159: What Men Need to Know about Sperm Health, IVF & Miscarriage with Mr. Jonathan Ramsay

So it has taken a very long time for us finally, almost to admit, rather than acknowledge that 50% of the problem, or indeed the success, must be resting with the male gametes as well as the female. By listening to the Coherence Code podcast, you agree to not use this podcast as medical advice to treat any medical condition, either in 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 the Coherence Code podcast, where we explore how the mind and body work together, so you can move from stress and intercomflict to clarity, calm, and alignment. My name is Lauren Brown. I'm a Doctor of Traditional Chinese Medicine and a Clinical Therapist. And through my work, I've seen that healing happens when you remove what gets in the way, and allow the body and the nervous system to do what they're designed to do to heal. Welcome to the Coherence Code podcast. Today, we're talking about the often overlooked half of fertility, sperm health. Male factor contributes to about half of infertility cases. Yet fertility investigations often focus primarily just on the woman. For many heterosexual couples struggling to conceive or even experiencing miscarriage, understanding the male side of fertility can be an important piece of this puzzle. My guest today is Mr. Jonathan Ramsey. He's a consultant neurologist who has spent more than four decades specializing in male fertility. His research focuses on sperm DNA quality, inflammation, the reproductive tract, the microbiome, and surgical treatments for male infertility. And just a quick note for our listeners outside the UK, like me here in Canada, when you see the title "Mr." before the name of a surgeon, it reflects a long-standing British surgical tradition. It actually signifies a senior consultant surgeon. So Mr. Ramsey is a highly experienced medical doctor and urologist. Mr. Jonathan Ramsey, welcome to the podcast. Well, thank you very much for that kind introduction of a moment. So we've already were chatting kind of, we're recording off the record and it was really interesting. So we had to get this intro in so we could start. And you know, when couple struggle with fertility, the conversation often focuses on the woman, even though we know sperm contributes half to the embryo's genetic. I always thought it's because reproductive manoecologist, organicologist, where you're a urologist, what's your take on why has the focus always been on the woman and not on the guy? Well, I think of course it starts way back in history, almost biblical, where an infertile union between a man and a woman was blamed or attributed solely to the female situation. So that terrible word baron, that is used biblically, biblically. So this it was just assumed that this was the way it was. And indeed, if we look back at the man who discovered the microscope, a von Lervenherg, it's a great story. He had a factory that made dresses. This is in the late 1600s. And in those days women's dresses had little glass adornments. So pieces of glass that were cut into crystal shape. And he noticed that when the sun came through the window and hit these crystals, it might start a fire as we, you know, the children boys will often use magnifying glass to get some leaves burning outside in the summer. And he thought, well, if I turn these, these baubles, these crystals round and orientate them, I might be able to do the reverse. And what did he choose to look at when he'd made the microscope, but his own sperm? Now here's the thing when he looked at the sperm with the head and the tail. He thought he could see the image of a man in the sperm, which he called a homunculus. And so it was thought from that moment on that the default position was male and that something happened in the womb when the sperm got in there to create a woman. So all everything that was known and written about was about effectively the supremacy of men in terms of creating fecundity or babies. And so it was a big leap for historians, for religious people, even for some scientists to take the view that men might be responsible alone equally as responsible. And then as you say, because fertility was run by gynecologists, because they were the ones who developed fertility units and IVF and X-EI before that, the word was with them. And because as you point out, they really only wanted to deal with women, with whom they felt comfortable and trained, so it has taken a very long time for us finally, almost to admit, rather than acknowledge, that 50% of the problem, or indeed the success, must be resting with the male gametes as well as the female. And that's what I want to really unpack today, not only explain that guys are contributing half the DNA, right? The Chinese medicine got this. This is why it was easy for me in my practice is it takes two to make a baby sperm and egg, and they both need to be high quality to create a healthy child. So both need to be healthy at the time of conception and also the period of time leading up to conception. After that, it's the woman she's carrying the baby. So with fertility though, as we unpack, I want to talk about testing, things guys can do, things were missing. But one of the things I had, Dr. Paul Turic on as an episode, and I think, I don't know if it's his quote or he got it from a study, but he often would say that the sperm or infertility, male factor fertility, was the canary in the coal mine for men's health. And because of your back and research, we're not just talking about, hey, can we make a baby? But if the guy's contributing to infertility, like we know he has male factor as a physician, are there other things that are a consultant? Are there other things that we need to let this couple know and the man know and even do further testing? If it is the canary in the coal mine and maybe if you can unpack what we mean by that term canary in the coal mine. Well, it's a great quote. And it is probably one of the simplest and most compelling markers of health for men. Easy to measure. Perhaps easy to measure in the laboratory. Perhaps not so easy to encourage men to produce the specimens of their ejaculate because it's all a bit upsetting and worrying and what might it show. And men aren't terribly good at being tested for anything. But if you look at men in general with poor quality sperm as measured by a simple analysis, then we know that the outcomes for their health throughout their lives will be reduced, reduced because they will tend to have more hospital admissions. They will have a tendency to high blood pressure. They will have a tendency to diabetes. They will therefore have all of those features of poor cardiovascular health. But it's more complex than that and probably relates to the DNA quality in their sperm because they will have more fractures, more accidents and their overall longevity will be significantly reduced. And this is a very recent study from Denmark where of course every healthcare intervention is logged so you can actually track a Danish person in their healthcare system for their lives. So a longitudinal study like this and there were 17,000, 75,000 men in this study, published last year, shows quite clearly that Paul Turex, lying about the canary and the coal mine, is absolutely right. So this is a big deal. It's not just about having a few to few sperm. It's not just about having reduced mortality. It is about the health of the individual and all the things that might go to influence his health, either genetically or as a result of his lifestyle and the environment. we should explain for those that don't get the proverb here or the canary in the mind is the miners would take canaries into the mind because they couldn't smell the gas and the canary would die and they knew they had to get out because there's danger. So in this metaphor, if the sperm don't look great, then there may be other things going on with the organism. It's a beautiful, again, concept in Chinese medicine, the microcosm and the macrocosm. And so the sperm is the microcosm by understanding the sperm. We can get it better understanding as to the man's help. So would you then in this idea if somebody has sperm quality issues, so they're going to be focusing on improving sperm, we're going to talk about that further fertility. But then do you look at metabolic health? Well, you run like, you know, blood sugar test, cardiovascular lipids, do you look at inflammatory markers when somebody has bad sperm knowing that these are the health risks they have throughout their life? Or is that something that the medical system should, if they're willing to pay for it? I certainly agree with the last statement, the medical system, physicians, primary care doctors should be very aware of this. I always look at a man's hormonal status quite closely because he will often find a relatively low testosterone or a relative increase in the luteus. A relative increase in the luteumizing hormone that drives the testosterone production. So there is often a hint that the spermative genesis, which of course is happening in the same place as angrogen production, is reduced alongside, not necessarily causation, but alongside a reduction in testosterone and all the things I was pointing to in terms of men's health outcomes. A lot of those, of course, as we know, are related to a relatively low testosterone as a younger man. And therefore, this man, as he gets older and to his late thirties, forties and fifties, is more vulnerable from having a demonstrably low testosterone, which by then may well be out of range and therefore contributes to all of those metabolic disorders. It makes me think of individualized medicine where medicine is going that it'd be nice if we had these tests done in your thirties, because that way, rather than comparing to the general population, we can start to compare yourself to yourself. So if you're relatively low in your thirties and we can see it continue to go, you can see that. Absolutely. The great thing about this simple observation related to thirtinity is that, as you know, in your practice, men can do a great deal, often with the help of their partners, to restore far better health and particularly better endocrine health, higher levels of testosterone. They attend to weight gain, to muscle bulk, to exercising without, of course, absolutely we have to say, resort to exogenous steroids. We don't want any of that, because that's a disaster. But men can do an awful lot to help themselves. And the first sign that they can start in proving their situation may well be when there's a failure to conceive in their mid-late 20s or even early 30s. And this is a moment, a classic, an important moment for straightforward lifestyle intervention. You mentioned 20s and 30s. Often, when we see people in our practice, they'll be coming into their 40s, 50s and beyond the age of the man. We focus so much about age of the female, of the age. What about men? Men definitely can father children until they die pretty much like we see that. But does that necessarily mean we're contributing quality sperm that will create that healthy child we want? Do we now see that age also impacts sperm quality in that if men are in their 40s or 50s or beyond, again, more reason to do lifestyle to try to give that sperm its best chance there for the child's health blueprint, that would be genetic impact on the child. I couldn't have put it better myself. The answer is absolutely yes. People, proper scientists, unlike me, have been looking at DNA quality of sperm and the outcome in terms of live births and the health of the next generation, particularly a great scientist called John Anderson, who's been looking at this for many years. And I think it is now pretty clear and generally accepted, just as you say, that after the age of 35, 36, 37 and onwards, the simple DNA quality of the sperm is measured by single strand breakage, the usual typical case for DNA fragmentation, this deteriorates and there seems to be a relationship to that particular deterioration. So not entirely dissimilar from the deterioration in egg quality and firstly, the ability to conceive. And secondly, the quality, the conditions that might affect the next generation, the offspring of that man with impaired DNA quality. Now I would love for you to talk more on this because the eggs, according to current science, how we understand it, women is born with all her eggs. So age and stuff, that's the age of that, that egg has been around for a while in utero. And I've been told that we make somewhere between 1,500 sperm or heartbeat. So when a guy is 40, it's not like that sperm is sitting around for 40 years in his body, but the system that's going to help with the maturation of the sperm is old, the four year old system. So I would think that men are easier to correct because we're constantly making new sperm. So for example, if you're a smoker, if you're overweight, if you have a poor diet, things like that could change. And then there's probably other interventions you can add. And therefore, if that system, the biological system becomes optimal younger, then the new sperm that are being made and then matured in that system, theoretically could improve greatly. It's a little bit harder to do it for females because it is that old that they, the egg has been there for 40 years. But the sperm, we're constantly turning over sperm. Can you, because so we have to differentiate that, it's a little different for the guys. So why is it that age impacts the sperm quality? Is it the cellular environment that's old, that's impacting it then? That's my thinking. Sure. I think you're quite right. So what's happening to the sperm in terms of relatively mild degrees, but significant degrees of DNA damage, not dissimilar to the DNA damage that happens with aging, which results in all kinds of conditions, a tendency to the earlier onset of some malignant conditions, inflammatory conditions, things as simple as using as losing skin quality. And so we're back to the canary and the coal mine. The breaks, the single strand breaks in DNA are very susceptible to lifestyle and age. And as you pointed out, in an organ as active as the testicle that is making hundreds of thousands of sperm per hour, then this single strand DNA breakage, which we measure in the standard test, it is something that will be very amenable to improvement. And of course, the amount of DNA damage that is acceptable, single strand DNA damage in sperm, it is really quite high. I mean, we tolerate quite high breakage rates in the sperm, which means that this is a naturally occurring process. But what we're doing by improving the lifestyle is largely improving our ability to repair those defects. So there are several angles, if you like, to actually strengthening that canary in the coal mine, making that canary a bit more resilient. And of course, the coal mine is a very opposite analogy, because in the coal mine, you are indeed surrounded by fossil fuels. And fossil fuels and their byproducts have an awful lot to do with everything. I want to talk about testing, but maybe we should go down that path first about the environment. So can you share, because you have a paper that you were showing me earlier years ago, I've been doing this since 2000. So I'm over two decades into this. And some of the under some of the IVF docs, the reproductive endocrinologist, when I would consult the guy to stop smoking, would tell the guy, don't worry about you can smoke, because you're seeing an analysis looks normal. Here we are many years later, what is the science now saying about the environment, not only we can talk about smoking, but how is sperm being affected by the environment? And I'd love you to be here. bring in, there's been stuff people seen on social media, sperms dropping by 50% from so many years ago, the drop in sperm quality or account, and the environment. I think it's important to share household products, the environment, what is it doing to sperm, or is it okay to just ignore that? So I think the point about the environment and fertility, it is largely about multiple exposures throughout life, where life is actually beginning at the time of conception, or even before. So it's about the lifestyle of the parents, which may be affecting both the quality of their gametes and their ability to conceive. But then it is about the environment to which the fetus is exposed, particularly a male fetus at a time in the first few weeks of this little fetus's life is crucially dependent upon the production of testosterone. And if in the environment, there are endocrine disrupting chemicals, then this is going to adversely affect the development of that fetus is go-mads. And then again, so there's a first head, if you like, that might have affected the sperm that went to make the fetus. Then the fetus is exposed by its, by via the maternal environment. And then the infant may be exposed to the external environment after birth, when again, there should be another testosterone surge. And then during adolescence, when testosterone again is important for further development, in adolescence, there's a further environmental exposure to the same toxic substances and endocrine disrupting organs, agents. And then of course, there may be weak gain and all the other adverse lifestyle factors might start to affect that developing adolescent and young man. So the difficulty with the environment and sperm and the development of the testicles is that it is a multi-hit phenomenon. Now, in order for all of these things to be relevant, it is argued and argued and it is probably true that a genetic predisposition, so some kind of genetic or epigenetic damage, which is pre-existing, then enhances and amplifies the environmental effects throughout life. So we've got a multiple environmental hit going on, serial, but we've also got an epigenetic or a genetic predisposition. And you put those two things together. And of course, this is a very powerful combination. And over the last 50 years, indeed, the simple measurement of fertility, which is with semen analysis, has shown worldwide a 50% decline. Now, I would relate that in part to a worldwide decline in fecundity or birthrate. But as soon as you say that, then of course, there are economic aspects that are also very powerful drivers, the cost of a family, some couples choosing not to start a family, the eight maternal age at the start of the fertility journey because of again, economic consideration. So it's quite difficult to relate the environment to fertility rate. But I think we have to all accept that we relate the environment to a declining sperm count. And probably therefore, for the reasons described, declining sperm quality. And there's something you can control and something you can't, our water, our air, but you know, there's filters. But I think of things like in our practice, we like to use glutathine in our IVs because it's such a good detoxifier mother, the mother antioxidant, just antioxidant therapy. But again, it's choosing more clean foods being cautious of what kind of bottle you're using the plastics earlier when we were off kind of camera, you were sharing that they're finding plastics in, is it in the testes or in the seminal fluid or both? Well, the the metabolites of plastics and of particularly of rubber particles, which are much more prevalent in the atmosphere than they used to be in there. For of course, get into the atmosphere and end up in the sea. And metabolites of phallates, of bisphenols, bisphenol, they used to be a, b, but now we got bisphenol s. So all of these metabolites have recently been found in seminal fluid. And if we add to that, the findings of microplastics all over the body, whether it be in the the plaque, the deposits of fat that that line blunt vessels, which means that they are ubiquitous or even in the substance of the testicles, once you're saying the plastics are getting in and the metabolites of those chemicals are within the body fluids, then one is beginning to get to the point of causation, rather than where we've been stuck for many years, which is a very strong association. You know, a small tangent about what you're sharing about the epigenetics in Chinese medicine, why I was so drawn to it? Because there's so much wisdom there. I can't be certain on this on it, but I'm pretty sure in the classics, they talk about that the lifestyle, the woman and the man will impact seven generations. So that's, that's 2000 years ago. Now we know for at least three because the grandmother, the mother and the daughter, that that's all we know that when somebody is a woman, when she's carrying her daughter, the daughter is carrying the granddaughter, like in one person, there's three generations. We least we know from science is three, but I'll share that Chinese medicine says what we do now impacts seven generations. I don't know how they know that, but it's something that's documented. It makes me think though when you talk about these plastics, do we know then they act as endocrine disruptors? It's one thing to say we see them in the testes or in the seminal fluid, but have we shown that this then does cause sub fertility in men? Or is it just something that's in the in the in the semen novel, but has no impact? Once again, we can look at the quality of the sperm in the man who have these substances, but certain levels and nobody really understands yet the cutoff because the publication that you and I were talking about is extremely recent. And there is another publication that is suggesting the same thing, a big, big publication from some researchers in China, where the interest in this topic has been much broader and indeed deeper than in other countries. So we can relate the presence of these compounds and their metabolites to semen analysis, but it will take a bit longer to be clear about the relationship, not only to fertility and what it might take to create live births in these men. And as you correctly point out, the health of the next generation. And so it makes me think that regardless, it's like, you know, somebody wants to run a marathon, they train before they run the race. If you want to have a child, women already are active getting healthier usually before they try to conceive, but it seems like men also would benefit through diet, lifestyle, losing weight, stop smoking. You need to if you want to have your have your child have the healthiest potential, because you're setting you are setting the health blueprint of your future child, at least three months before conception at the time of conception, if you're the male, you're participating, which we call now epigenetics in science and Chinese medicine, they called it preconception, prenatal, prenatal, cheat, is what it was called, or prenatal, gene, that's epigenetics. But this makes me go into the testing part. So many heterosexual couples, when the male does a semen analysis, they assume it tells the full story, you know, they're looking at the count motillium morphology. But we know that heterosexual couples where the man has a normal semen analysis can still struggle with infertility. So they become designated as unexplained infertility, or they even sometimes conceive, but quickly miscarry. Are there limitations to the standard semen analysis? Absolutely. So the case that you point to, which is, of course, styled in fertility units, as unexplained in fertility, where there may be a normal, or indeed very near normal semen analysis, where really this should have been associated with relatively easy natural conception. I think that there is increasing data to show a very clear association in maybe 20% of these normal seamen analysis cases called unexplained, which actually is due to the DNA quality of the sperm. And so a straightforward seamen analysis, even when it's normal, may not be helpful. And it's got to be looked at in the context I think when I see a couple of two things. Firstly, should this couple of conceived? How old is she? And if she's under 30 and he's got a normal or near normal seamen analysis, they should have conceived. There's something the matter here. And the old wisdom, which was there that are try harder, you know, it'll come right. I think we should not be giving that advice any longer. And then the second, very important pointer. To a possibility of disturbed male fertility is the again, usually younger couple who conceive relatively easily, naturally, but who then have early miscarriages. And it really was believed. And to a certain extent still is believed that this business of miscarriage was purely a female issue. And I think the time has come for us to reexamine that statement because we know that when our gynecological colleagues have really thoroughly investigated, a woman who may have had three miscarriages or more, they thoroughly investigated her. They find no abnormality in terms of endometrial receptivity or the other female factors in 50% of those women. So that does beg the question after three natural naturally conceived miscarriages. If you don't find anything wrong in 50% of the women, 50% should be a little signal. It should be sending a little sign that perhaps that could be to do with the male factor and the DNA quality of the sperm. And it seems again, I'm quoting data and evidence that there is a strong association between double stranded DNA breakage and these recurrent early miscarriages in the presence of the normal seminar analysis. And so I think of the cement analysis often as it's the contents of the book. You've opened up the book and looked at the contents, but you haven't read the book. And then there's other tests where you're now reading looking at the DNA. So we'll talk about DNA fragmentation test. And the other thing I want to ask you from your experience, I'm going to pull on Paul Turic when I interviewed him and this is jumping around to the varicose seals. But when a guy had issues and he likes the like the DNA epigenetic type testing and DNA fragmentation. He said that theoretically when we do these interventions, we should see an improvement within, you know, at least 90 days, one cycle sperm agenesis 72 90 days. But he says, interestingly enough, clinically, it sometimes takes two cycles. So when he would do a varicose seal repair and they retest the sperm three months later, not great improvement yet, but six months later, he would see great improvement. And I'm curious because so when I consult patients and they're doing all these changes, I tell them do this, but don't just do it for three months, you really to give it a chance. Let's see what happens over six months of falling these new changes dietary supplements, all these things. And you see it also sometimes takes two cycles of sperm agenesis and varicose seal repair is the perfect one because they have the issue usurgically repair it. They no longer have the issue. It's not like we're taking time to lose weight, for example, right. This is, you know, immediate. So can you unpack that a bit for us of why it may take six months versus three months. And I should ask, have you seen that because that was something in the interview, Paul Turic discussed. I can say I entirely agree with with Paul over this. I think that the three months has become a bit of a law, not an L A W, but an L O R E in fertility treatments. And I think that it often and probably more often than not takes more than the three months and the one cycle for sperm agenesis is something that gets fixed in the minds, certainly of doctors, but, but also of the patients because they want a resolution. And often when one's working in cooperation with the fertility unit, then particularly the female partners worried about her age will be booking the next treatment after one sperm agenic cycle. She will be making the bookings 70 days to the day after the guys had his varicoseal treated. And then of course there's terrible disappointment when the next cycle doesn't work or when there isn't the sort of improvement that one might expect both in the semen analysis and in the DNA fragmentation. So I say to my patients that we should be seeing in some improvement at three months, but you're not going to be at your best until five six seven maybe even eight months. Of course that business of being at your best slightly depends where you're starting and how much lifestyle change you can make in addition to having the varicoseal treated. But I would agree with Paul that generally speaking it's longer rather than shorter. Now of course the other thing about this is that with varicoseal repair you even large varicoseals you don't sometimes see the sort of improvement you would expect. And so be interesting if Paul were here too. So you've got a big varicoseal one that you can actually see let alone measure with ultrasound. And you look at this guy with perhaps reduced numbers bit of reduce mate to the team or apology round about one or two percent. And you think to yourself I can make this guy better and you look at the DNA fragmentation and it's raised and you think to yourself I'm sure I can make him better. But in fact it is only recently that we've been able to look at this double strand DNA breakage because if he's got that then we are far less likely to make him significantly better just by treating the varicoseal. So in my practice I am beginning to look at both types of fragmentation to better predict which of the men will are expected to be better because those ones who didn't get better despite treating a big varicoseal properly. Then they're the ones I think that we should be extending the extensive tests a bit further to learn more about what actually is going on in the sperm because as you point out the sperm they are merely carriers of the DNA material. And of course you need a decent delivery system but of paramount importance is the payload of those little sperm vehicles. So what are the extra testing and I know sperm DNA fragmentation are all tests equal with DNA fragmentation because I'm kind of here for the first time there's two types of things that you're looking at like you talked with the double the double spindle I think you were sharing with the DNA. So can you go into testing because when somebody has a normal seam analysis unexplained infertility diagnosis for current pregnancy loss. We often will look at the microbiome will look at issues if they have other health issues we look at that got microbiome so we're looking at other things that can be impacting their overall health will look at some inflammatory markers. Can you talk a little bit more about what this sperm DNA fragmentation test is testing. Okay. So I think the other tests that are helpful let's start with the cheapest and the simplest. Okay. So if we look at we can easily look at the levels of oxidative stress in seminal plasma and this is looking at the oxidative versus the reductive chemicals in the fluid. Sometimes this test is referred to as the reactive oxygen species and sometimes it's a redox test and the communist one of those is called myoxys. So this is not expensive and it gives us some idea of the levels of oxidative stress which can relate to lifestyle which can also relate to to varicoseal. But generally there is a pretty clear relationship between oxidative stress and single strand DNA damage that's the sort of damage that we were talking about earlier which is happening really all the time and the body's repair mechanism. are treating this. So I get a seeming analysis on a level of oxidative stress because if I know that there's oxidative stress in the seminal plasma, then I know that there must be something else going on. This could be heat stress. It might be gain due to lifestyle. It might be due to an inflammatory process. There may be some white cells in the seminal fluid. So all of this little package of events with oxidative stress is telling me that something is happening to the sperm probably after it's been produced. And I've just got to look for it and try and treat it and we should be able to make this bloke better. Now if he hasn't got oxidative stress and I've examined him and he hasn't got a varicoseal and there is nothing really to suggest in either party that they have had overt inflammation of their gentle tracks. I'm beginning to think to myself, if you've got a bad fertility history and your seeming analysis isn't too bad and you don't have oxidative stress and you've not got anything in your story that suggests an inflammation of the prostate or pelvic inflammatory disease or an having like that and you don't have a varicoseal. Then I might want to know whether you've got double strand DNA damage, which is a much more subtle thing, but is a function of the process of spermatogenesis more than what might be happening to the sperm after production, which therefore to a certain extent may be correctable. So this is entirely new. The availability of these tests is reduced. The cost is more than an ordinary single strand breakage test, but in circumstances where you are not explaining the unexplained, then I think it is a useful test. I've often heard and I never really totally understood this that it used to be when they did a DNA fragmentation test, the recommendation be IVF, right? And I always thought, well, if it's the DNA issue, how does IVF fix that because you're putting the DNA into the egg. And so I would think that there must be something that walks with DNA fragmentation that's causing the infertility naturally that yet IVF bypasses. And this is just me asking you from your experience, why is it if somebody has DNA fragmentation, at least the single one that IVF would fix that if it's the DNA. Okay, so I think it probably you're absolutely right. I think it's probably the things that go with it. So with single strand DNA breakage and high levels of oxidative stress, all those things that you're talking about will of course improve the thing, but in the days before we took any notice really of lifestyle or indeed much of antioxidants. Then we were getting beyond the time often in terms of time, lapsed that there was going to be enough sperm for this lady now in her mid 30s to get pregnant naturally. And so there was an assumption that it had to be XC bearing in mind that in those days we're thinking even five, six years ago, then the accent was not on lifestyle. Because it was genuinely thought that you couldn't do anything about male fertility, but that XC would fix it. So the reason why what you're describing is because XC, I think, became a self fulfilling prophecy in men who probably had we started early enough could have been improved to the point of natural conception. Of course, that's not true when we've got a severe oligospermia. So we've got we've got something running in parallel with the oxidative stress and the DNA breakage. So I think it it has come to be written that XC solves DNA fragmentation. But I think is any come to be written because nobody trying to solve it before the XC right and we talk earlier if your goal is healthy child, you'd want to do all these things before the XC to give your child the best health blueprint and theoretically if it's not like he said severe County issues or something more severe that often when you do this. If you correct the fragmentation, you'd be able to conceive naturally so a couple hundred dollars in hiring a trainer, maybe a dietician taking some supplements is a lot cheaper than an IVF cycle and your wife would not have to go through IVF. We don't forget that right if it's the male factor and the woman's perfectly fine healthy, she's the one that takes the brunt of the treatment surgically and medically. But I, you know, in my long career and association with my colleagues in fertility medicine reproductive medicine and the gynecologist, it's very easy for us, the two of us who have spent a long time looking at all of these lifestyle issues and the reasons for unexplained infertility is easy for us to to try the gynecologist and possibly accuse them of being too keen to do IVF and XC particularly XC. But of course they have brought millions of couples, the joy of a baby. And it wasn't that they were doing anything wrong because after all when a woman gets to be 35, 36 or older, then the state of her eggs is becoming critical because only half of them are not able to do anything. And then the other two of them are going to be chromosomeally okay. And therefore it wasn't just an excuse that the gynecologist were using to do XC because if you unpack what they were actually doing, they were taking a year's egg production maybe in one hit. And then at the same time there was a problem with oxidative stress and single strand damage, at least they were getting what they had selected to be the better sperm into the available normal eggs sooner rather than later. And of course the rationale from that and it's only you and I have been interested in doing what we're doing who can take a different view because after all the data that says that XC works with poor DNA fragmentation is very old, it's historic. And if the two of us are being honest about how long we've really thought that we've understood this and have worked with men, it's not that long compared with the history of XC which is now, you know, as we were speaking earlier is now in excess of 30 years. I would like to ask you stuff about just because the science behind us the evidence because that's that's your medicine you're a consultant you're a mister. So does weight and metabolic health impact sperm quality therefore miscarriage risk or unexplained infertility what about smoking alcohol, die heat exposure can we just touch on each of these. So the understand what's what's happening and why the first thing to the statement the opening statement has to be that the doctors all of us quite rightly are more and more interested in an evidence base for what we do. And therefore those two words evidence and base have become extremely attractive they've become the new currency of medical practice and that is quite right and proper but of course evidence as opposed to data is really difficult to get in the context of fertility. And I would suggest almost impossible when you cannot make a clear diagnosis now why can't you make a clear diagnosis it very difficult to make a clear diagnosis when unlike any other disease state in an individual you and I are dealing with a couple. So there's another set of variables which is extremely difficult to control for and then we're dealing also with a condition an absence of a baby infertility which once again may have a basis in either partner or both and then we're dealing with a condition infertility which is very much open to as we know. We know lifestyle changes and therefore there are variations in the condition which may be happening unknown to the observers unlike a condition like rheumatoid arthritis, even psoriasis of course all the malignant conditions which have a progression and a natural history which isn't dependent upon anybody else. really dependent upon external factors. So it's really difficult for us to talk about evidence. We've already been talking about how variable and ill-defined semen analysis is. So really, when it comes down to it, the only real measurement of fertility is fertility. That is a live birth, but you may have to wait for years to get that. And the attention span of a researcher is often not long enough to really understand what interventions resulted in live births. So I say to my patients that evidence is a very slippery phenomenon in fertility. Data, we've got loads of data, and I think what we need to do within our profession is to ask the right question. Now, we've been asking the wrong question the whole of my professional life. It's not an unreasonable question, but when faced with a couple, the question that we've been asking ourselves and they've been asking us is how do you make it better? Now, if that's the only question you ask, then inevitably you just throw things out in the fertility unit. You try this technique for sperm selection, that one, the other one. And therefore, we're not really doing this in a scientific basis, but then we ascribe evidence to our results, which is inconsistent. The reason we get ourselves into this mess, I think, is because the question we should have been asking is not how do I make it better, but why did it go wrong? What was it about this sperm and this egg? Let us work hard to try and understand that, because until we do, we're not going to get real evidence. We're just going to get more and more data. So I'm the first to admit that much of what I have wanted to call evidence-based practice actually hasn't been, because I haven't known what it was that went wrong. So do we know, from the data and from what do we know that's gone wrong? Because I know in preparing for our meaning that you've talked in the past about metabolic health and weight, smoking is a non-negotiable. But, well, I think the data tells us pretty clearly that all of the lifestyle is used, and we can extend those beyond smoking into vaping, I think. But we can, I think that the data is telling us very clearly that we can make a big difference to male health and therefore to male fertility. And I have no doubt about that. And all of that stuff, given reasonable sperm adogenesis, should result in fewer runs of IVF and XC and more natural pregnancies. And if I could go out and make a big play for world fertility and therefore at a microcosmic level, couples happiness, I would cease to spend so much educational time with teenagers telling them how wicked it was to get pregnant, but actually start to explain to them when it is best to think of starting a family. Don't leave it too late. Look after yourselves guys. It's 50% male. And I think a little bit of that, rather than concentrating on how wicked it is to get pregnant, might go a long way to helping the cause. Thank you for that. I have questions that people, patients, wanted me to ask you, as I told them I was going to interview. So, are you up for a couple, almost rapid fire session as we come to the end here. So, one was about fevers and illness and hot tubbing. They wanted to know what happens. I use a term heat insult, but what happens if a guy has a high fever of an illness or they have been hot tubbing? The question they want to know is they've heard it can impact motility and potentially even count. But how after or how much time did the need of delay trying to conceive? Like, is it right now that the sperm is not great for the next couple of months? Or is that heat insult going in packs sperm three months from now? So, if my husband had a fever, do I have to wait three months before we try to conceive again? Or should I start trying now because in three months it's going to show up. Okay. So, it's an extremely good question. So, let's take the easier one first, which is the effect of heat. Because of course, we can actually measure that situation much more accurately because we know what temperature the testicles prefer, which is three degrees centigrade below core. So, if we think about a hot tub, we think about water that feels pleasantly hot. Then we can measure that temperature and we know that it's probably 38-39. Those are the temperatures that showers get set out and and bath water, partially to prevent people burning themselves. But if the testicles like three degrees below core and core is 37, then actually, once we get up to 38-39, there will be an acute effect. And so, I say to the people who use hot tub regularly, that they really ought to desist from this for a few weeks and they will begin to recover. So, I think that's a more acute effect than maybe the fever. Because the fever, it's not so much the temperature, which of course will have a similar effect, but it's also all the cited kinds that go with that. So, there is a chemical disadvantage to having a fever. And then there is a further possible disadvantage to having a fever, which is why you've got the fever, because we thought up until COVID that there weren't very many viruses that actually got into your testicles. But then with COVID, we began to realize that possibly you could have a viral effect, so a direct effect of the virus. So, irrespective of the fever, without having any testicular symptoms. So, I think that the fever issue is more problematic, because that, depending upon its cause, may have actually impaired transiently spermatogenesis itself. So, it's not just an effect of the heat on the quality of the sperm, of the cited kinds on the quality of the sperm, but it may be, depending upon its cause, an effect of the virus itself. So, I think that the issue of virus and fever, what I do is I say, well, let's look at your sperm, if they're coming up to a cycle, I say, let's look at your sperm now, both its simple quality and the DNA frag to see if you're okay to go, no. Thank you for that. That's great information. And yeah, on that, any, is there any data you're familiar with? So, I'm using the word data, purposely versus evidence, data on COVID impacting, for nail fertility, do we know that? So, we certainly know about the acute effects, because there were opportunities during the first and the second wave of COVID to understand how that spike protein actually affected the seminiferous tubules, so the production lines for sperm. I think, now it is more difficult to know, because of course we've got COVID everywhere, but we're not able, so easily, to test for it, and we're not seeing the sort of cases of such severity that we're able, actually, as we were, in the first wave, to look into the testicles, because these poor people succumbed. So, in my practice, which is probably the best answer here, I'm very careful about viral illnesses, because I've now understood that whereas before we thought, well, if you've got the mumps virus, of course that would damage your testicles, because you had a great big swollen, painful testicle, but now I'm much more wary, and again, having seen myself, men, without any testicle symptoms, tested positive for COVID, had five, six days of illness, and then their semen analysis really was substantially affected, like, you know, 30, 40 million to five million, and you could only observe this if you were actually practicing, as I was, through COVID. Thank you. Another question from my beautiful patients, they want to know both these ad-homes sperm tests. I wasn't able to answer this, and the Sparkphone apps, are they helpful to analyze the sperm? Are they useful yet? I think anything that increases a man's awareness of his situation and allows him to be a bit more comfortable about doing the tests is good. Now having said that, then you certainly there are erroneous results. And perhaps one of the biggest difficulties with home kids is their unsolicited use. So the company that makes them will find it very difficult always to have a full picture, a clinical picture, a fertility history that surrounds a one-off test. So whilst there may be benefits of knowing rather than not knowing in the broadest terms, we have to be very careful that we don't get a result which out of context seemingly means much more than it actually does. So I worry not so much about the nature of the test because you can argue about whether the preservative they put in it is damaging motility, whether these tests are as good as tests that are done in a laboratory by a person or even in a laboratory by a computer aided. Although one can argue about that, I think once just when men are ordering or getting home tests, they must be very careful, I think, to have somebody to interpret it for them in the light of their history. Otherwise it causes more harm than good. And the other time it causes more harm than good is when men who like to fix things, we all like to fix it, it's in our power and we can get a bit obsessional about things and we can end up doing our home kids every three or four days and driving ourselves bonkers. So there are caveats about it and it's largely about where is the medical or parametrical advice to help you through your results? Yeah, that's no different than the women that use the at home apps or the basal body temperature can become obsessive. I'm assuming one semen analysis, if it's poor, you'd want to repeat it a couple times to confirm that. If it's good, I could take it as good, but you're the one with the decades of experience. If somebody has a poor versus a good, do you get them to repeat? If time and money wasn't an issue, would you like more than just one semen analysis to evaluate the man? The answer that is absolutely. And I would never encourage a semen analysis without understanding the full fertility history so that I could see the whole thing in context. So do I think in general it's okay to do home semen analysis in general? Yes, it is providing there's somebody overlooking it. Do I think that one semen analysis, whether done at home or anywhere else, is useful? Most of the time it isn't because most of the time in our patients, there's likely to be a bit of a problem. The number of times you see plumb normal in a patient who has had calls to do this is relatively rare. Although, certainly in my UK practice, I am beginning to see a few people before they've even tried. That's good to hear. The last question I think is a big question, but I have you here, so I'm going to ask it. If a couple is preparing for IVF or trying to conceive naturally, they're interested in what the male partner can do for the next few months to improve sperm quality. So what would you be counseling the man to do? Well, I suspect, lo and exactly what you'd counsel him and you probably doing better. So are you integrated then with like, do you have nutrition? Have you ever worked with acupuncturists or herbalists? You're curious what your what your practice is like? So I work very closely with nutritionists because I'm a believer. So I think that the biggest statement to the man three, four months after he wishes to conceive, so the preconception advice is I say to him, you just stop eating what you enjoy, processed foods. You don't have to go on the wagon, binging is a thoroughly bad idea. We're talking alcohol here or food. Well, both. Both. And often the two come together. We're taking it as red that's smoking any kind of smoke, whether it be tainted with cannabis, nicotine in a vape because it's heated vapor, but above all else tobacco is right off the menu. And then I say to them, so if you do these things and you begin to lose a little weight, don't go mad in the gym, don't wear light crap and sweat for an hour, but just go gently and you will begin to feel better. You'll feel different. And you'll start to sleep a bit better. And you'll say to yourself, perhaps I don't need all that that caffeine in the morning. I just don't. And certainly in the health drive, he will have astute powerful sugary drinks. And I'll say to him, just think about plastics. Just think about food that could have been cooked in plastic. Just think about the plastic linings in cups and tins. And then as one explores the plastics issue, you want to drink out of glass. You want to think about where you could be eating things that have been so processed that bits of other plastic that have gone into them. And so, and with all of this, I know that if they can do this, they will feel better. They'll see the benefit. And then they'll go on doing it. And I'm out you've alluded to it earlier. I'll add to it for the when they're going to the gym, not to take exogenous testosterone to help them bulk up. So careful supplements for weight lifting. If you're going bald, if you're taking a drug to help your hair grow, you need to talk to your hair, your healthcare provider, because some of those can impact. So careful the drugs you take, the supplements you take. Well, I absolutely agree with you. I mean, I will give further. I don't say talk to your healthcare provider because they may have a vested interest in the hair growth supplements. Really, it's a question of just don't just don't do it. And topical things, of course, can can be absorbed very easily, as we know, not just from the scalp, but some of the cosmetics, as I'm sure you know better than I lawn, a full of parabens, which once again can disrupt your end and end system. So there's quite a lot of stuff that you can stop with benefit. So diet lifestyle, and do you encourage or would you recommend antioxidant supplements, you go to that level or you just do diet lifestyle? So I do tend to use measuring the oxidative, the levels of oxidative stress as a guide, because coming back to men who really want to fix it and can be a bit obsessional, I worry that if they start off without levels of oxidative stress, they can take too much antioxidant and then cause reductive stress, which might have the same impact, damaging impact on their DNA. So if I, if they're already taking an antioxidant, then I say, do you know, overdo this, you know, just, just take one and only one and and don't add a little bit of this and a little bit of that, but I always feel happier to actually measure their oxidative stress. So what people want to learn more about you, if I know about your clinic, your website is Jonathan Ramsey dot code UK. We're going to put into our show notes. Is there any other place where people can find you? We got your website. You know, do you have social media or any place we want to direct people? They want to read your papers and learn more about you. Well, I don't do social media. Okay. That's another good health advice. Well, it's a good place to say that the websites are good place. Okay. And my PA Allison's address is on that and you know, I'm quite get atable, but not social media. Right. And where are your clinics? Where are you working out of in the UK? UK is a big place. Where are you? So I'm in London. Okay. Mostly. And I got another clinic where we actually do a lot of testing on site just to the west of London in a place called Beckenfield. So they're two venues. Excellent. So we've been listening to Mr. Jonathan Ramsey. He's a consultant neurologist specializing in male fertility and investigations and treatments. Jonathan, I really appreciate you making the time to talk to me today and share this with our audience because it is one of that the groups when it comes to fertility men have seemed to be underserved under diagnosed under treated and education is one of the way to kind of switch that. And so thank you for your decades of clinical work and again coming here today and sharing this information. I really appreciate it. Lauren, thank you very much. We've had a good conversation. Thank you. Thank you. for spending this time with us on the Coherence Code Podcast. I'm Dr. Lauren Brown, and I will see you next week for another conversation on Coherence and Healing. If this conversation resonated with you, please like, subscribe, or follow the show, and also share it with someone who might benefit from it as well. Remember to take a moment to breathe, reflect, and stay connected. [Music]