
  When should men be referred to a male fertility specialist rather
• 30:47
  than just a basic semen test? Yeah, so first of all, a semen
• 30:53
  test and typically 2, it's important to get more than one
• 30:58
  for most guys because it is a very, extremely variable system.
• 31:03
  You can have bad days, get a retest to make sure it's true or
• 31:07
  not. You should have your semen
• 31:10
  analysis done right away, immediately, right along with,
• 31:15
  you know, as you start your journey.
• 31:17
  That has to be factored in. I would say referral to a male
• 31:21
  and fertility specialist is reasonable if sperm, if there's
• 31:26
  a consistent defect either in count or motility, OK.
• 31:33
  Obviously if there's ejaculatory dysfunction, that's an early
• 31:36
  referral to right? We got to have ejaculate to get
• 31:39
  pregnant. Yeah, absolutely.
• 31:43
  And other sexual dysfunction we can address as well, but
• 31:47
  ejaculatory reflex is the big one that needs to be intact.
• 31:53
  That being said, I don't mind seeing folks with normal semen
• 31:58
  analysis. I think there's a lot of value
• 32:00
  in talking about lifestyle. Discussing the testing thus far,
• 32:05
  and reviewing the data together in a shared capacity.
• 32:10
  I think that's helpful. We can also discuss the fancier
• 32:14
  sperm test if we want to go down that route, which can I believe
• 32:21
  can be a predatory market. You got to be careful how you
• 32:23
  spend your money. So I can help guide you in terms
• 32:26
  of I don't think that test is really ready for prime time yet.
• 32:30
  Let's not utilize that one versus this one, which I think
• 32:33
  is probably much more effective in guiding my patients.
• 32:37
  So I think that's a reasonable thing to consider as well.
• 32:43
  And for couples listening who may have just received a
• 32:46
  diagnosis involving male infertility or are just starting
• 32:50
  this journey, you know, what would you want them to
• 32:53
  understand about how far treatments and technology have
• 32:56
  come? Yeah, so I I always tell my
• 33:02
  couples the testing is limited. Only interpret your tests with
• 33:09
  what the test can actually tell you.
• 33:12
  So if you have a normal test but your morphology 0, you don't
• 33:17
  know much about that about that male other than he has a normal
• 33:21
  modal sperm count most likely. I wouldn't weigh into the
• 33:25
  morphology too much. As I said earlier in the talk, I
• 33:31
  think like I said, the semen analysis typically 2, I have a
• 33:36
  low threshold to get three. You have to understand that the
• 33:39
  male stock market really varies day-to-day, and so you can get
• 33:44
  some wonky tests on your semen analysis.
• 33:47
  Always repeat, always repeat. But overall, I think it's high
• 33:55
  value still to see someone like me to review these things and
• 33:59
  have a discussion. It's it's not much time.
• 34:02
  And really, I always tell my folks, 90% of what I do is
• 34:07
  education, 10% weird stuff. Yeah, yeah, it's good to know.
• 34:12
  Yeah, Sir. Russ, what would you like to
• 34:15
  leave our listeners with? And also, if you could change
• 34:18
  one misconception the public has about male fertility, what would
• 34:22
  it be? Yeah, I #1 the testicles on you
• 34:33
  only contribute 3% of the volume to the ejaculate.
• 34:37
  If the guy is saying I have a normal looking ejaculate,
• 34:40
  doesn't matter, you don't know if spermor is in there or not.
• 34:43
  He needs a semen analysis. OK?
• 34:46
  That's why after vasectomy for instance, the ejaculate looks
• 34:49
  unchanged. OK, Abstinence interval is not
• 34:53
  as important as we all think it is.
• 34:56
  We we focus on it because it's one of the few things you can
• 34:59
  control. But by and large it's not that
• 35:03
  important. I what I would like to leave my
• 35:07
  folks with is that you got to rule out a male factor and you
• 35:11
  should do it early. It takes 2 to tango.
• 35:14
  Just get the semen analysis, it's not a big deal.
• 35:19
  I know. I think that's tough, especially
• 35:21
  with males maybe to venture into realizing there might be
• 35:26
  something contributing or wrong that can be fixed or, you know,
• 35:30
  not, but just to have those conversations.
• 35:33
  And a lot of times, you know, our lost parents and couples and
• 35:35
  the moms come to us, you know, and they're thinking it's a lot
• 35:39
  of things are getting done on their side and the males are
• 35:41
  more dragging their feet with things.
• 35:43
  So to hear that rough is is huge.
• 35:45
  You just got to do it, do your business.
• 35:48
  Yeah, get it done. Get it done.
• 35:52
  Thank you so much, Doctor Heyman, for being here, for
• 35:55
  everything that you covered, you shared about male infertility.
• 36:00
  Definitely encourage anybody listening that has follow up
• 36:03
  questions or would like to do a consult with Doctor Russell,
• 36:07
  please reach out to him. We'll put the contact
• 36:09
  information and the description. So you have all of that.
• 36:12
  And thanks again, Ross. Can't say that enough to you.
• 36:14
  Absolutely, my pleasure. To everyone that is listening,
• 36:19
  that is navigating infertility, recurrent pregnancy loss, any
• 36:23
  type of pregnancy loss, infant loss, please know your story
• 36:26
  matters, your baby matters, and your grief matter.
• 36:29
  Healing doesn't always follow a timeline.
• 36:30
  Trauma and loss don't have a schedule and you deserve
• 36:33
  compassionate care through every step of your journey.
• 36:36
  If you need support, we have free daily support resources and
• 36:39
  a community at Chasing the Rainbows.
• 36:41
  Because every loss does matter. If this conversation resonated
• 36:45
  with you, please share this episode with someone who may
• 36:48
  need it and to hear it as well. And if you are looking for
• 36:50
  support, want to volunteer, donate, host an event, please
• 36:54
  visit chasingtherainbows.org. Thank you for being here, for
• 36:57
  listening, and for continuing to break the silence around
• 36:59
  infertility and baby loss. Until next time this is cried
• 37:02
  out loud.