Speaker 1By listening to the Conscious Fertility Podcast, you agree to not use this podcast as medical advice to treat any medical condition in either yourself or others. Consult your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Welcome to Conscious Fertility, the show that listens to all of your fertility questions so that you can move from fear and suffering to peace of mind and joy. My name is Lorne Brown. I'm a doctor of traditional Chinese medicine and a clinical hypnotherapist. I'm on a mission to explore all the paths to peak fertility and joyful living. It's time to learn how to be and receive so that you can create life on purpose. Welcome to another episode of the Conscious Fertility Podcast. Today, we have reproductive urologist, Dr. Paul Turek. I'm looking forward to this discussion because I'm going to be talking to him a little bit more in depth. So, let's get started. Men are so important to the equation. Apparently, it takes sperm to make a baby, yet they don't seem to be a big part of the equation. Now, a little bit about Dr. Paul Turek. I've had the pleasure of sitting on many of his lectures when I've chaired the Integrated Fertility Symposium, and he's come out to lecture on many occasions. He is the founder and director of the Turek Clinic. He is a leader in his field. He's the past president of the American Society of Andrology. He is a recipient of a prestigious National Institutes of Health grant for research designed to help people with infertility. He's also the founder and director of the Infertile Men Become Fathers, and has published some of the highest success rates worldwide for vasectomy reversals. He also invented sperm mapping, which is an advanced alternative to micro-dissection procedures. And in addition to being one of the most popular doctors online, Dr. Paul Turek blogs on a weekly basis about common medical issues, solutions, and innovations. His blog is Dr. Turek's Blog on Men's Health. I love a quote that I've seen on his website saying, my approach to the treatment of male sexual health issues, similar to a vintage Ferrari, if you take the time to straighten out all the kinks, it will run hard and fast. So it's appropriate that we have Dr. Turek in a garage with lots of cars. First of all, our audience can't see this because this is a podcast, but can you describe where you are? And we will have a video of this, by the way, on our website. So there will be a video, but can you describe where you are and what we're seeing? Yeah, I have to apologize. I was
Speaker 2planning to do this from my office, but my vintage Alfa Romeo has a flat tire and it's raining in LA.
Speaker 1The car above me. Oh, yeah. It's kind of a reddish color. I think I see that one. Yeah,
Speaker 2right there. Anyway, I've had it for 40 years and believe it or not, it's Italian. It never fails, but it failed. And it is absolutely true that you take care of them in the same way. If you maintain them, they do really well. I've had this car for 40 years. It's always reliable. I drive it to work, but today I got a flat tire. I'm going to have a big commitment later, so I got to get it fixed. So this is a vintage car mechanic who does amazing work. He's brilliant. And he's the
Speaker 1touchy. And that's why I think a lot of men say about you when it comes to fertility, because you're a brilliant guy and you're the only one they allow to touch it because you're really good
Speaker 2at fixing. I treat them like mechanics, like artists, right? You find a good one and you pay them whatever it's worth because they do a good job and they do it once. And so I actually give them a book called Shopcraft to Soulcraft, which is a book by Matthew Crawford, a philosopher about the nobility of a stuck bolt. A lot of people think that small, like manual labor isn't cool, it keeps people flowing. And I just admire anyone who can unstuck a stuck bolt and do it well. And I kind of see myself that way. I look at those problems and that's how I try to solve them very mechanically. And men are pretty mechanical, so it works out well. I'm expecting that the majority
Speaker 1of our listeners are female listening to this, but hopefully now that you're talking a little bit about cars, they can kind of share this podcast if they're in a relationship with a guy so they can hear about this. But I guess I want to ask you is, it doesn't seem like the men are involved a lot, as in not always showing up in the treatment or not always being considered important. From your perspective, you're a reproductive urologist. This is your focus. A big part of your focus is helping families, grow families, treating the male side. How important is the sperm for having a baby and the health of the baby? Are they neglected or does this make sense that the women are the key and men are just a little side dish? Side dish. I would say that my two quotes
Speaker 2that sperm is a, fertility is a team sport and sperm matter a lot. And we're literally, we're learning that very quickly as we know more about the basic science of sperm. So, which is interesting, I've spent a lot of my life trying to blame sperm. So people come to me and they can't conceive or they fail IVF, then they say, we wonder if it's a sperm problem. And my goal is to blame sperm. I like to be their lawyer, but I'd like to be their executor too. If they are the problem, let's figure it out because it's something that might be treatable or fixable. And I'm associated with some companies that do offer say sperm sorting and things like that. So there's disclosures there, but it's because of that one motivation is if it's the one thing, if things fail, that you can actually work on, you can't really work on eggs. You can't really, you know, IVF programs do a pretty good job in the lab and it's not usually a lab problem. So you're left with sperm. So by blaming sperm a lot, you learn a lot about them and you learn about how much they do matter. And they do matter a lot. And I would call it half, you know, I would say half the time. So I gave some stats. If you're a couple and you're not conceiving at home, then you can probably blame the sperm, you know, maybe 25, 30% of the time. If you're a couple who haven't conceived with IUI, then it might be 50% of the problem or, you know, it goes up from there. If you fail IVF with donor egg, it's 100% sperm, right? You know, there's, so you can, you can crank it up, but it starts out substantially
Speaker 1at around one third and it goes up from there. And do you think with the sperm being part of the issue, is this contributing to unexplained infertility? Is this contributing to miscarriages? Is this contributing to poor embryo? Based on the science, what you're seeing now in the last two decades?
Speaker 2Great question. It's a great question. I think we used to think it's just infertility at home. Now we know that DNA fragmentation of sperm can contribute to failed IUI. It can contribute to inseminations can fail because of sperm. And we know that sperm, not fertilization of eggs with sperm, but that IVF embryo development in a dish from day sort of three to five and all the decisions are being made about the genomes mixing that can be sperm related and failed embryo, you know, failed blastocyst development. We think probably the failure of making normal embryos that are normal at IVF. And certainly we now know that miscarriage either conceived naturally IUI or IVF can be sperm related to DNA issues. And that's just looking at sperm fragmentation, which is something that's around 10 to 15 years old. And it's one little aspect of sperm. But if you now look at sperm epigenetics, which is a whole lot of sperm, it's a whole lot of sperm. It's a whole lot of sperm. But if you now look at sperm epigenetics, which is a whole new science that's developing, it's going way beyond that. I mean, I think it's going to be a big chunk of all of those again, and explain a lot of what we now consider unexplained in a lot of levels. And there's some very provocative evidence from Utah and Washington State that sperm contribute to autism rates. And there may be ways to lower those by picking the youngest sperm. And a lot of things that are inherited, you know, sperm matter because what you see in a sperm goes to the next generation. Unlike a liver cell, right? So if you have a problem with the epigenetics of your liver, which is the marks from the DNA are off, you may develop a cancer or something. But if you have a problem with your sperm, it's going to your kid. So that becomes much more relevant. And the science is much more intense than sperm, because it's transgenerational.
Speaker 1This is interesting.
Speaker 2None of my mechanics would know what I mean. None of those guys would know what I mean by that.
Speaker 1Right. But reminding our listeners, so it's perfect, because we're talking about male fertility, we're talking about sperm, and it's... It just so happens that this interview is happening inside a garage where he's having his mechanic...
Speaker 2Vintage car repaired.
Speaker 1Vintage car being repaired. And just like he's taking great care of it. It's 40 years old. But even with good care, sometimes it needs a little extra help. And you go to the mechanic, or if you're having fertility issues, you go to the fertility mechanic. In this case, they're called a reproductive urologist. And one of the best in the country we're talking to right now is Dr. Paul Turek. What about when they come to you or they talk to... The naturopath, the acupuncturist, they're even the reproductive endocrinologist. And they go, oh, the semen analysis, the shape, the speed, the count looks all good. So they're not... Is that still considered unexplained? Or is that semen analysis, if it looks within range, is that considered okay?
Speaker 2Okay. So I'll say my statement about that is a semen analysis does not make the man. The man makes the semen analysis. So a normal semen analysis by WHO criteria or anyone's criteria does not mean you're fertile. And an abnormal one doesn't mean you're infertile. Unless it's zero. So there's no real strong correlations there. But I would say if the history, thorough history is clean and his physical exam is clean and his semen analysis is abnormal, then I think you have a good chance of that man being normal, right? I would say I published a paper recently that semen analysis was normal. The history was normal. The physical was normal. Hormones have gone normal. It's checked out. And I cleared these men and I said, you're not the problem. And then no one believed me. So they would go back. I went back to social media and say, Turk couldn't figure out what was wrong with me or my husband because it was unexplained. I got a little angry and upset. And then I had a resident from USC call these couples a year later and say, you saw Turk a year ago. What happened since then? And two thirds of them had natural pregnancies. They were infertile for a year and a half. So two thirds were normally fertile. And another 20% conceived with IUI or IVF after that visit. And so my statement was, you know, they had varicose seals. They had things going on, but I cleared them. And the point, it was probably the first paper ever published where I said to people, you know, I believe I'm right about this. And because I like to blame sperm, and there was nothing to blame here. And so I went back and I said, I'm sorry, I'm sorry. went that way. And it ends up that, you know, 80% had children, had been pregnant and on their way, just being clear, not even giving them any therapy. I published it, not as I see, as I told this old paper, I published it as a lifestyle paper, because what I assumed happened was that they talked with me and then they ended up doing things, lifestyle changes. They got out of the hot tub, they stopped Propecia, they took their old antioxidant supplements, they timed it better, and they did things to make it happen. But again, the group was 35-year-old women on average, a year and a half of infertility, they weren't going to wait that long. So I was pretty excited by that. So it meant that we can say things both ways and they can be right. They can be right.
Speaker 1And so since women are born with all their eggs and men are making sperm all the time, so I've heard it's 1,000 to 1,500 per heartbeat. Is that a true statement?
Speaker 2Yep, normally, yeah.
Speaker 1So what are some of the things that men can do to help optimize their sperm quality, to help with that, help them grow their families? Because I heard you say hot tubs, can we kind of unpack that and talk a little bit more about that to let them know? And I know you've been at the conferences where they talk about acupuncture and herbal supplements diet. Can you let them know that there are things that they can do if their semen analysis looks normal, there's still things that they can do to optimize it? And I guess I'm going to add another part to this question is you cleared these men- That's a nice sound. Yeah, you cleared these men that, reminding you guys, we're doing this interview while he's in a vintage car garage.
Speaker 2A mechanic shop, yeah.
Speaker 1Yeah, mechanic shop. So what are some of the things that you would say, semen analysis looks normal, but I'm seeing this, so you're not cleared. And what are the things that they can do?
Speaker 2Yeah, I'll say one thing even more philosophically and generally speaking, 30,000 for you. People think that you can take a man and do something and make him better. And I would say that you have to think about it as an old car that just wants to run hard. And if you leave it alone and surround it with health and good care, it should run hard all the time. It wants to run hard. I have a blog on this. I forgot what it's called. Maybe the sound and the theory, but the concept is that people think you're for some reason low and you can push it up by adding more gas to the tank. No, it's running like a lawnmower at full tilt. If you leave it alone, it runs as hard as hell. That's the way it wants to run. So now you think about it that way, the best thing you could do for your sperm, for your semen analysis is stay healthy, surround it with health, and that'll run the best, right? So keep the air. Get the gas in the tank, get the oil in the thing, the tuned up, keep its weight down, right? And it'll run beautifully. And that's, that's now there are exceptions like genetic infertility where you're handed less and it's, you know, it's going to be problematic. But in general, when you think about lifestyle, which is the first thing you treat is what is this person doing to lower their sperm quality? And you can think of a million things, any medical disorder, diabetes, thyroid out of control, you know, obesity, classic, right? I would say obesity is probably the reason everyone thinks our sperm counts are falling. It doesn't mean we're less fertile, but, but that's probably what's going on because you only see it in developed countries where obesity is going on. Another conversation. But, but you asked the question about a man who has a normal semen analysis and it's unexplained. Poor, poor embryo development. They're not
Speaker 1getting to blastocysts or they're having miscarriages. She, they can't find anything wrong with her. They can't find, and her age is appropriate. They can't find appropriate as in the reproductive window and his semen analysis comes back within range, but you do other things. And so what are the things that the guy can do that's proactive or what makes you think he wouldn't be cleared if his semen analysis was within range?
Speaker 2So you can have toxins on board such as tobacco or pot THC. I don't know about CBD. I don't think there's enough data yet. I don't know if it has any effect, but we know that tobacco and pot can have problems with sperm DNA fragmentation, which is not reflected in the semen analysis. Sperm epigenetics, which is not reflected in semen analysis. So I would call the semen analysis a requirement. And you've got to look beyond it. So you look at things that are known to be reproductively toxic, things like diet, lifestyle, all that stuff, obesity, diabetes, they'll typically affect the count. They'll typically drop your count and you'll see a, that'll be manifest as an abnormal semen analysis. That's the whole biomarker concept. But when it's really subtle, might just be something like, you know, recreational drugs or a medication. For instance, a classic one is sulfa-based medications for IBS and things like that. Like the sulfosalicylic and salazine medications, semen analysis looks great. And the sperm bounce right off the egg because they're calcium channel blockers sort of, and they cause effects on sperm function, calcium channel blockers, amlodipine, other medications that are used for blood pressure, not often in young people. Semen analysis is normal, but it's blocking calcium channels, which is responsible for fertilization. And these again, bounce right off the egg. So it gets subtle. So antiandrogens, things like that. So you got to look carefully at the mechanisms of physiology and that you're probably looking at it. And then you look at the fertility specialist, you know, what he's doing to find that stuff, right?
Speaker 1Prescription drugs, trans fats, like a really poor diet, not being well, like overweight. Some people are working out taking androgens or testosterone. Another one, the classic is the ejaculatory
Speaker 2abstinence, which can cause a problem. So a lot of abstinence can cause sperm to be old, anything that causes sperm to be old. So in frequent ejaculation, it's not getting out. You don't ejaculate from the testicle. You ejaculate from an epididymal pool, which has 600 million sperm in it normally. And you take a scoop out of that. And you ejaculate it. So if the pool is old, and the person's not ejaculating much, it stays old. So you do a little abstinence of two or three days, thinking that it's young. No, you got to do it for eight to 10 times. It's a lot more complicated than that. So that's what I think about.
Speaker 1I want to know if you still believe in this quote. I remember at one of our conferences at the Integrated Fertility Symposium, this 2015-16, you had said, "One of the worst things that ever happened to men's health was ICSI." Do you still think that? And if so, can you unwrap that, what you mean by that?
Speaker 2Yeah. So I was at the International Fertility Meetings in '95, '96, and it was about IVF. And Eberhard Nieschlag, who's one of the gods of urology, a generation above me, and I were having a debate. And it came up that testis cancer in Europe is a lot more common, early-stage testis cancer, than in America. Late-stage cancers are more common in America. And so, one of the differences between the European and US systems is that, in America, women, women will go through IVF, maybe one or multiple times, fail, then the guy comes in for an evaluation. And the data came out from Keith Jarvie that it was around 25, 23% of men get checked out by a competent reproductive by somebody other than, you know, a general practitioner, before IVF cycles in Northern America, Canada, and US, 23%. The ASRM recommendation is they get evaluated at the same time, but that never doesn't happen. 75% of the time, that doesn't happen. So, that was the data going in. And so, it came out from this conversation with Eberhard Nieschlag that maybe what's going on is that American men have the same cancer rates as, testis cancer rates as European men, but the European men and their system get evaluated along with the women, because the European system is a one single-payer system, knowing that it's cheaper to get the guy evaluated and fix it than it is. It's all a third of the problem, and it's usually easy to fix. It's easier to evaluate, get that done first, fix that, cheaper for the system, a single-payer system, right? And so, they find their cancers early, because fertility is a biomarker of health, which we later showed. But in America, we're thinking that maybe because these guys get delayed care, their cancers are found later, and they're missed earlier. So, to me, that's a health risk, right? So, I'm saying that the early use of IVF before the guy's evaluated is the way it's happening is the worst thing to happen to men's health. Not IVF fixing, but just IVF. Because if you have a sperm count in North America, you're going to IVF. Dr. Justin Marchegiani: If you have a poor sperm count, you're going to IVF. Dr. Tim Jackson: Any sperm count. Any sperm count. You may or may not go to a urologist to find out it's a cancer that causes it. And this really came home to me after that, when I got back, and I diagnosed one or two testis cancers a year. The last one was a couple that trailed two IVFs, and they said, "Maybe we can fix your slow sperm count." They weren't sent to me, they came to me on their own, and I said, "You have testis cancer." And it's like, "Holy shit, that's not healthy." Dr. Justin Marchegiani: Now, you were talking about,
Speaker 1the health risk, as in men not being evaluated earlier enough, and leading to diseases not being seen earlier. And I was going to share with you that this, to let you know that I do pay attention to when you present at our conferences, because another thing I heard you say is that male infertility is the canary in the mind. And that's tying into this then. If a guy's having some fertility issues, or you see it in the semen analysis, you're not thinking, "Oh, he's just having trouble conceiving, he has some sperm issues." This is where you start to think about whole health for the guy, is it not? Dr. Tim Jackson:
Speaker 2Yes, exactly. And so, I gave a lecture at Google Health about, oh, probably 12 years ago now. You can see it on YouTube if you search Turek Google lecture. And I talked about the fact that we have to stop thinking about male infertility as an unfortunate circumstance, and more like a canary in the coal mine of his health, right? So, it became clear with erection problems with men, men, with significant erection problems came out in the sort of 2000s, are two to three times more likely to have a heart attack or significant cardiovascular event than men without significant erection problems in their 40s. It's not plaques, it's something else, it's, you know, endothelial function. But it was the first sexual health canary in the coal mine that was validated, like in several papers. So, that brought me to the concept that maybe true fertility and maybe the semen analysis being abnormal isn't just too bad for the guy. But right now, what I would say is if the semen analysis is abnormal, and I know it should be running hard, if he's healthy, you got to find something. So, an abnormal semen analysis, especially a count, you got to look at it and say, what's going on with this guy, and you got to find it. That's my approach now. And you dig and the questionnaires, 200 questions, and it's pretty significant. That's an old Mercedes back there,
Speaker 1by the way. So for our listeners, and we will have this video up on the Conscious Fertility Podcast YouTube channel, so you can see the cars that Dr. Turek is walking around. Now, Paul, a couple of things I want to ask about your practice. By the way, I don't do this all the
Speaker 2time. I mean, it's the first time this car has broken down. You said it doesn't break down.
Speaker 1No, that's what I understand. And it's Italian, and it's Italian. But you used to do consults in cars with men too, did you not? You did it before Jerry Seinfeld.
Speaker 2I know, I wanted to do it. I wanted to do it, yeah.
Speaker 1Meet the guys where they're at, right? In a nice sports car. It takes the pressure off to have the consult over there. I just think people may wonder what the hell you're doing if you're parked over at a field, and you're two guys in the car, and they're getting their full urology work up.
Speaker 2I did offer a men's health tune-up to auctions in LA, San Francisco. Yeah, so it's a tune-up. And it's a tire with a wrench. And usually the partners bid for it, and the guy comes in, and we thought, oil is testosterone. We do a tune-up on them. We check them all out. It's really fun. It's really fun. And the women love it, and the guys actually like it. It makes
Speaker 1sense to them. Right. You meet them where they're at. That's what I hear. That's why you get such good reviews. You're really able to reach the men and help them with their men's health. Did you invent a artificial testicle? I can't remember. Are you involved in that, about some type of apparatus to study sperm? Is that you?
Speaker 2Yeah. NIH grant was for, and we developed an artificial testicle, essentially. And we ran out of money before we could get it running, but it got running, and it did pretty well. And now I'm trying to do it again. We've written three NIH grants for $2 million during COVID, and the government has not funded it. So we're now looking for $10 million of seed money outside, and we're getting there. It's taking time, but I have- What are you hoping to do? What's the, with this, what would, how would this- The earliest cell would, if you don't have sperm in your testicle, but you have some of the earlier germs, some of the older cells that are precursor cells, they're pretty valuable. There's a spermatogonial stem cell, which is the first of 12 stages to make a sperm. I have a patent on that cell because we put it, we can grow it in a dish. That is basically an embryonic stem cell for men. That is the equivalent of an embryonic stem cell. And I published that it's, it can do lots of things. It can become nerves and muscle and a foot and other things if you put it in the right environment. So that's the cell we want to start with. So men with maturation arrest or other issues that don't have sperm, but have some of the- The earlier cells, we could take that cell, take it out, shake it out of the testicle, put it in this chamber, this microfluidic chamber and grow it. Well, we've got to figure out why it didn't grow, right? So we have to know more about genetics because we only know about a 10th of all the genetics. So the other part of this story is to do a deep sequencing of men, look at all the fertility genes that might be involved. Renee and I, who's the, Renee is the leading genetic male fertility specialist in the world who invented the Y chromosome deletion. She feels, and I agree that there's- There's probably of 2000 genes controlling sperm production, maybe 10 or 12 master regulators that run the show. And if you can get those working, you're probably on your way, right? It's the master switch thing. So we're going to figure out all 2000, but basically focus on the top hundred, which will probably be 99%. And if we find that this matrionyl stem cell is missing one of these important genes, that's why it's not progressing. Then in addition, you could add it with mRNA technology, which is simply off the shelf. You can make all the mRNAs, have them in drawers and simply add it to the frame. And that's what we're going to do. We're going to do a deep sequencing. And we're going to do a deep sequencing and we're going to do a deep sequencing. And we're going to do a deep sequencing, and we're going to do a deep the cell like you have a vaccine. So CRISPR technology can be used to create these cells. mRNA technology can be used to modify them without viruses and healthy in very, very specific ways, and then get them through that process in a dish. I'm not a big fan of putting those cells back in humans. So Kyle Orwig and a bunch of others are doing in vivo work, which means you take the stem cell out and you put it back into the testicle that may be missing it and let the testicle be the house or be the microfluidic environment. But I'm having trouble because we published a paper that if you take one of these stem cells and we did it in mice and you put it back in the wrong place, not in the tubule, but outside the tubule, it may form a tumor and they were forming tumors. That bothers me a lot because tumors, who knows anything about these tumors, how bad they are, kind of follow up you need. And so I think if you're going to do that, you've got to tell the patient there's a risk of tumor development. And I don't know if the FDA is going to be happy with that because we don't know anything about these tumors at all. We know they're embryonic in nature, which can mean they're being very mean. So doctor, so you made sperm for me. Great. Thank you. Do I need to have a testicle removed now because it's going to form cancer or is it going to get worse? Do you know anything about this cancer? No, we don't. So to me, that's problematic. And I think if you have do it outside the body, it's vivo and you throw it and it forms a little tumor in the little device, you throw it in the trash can. Okay. And that's, that's why you want the funding for, um, yeah, I'm not stopping with this. Uh, and I've got the dream team on it. Uh, we just need enough savvy investors to, it's a long-term play. It's a biotech play with a drug timeline, right? 10, 12 years. And then we have to deal with, with regulation. We don't know what the FDA will think about this. We don't know if it's a regulatable at all because it's, it's IVF and IVF doesn't really regulate it, but stem cell
Speaker 1stuff might be. Now I want to take a turn to your mapping. Cause that's something that part of your invention, your contribution. Why are you so interested in that? And what problem is that solving? Why would men need mapping? What are the, what are most clinics currently doing and
Speaker 2why are you excited about this procedure? So back in the nineties, you know, I like to get pushed against the wall. Uh, cause I think a push sense, Well, I think really creatively, you've got to think of a way out. So men were coming to me with non-obstructive azoospermia, so no sperm in the ejaculate and they had biopsies and older technology and they didn't find anything. And so Schlegel, Peter Schlegel Cornell has saw the same patients and we're both kind of people who want to want to constantly evolve. So he said, you know what, I'm just going to make a bigger incision and stick a microscope under the testicle and see if I can tell which two bills have sperm in them. And that's called micro dissection. I think the sperm extraction works quite well. It's about twice as good as a biopsy, but it is a pretty large procedure. You're bi-valving the testicle, like a clam or a book, and then you're putting it back together again. So I can't think of a procedure that's more invasive than that to a testicle. Even a trauma might be less as a consequence, testicles will fail after that. You can drop testosterone and we have published that recently that rate, but I was around different people and my people were the Swedish group and the Swedes like to stick needles and things. And the person Rick Murray Young who taught me this, I said, here's the problem. We're not sure we're testing the whole testicle because for instance, at Stanford, when I was working with them, I had a guy who came in as a doctor. He came in and he had 25 sperm in his ejaculate one day, and he had three on the day of IVF. And I said, well, I'll just go to the testicle and do some biopsies and get sperm. This is before I invented it. And I did like four biopsies and it came up with nothing. And I said, how can that be? How can it be that there's sperm in his ejaculate and there's no sperm in his testicle? And the answer is because it's not everywhere. And that taught me how tricky this field can be because it's in pockets or islands, when it's in low production, no matter what the cause is. And you have to have a very thorough way of looking. And so microdissection does that. You open the testicle, you look through the whole thing, left, right, up, down, and then you find it or you don't. And mapping is a similar procedure, but it's non-invasive. So it's done with needle aspiration. It's diagnostic only. With microdissection, you will keep the sperm. You can freeze it or use it. This is a test more like GPS. It tells you, okay, here's where I want to go. Here's what I want. And it gives you direction because it tells you if there's pockets of sperm there, where they are, which testicle, how much is there. And then you have a lot of information, but it's only information. But it's a lot less invasive. It's not surgery. It's a procedure. So the Swedish school was diagnosing. Here's an example of how they differ. The standard of care for retinoblastomas in children's eyes, cancers of the eye, is to take the eye out and then find the diagnosis. So you take the eye out and there's a cancer in it. Okay, good. What they were doing at UCSF with the Swedes is they were putting the people, girls or boys, under anesthesia and then sticking a needle through the side of the cornea, which can opacify if you're too rough with it, and stick a needle in it and do a fine needle biopsy of it. Diagnose it with the eye left in place and treat it with the eye left in place. So you leave the eye in. Really cool idea, right? So I just thought, I mean, that is a classic difference. And so mapping doesn't hurt testicles. It gives you a ton of information, but you do have a second step to do the procedure, but it's GPS. You know where to go. And in my hands, if you have sperm on your map, then the chance I'll find it again is, Essex of 95 to 100% with procedures that don't necessarily have to be microdissection procedures because you know where it is. So for instance, you know which testicle it's in or which one it's not. And if it's in enough sperm, you can use a biopsy or a needle. And so my favorite patient is a cancer, testis cancer survivor with one testicle, had chemotherapy, and I find a couple of pockets of sperm and I'm able to target the sperm retrieval and leave the rest of the testicle alone so he can use it for the rest of his life to make testosterone. I think it's the bomb. I think it's just a workhorse. You know, it's not young, it's 25 plus years old, 33,000 cases and people don't like it because it's different and it's hard and it's not surgery. But a very famous surgeon who trained me in Philadelphia said, sometimes the best care for patients is not surgery, even though you're a surgeon. Sometimes the best thing is not to pull out the knife and think of other alternatives. You'll get grayer, he said, and you'll worry more, but it might be the way. And that taught me a ton, which is why are we doing bigger procedures? Why are we doing bigger procedures? Why are we doing bigger procedures? That can, you know, violate the testicle and kill it basically, when we could learn so much information a different way. It's two steps, but it's much more conservative. So, you know, I published a paper. We haven't done a randomized trial, but the pair of the two techniques, Schlegel and I constantly argue on in public and wring each other's necks at podiums about it, but patients are coming because it makes sense. And especially the engineers, right? Because you're getting a lot of information. I mean, I can tell you if it's worth fixing your varicocele and you have no sperm count or, or do something else or take some medication. So I had a couple of men last month, the maps were showed sperm, but very few. the rest of the pattern was maturation arrest. And I said, you know what? I want you on FSH and LH injections for four months. And I think I can push the sperm, these areas that don't make sperm into sperm. And both cases had ejaculated sperm for IVF, never needed a sperm retrieval. You know, it's fantastic what you can do with information. And microsection gives you no information. You either have sperm or you don't. That's all you know. The third thing I like about it is that it's archival. So when you do a map, you can figure out what is in the testicle, even if sperm are. What is there? Are there early spermatogelinal stem cells there? Are there primary spermatocytes there? What can we work with? So it's future technology evolves. Each of these patients is archived. And if I could say, okay, you know what? We can use the cell right now to make sperm in a dish. Call them up, say you're on, right? So it's about the future too. So you get great information going forward. So I can't think of a reason not to do it. I mean, it's powerful. So I did a study where I said, you know what? We're finding sperm on maps in men who had biopsies routinely. We're finding sperm in men who had this and that. I'm going to start mapping men who failed microdissections because we don't know which one's better. And I published it. And the answer was, if you fail the microdissection on both sides, you never had a sperm anywhere. I'll find sperm 29%. Almost a third of those cases, I'll find sperm by mapping because it's different. It doesn't find sperm by the look of the tubule. It finds sperm because it identifies the sperm with a tail. So it's very different. And that took a year to publish. No one wanted to hear that. And plus I said a couple other things. Like, by the way, since maps are, you know, they're all templated, you can compare one to the other and stack them up and look in where you're finding it. And I said, by the way, you're missing the middle. You're missing the edges because you're not doing a good job microdissecting the central testes, but the peripheral edges are being missed. And that's where we're finding all the sperm and it was significant. And no one wanted to hear that. But my point was, you know, let's improve guys. We're doing big things here. We're doing herding testicles. Let's make this to the best job we can. I'm not trying to say anything's better. It's not. It's not a randomized trial. I'm just trying to say, let's do, let's constantly improve. And what we do, let's just not sit there. And so this is another non-invasive way to
Speaker 1find sperm, especially for men that look like they don't have sperm on the theme of non-invasiveness then for helping families grow, grow their families. You talked about there's dietary changes, there's lifestyle changes. So recreational pot, certain pharmaceuticals, smoking, not to do hot tubbing, not to do, you talked about eating well, antioxidant therapy. So there's things that guys can do that are, very non-invasive. And then obviously there are some data on using acupuncture, Chinese herbal medicine as well. Lots of non-invasive ways to do this. And it sounds like you're a fan of this non-invasive way of diet, lifestyle, get healthy, keep your car running.
Speaker 2Absolutely. Absolutely. I mean, if, so when I look at therapy for men for this, I don't look at it as a surgeon looking for a case. These guys get the feeling that everyone just wants to operate on them. And it's true. That's how urologists make their money. But I'm kind of beyond that. I sort of said, what's the best thing for men? And they're like, well, I don't know. I don't know. I don't know what to do for this person. So I would rather spend time getting them what they need to stop smoking than do something else, because that's going to help their fertility and it's going to keep them alive longer. So it's a men's health play, not just a fertility play. I'm all about that. And patients sense that. They sense this guy really cares about me as an individual and how I live my life and dangerous behavior. So when I see therapy for anybody, I think, first of all, lifestyle. What can we do to improve this man's lifestyle? Second is, can we give him medication? And so that's usually based on hormones, but it could be based on other things. So you get a hormone panel and you see if they're a candidate for that. Third thing is, there's something I can fix surgically. Third thing, something I can fix, varicoceles, blockages, infections, whatever. And the fourth is, well, you know what? You're going to need IVF or you're going to need IUI. So I think it is a failure when they go to IVF. That's how strongly I feel this. I mean, IVF is great if you don't have sperm in your ejaculate and if you're a cancer survivor, it's the only thing you can do. But in the, real world where people aren't, you know, not that severe cases, it's, to me, it's a failure. If we have to do that, then I failed. And I'd say, you know.
Speaker 1You're not saying it's a failure for the man or the couple you're saying you, for the doctor, for you, that you weren't able to help repair it.
Speaker 2Right. Without IVF.
Speaker 1Without IVF. Got it. So that's a good challenge.
Speaker 2I love it. I love IVF, but that's my opinion on it.
Speaker 1And most people, IVF gives them babies, but if they don't have to go through IVF, that's what they prefer. Most people prefer.
Speaker 2IVF is the only therapy in medicine. Where you treat the opposite sex for your problem.
Speaker 1Right. And just what you're saying is it's male factor and let's, let's, let's treat the female. And you're saying there's things that you can do to help the man. And we talked about diet and lifestyle and other ways to support the men. We have a, uh, another podcast, um, on men's health here by Dr. Olivia Poirier on spermageddon, where she goes much more into dietary therapy and supplements. And then with Dr. Turk, I will put in the show notes, how to contact him, his blog and his website. But he has mapping techniques. He has technology mapping procedures, and he has his questionnaire and he has a way to really look to see, as he said, he's looking to blame the sperm, meaning to put it into perspective, he's looking to find the issue that could be interfering with you growing your family. And so he wants to do a real thorough job. And Paul, correct me if I'm wrong, but what I'm hearing is you really want to work up the guy. So they don't need to do IVF because currently it's like, Oh, you have sperm problem. Let's do IVF. And you're saying we may be able to find the, the problem and a solution that doesn't require IVF.
Speaker 2And if it's a health issue, we can improve his health and teach him a different path because it is related to health. And I'm the founder of that whole concept. So, um, you know, one of my, probably that's probably my bucket list item I'm most proud of is after leaving academics, when NIH called a study section together and had people from all over the world talk about the biomarker concept and all my fellows were there and you know, the people I have on faculty, and I was still in a suit, you know, just a suit as a private practice guy, but man, when Lou DiPaolo stood up and said, you know, this, this meeting was inspired by a conversation I had with Paul Turk 10 years ago, when he said, I'm worried about what's going on with infertile men. We're finding some serious stuff going on. We published that their cancer rates were higher later in life. And you know, that's all epidemiology needs confirmation, but it has been published basic science suggesting the relationship. So it's, um, you know, there's
Speaker 1something larger going on here. Great contribution because that's the philosophy in my clinic is we want healthy people to be healthy. We want healthy people to be healthy. We want healthy people to be healthy. We want healthy baby, and we want healthy mom. And if a man is involved, healthy dad, and that's what you're talking about here as well as the healthy lifestyle and preventing
Speaker 2disease and death on their way to, for top foot in the door, getting guys who are infertile in for care and making it a good experience for them is the foot in the door. We've never had before for
Speaker 1their care, their general health, never had them. All right. Dr. Paul Turk, how can people find you? What's the best way to find you? Whether it's IG blogs and we'll put these in the show notes,
Speaker 2but if you kind of list them off for us, I mean, the site would be the turret clinic.com, you know, www the turret clinic.com. You can call us, uh, 4, 1, 5, 3, 9, 2, 3, 200. Um, there's places you can get your appointment online. You can just hook up with staff. We'll call you right away. We have very, very motivated staff to help out. And the blog is Turek on men's health.com Turek on men's health. And there's ways to connect. You should actually sign up for and just get it delivered every week to year. Just get it. It's a lot of fun. Four minute read should make sense to anybody. Usually women read it and then just print it out and give it to their husbands until they read this. But you know, my I'm very excited. The one that's coming out in February, I just wrote on a plane it's called, well, my son be infertile too. Will my son be infertile too? All right. So,
Speaker 1and where can they find that? Cause this, this is going to come out after February. So it will be out already. So Turek on men's health.com Turek on men's health.com or Turek blog on Google. All right, Paul, thank you. Once again, I always, I always enjoy our conversations. We've been doing this by the way, for years, everybody, the integrated fertility symposium, we've had you on our community lectures for the profession. You, you've been a great resource and it's nice to have somebody representing the other part of the equation when there are a man involved in creating this family.
Speaker 2Yeah, you bet. I think my, my tires are holding air.
Speaker 1His tires are holding air. So it's perfect timing. So he can get back into his Ventus car. What is it there? What is it?
Speaker 2It's a Alprom AOG TV from the seventies.
Speaker 1There you go. Still working.
Speaker 2But I've had it since I've had it for 35 years.
Speaker 1Awesome. All right. If you want to see what the car looks like, you'll have to go over to the conscious fertility podcast and you can see the video of this
Speaker 3interview. All right, Paul, take care. If you're looking for support to grow your family contact AccuBalance Wellness Center. At AccuBalance, they help you reach your peak fertility potential through their integrative approach using low level laser therapy, fertility acupuncture, and naturopathic medicine. Download the AccuBalance Fertility Diet and Dr. Brown's video for mastering manifestation and clearing subconscious blocks. Go to AccuBalance.ca. That's A-C-U-Balance.ca.
Speaker 1Thank you so much for tuning in to another episode of Conscious Fertility, the show that helps you receive life on purpose. Please take a moment to subscribe to the show and join the community of women and men on their path to peak fertility and choose to live consciously on purpose. I would love to continue this conversation with you. So please direct message me on Instagram @laurenbrownofficial. That's Instagram @laurenbrownofficial. Or you can visit my websites, laurenbrown.com and accubalance.ca. Until the next episode, stay curious and for a few moments, bring your awareness to your heart center and breathe.
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