Lorne Brown:

By 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 guest 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 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 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 microdissection procedures.

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 is 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?

Paul Turek:

Yeah, I have to apologize. I was planning to do this from my office, but my vintage Alfa Romeo has a flat tire and it’s raining in LA. So, there’s the car above me right there.

Lorne Brown:

Oh, yeah. It’s kind of a reddish color, I think I see.

Paul Turek:

That one, yeah. Right there. Anyway, I’ve had it for 40 years. And believe it or not, it’s Italian and 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, and I have a big commitment later, so I’ve got to get it fixed. This is a vintage car mechanic who does amazing work, he’s brilliant, and he’s the only guy I’ll let touch it.

Lorne Brown:

And that’s what 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 at fixing.

Paul Turek:

I treat them like mechanics, like artists. You find a good one and you pay them whatever it’s worth because they do a good job, and they do it once. So, I actually give them a book called Shop Class as Soulcraft, which is a book by Matthew Crawford, a philosopher, about the nobility of a stuck bolt. A lot of people think that small, manual labor isn’t cool, but 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.

Lorne Brown:

I am expecting that the majority of our listeners are female listening to this, but hopefully now that you’re talking a little bit about cars, they can share this podcast if they’re in a relationship with a guy, so they can hear about this. But I guess what I want to ask you is, it doesn’t seem like the men are involved a lot in reproductive health, 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?

Paul Turek:

Side dish. I would say that my two quotes, “Fertility is a team sport,” and, “Sperm matter a lot,” and we’re learning that very quickly as we know more about the basic science of sperm. It’s 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 and 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, it’s the one thing if things fail that you can actually work on. You can’t really work on eggs. IVF programs do a pretty good job in the lab, and it’s not usually a lab problem so you’re left with sperm.

By blaming sperm a lot, you learn a lot about them and you learn about how much they do matter. They do matter a lot, and I would call it half. I would say half the time. So, I’ll give some stats. If you’re a couple and you’re not conceiving at home, then you can probably blame the sperm 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 it goes up from there. If you fail IVF with donor egg, it’s a hundred percent sperm, right? So, you can crank it up, but it starts out substantially at around one-third and it goes up from there.

Lorne Brown:

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 development, then, based on the science and what you’re seeing now in the last two decades?

Paul Turek:

Great 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, and can contribute so that inseminations can fail because of sperm. And we know that sperm, not fertilization of eggs with sperm, but of IVFs, embryo development in a dish from day three to five when all the decisions are being made about the genomes mixing, that can be sperm-related. And failed blastocyst development. We think probably failure of making normal embryos that are biopsy normal at IVF, and certainly we now know that miscarriage either conceived naturally, IUI, or IVF can be sperm-related due 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 new science that’s developing, it’s going way beyond that.

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 at 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… Sperm matter because what you see in a sperm goes to the next generation, unlike a liver cell. So, if you have a problem with the epigenetics of your liver, which is the marks in the DNA are off, and 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 in sperm because it’s transgenerational.

Lorne Brown:

This is interesting.

Paul Turek:

None of my mechanics would know what I mean. None of those guys would know what I mean by that.

Lorne Brown:

Right. But reminding our listeners, so it’s perfect because we’re talking about male fertility, we’re talking about sperm, and it just so happens that this interview is happening inside a garage where he’s having his mechanic-

Paul Turek:

Vintage car repaired.

Lorne Brown:

Vintage car being repaired. And just like he’s taken 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 naturopathy acupuncturist or even the reproductive endocrinologist and they go, “Oh, the semen analysis, the shape, the speed, the count looks all good.” Is that still considered unexplained or is that semen analysis, if it looks within range, is that considered okay?

Paul Turek:

Okay, 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, a 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.

I published a paper recently that the semen analysis was normal, the history was normal, the physical was normal, hormones [inaudible 00:09:16] normal. 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 to social media and say, “Turek 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 Turek a year ago. What happened since then?” Two-thirds of them had had natural pregnancies. They were infertile for a year and a half, but two-thirds were normally fertile and another 20% conceived with IUI or IVF after that visit.

My statement was, “They had varicoceles, they had things going on, but I cleared them.” And the point was that’ll be the first paper ever published where I said to people, “I believe I’m right about this,” because I like to blame sperm, and there was nothing to blame here. And so I went that way, and it ends up that 80% had children, were pregnant and on their way just being cleared, not even giving them any therapy. I published it not as a, “See, I told you so,” 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. They can be right. They can be right.

Lorne Brown:

And so since women are born with all their eggs and men are making sperm all the time, I’ve heard it’s a thousand to 1500 per heartbeat. Is that a true statement?

Paul Turek:

Yep. Normally. Yeah.

Lorne Brown:

So 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 and supplements. 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-

Paul Turek:

That’s a nice sound.

Lorne Brown:

Yeah. You cleared these men that, reminding you guys we’re doing this interview while he’s in a vintage car garage.

Paul Turek:

A mechanic’s shop. Yeah.

Lorne Brown:

Yeah, mechanic’s 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, for example?

Paul Turek:

Yeah. I’ll say one thing even more philosophically and generally speaking, 30,000 foot view, 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 Fury. 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. So keep the air in the tires, get the gas in the tank, get the oil in the thing, get it tuned up, keep its weight down and it’ll run beautifully. And that’s that. Now, there are exceptions like genetic infertility where you’re handed less and 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, obesity, classic, right? I would say obesity is probably the reason everyone thinks our sperm counts are [inaudible 00:12:59]. Doesn’t mean we’re less fertile, but that’s probably what’s going on, because you only see it in developed countries where obesity’s going on. Another conversation. But you asked the question about a man who has a normal semen analysis and it’s unexplained.

Lorne Brown:

Or poor embryo development, they’re not getting to blastocyst or they’re having miscarriages. They can’t find anything wrong with her and her age is appropriate, 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?

Paul Turek:

So 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 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 the semen analysis. So I would call the semen analysis a blunt instrument and you 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 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 recreational drugs or a medication. For instance, a classic one is sulfur-based medications for IBS and things like that, like the sulfasalazine medications, semen analysis looks great and the sperm bounce right off the egg because they’re calcium channel blockers 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. You’re probably looking at a fertility specialist who knows what he’s doing to find that stuff, right?

Lorne Brown:

Prescription drugs, trans fats, like a really poor diet, not being well, overweight. Some people are working out taking androgens or testosterones.

Paul Turek:

Yeah. I mean, another one classic is ejaculatory abstinence, which can cause a problem. A lot of abstinence can cause sperm to be old. Anything that causes sperm to be old. So infrequent ejaculation, it’s not getting out. You don’t ejaculate from a 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 a pool is old and a person’s not ejaculating much, it stays old. So you do a little abstinence for two or three days thinking that it’s young, no. You got to do it for 8 to 10 times. It’s a lot more complicated than that. So that’s what I think about.

Lorne Brown:

I want to know if you still believe in this quote. I remember at one of our conferences at the Integrated Fertility Symposium, this is 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?

Paul Turek:

Yeah. So I was at the international fertility meetings in ’95, ’96, and it was about IVF. 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 testes cancer in Europe is a lot more common, early stage testes cancer, than America. But late stage cancers are more common in American. One of the differences between the European and US systems is that in America, women will go through IVF maybe one or multiple times, fail, then the guy comes in for an evaluation. And the day that came out from Keith Jarvey, that was around 23% of men get checked out by a competent reproductive… by somebody other than 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 tests cancer rates as European mean, but the European men in 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 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. And so they find their cancers early because fertility’s 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. 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 [inaudible 00:17:47], but IVF, because if you have a sperm count in North America, you’re going to IVF.

Lorne Brown:

If you have a poor sperm count, you’re going to do IVF.

Paul Turek:

Any sperm count. Any sperm count. You may or may not go to a urologist to find out it’s a cancer that caused it. And this really came home to me after that when I got back. I diagnose one or two testes cancers a year. The last one was a couple that failed two IVFs and they said, “Maybe we can fix your low sperm count.” They weren’t sent to me. They came to me on their own and I said, “You have testes cancer.” And it’s like, “Holy,” that’s not healthy.

Lorne Brown:

Now, you were talking about the health risk, as in men not being evaluated early enough and leading to diseases not being seen earlier. I was going to share with you 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?

Paul Turek:

Yes, exactly. 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. 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 forties. It’s not plaques, it’s something else endothelial function. But it was the first sexual health canary in the coal mine that was validated in several papers. So that brought me to the concept that maybe true of 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’ve 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. The questionnaire’s 200 questions and it’s pretty significant. That’s an old Mercedes back there, by the way.

Lorne Brown:

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, couple of things I want to ask about your practice-

Paul Turek:

By the way, I don’t do this all the time. I mean, it’s the first time this car has broken down.

Lorne Brown:

You said it doesn’t break down. That’s what I understand.

Paul Turek:

And it’s Italian. It is Italian.

Lorne Brown:

But you used to do consults in cars with men, too, did you not? You did it before Jerry Seinfeld.

Paul Turek:

No, I wanted to do it. I wanted to do it, yeah. [inaudible 00:20:35]

Lorne Brown:

Meet the guys where they’re at, right? In a nice sports car. It takes the pressure off to have the consult over there.

Paul Turek:

Yeah.

Lorne Brown:

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 workup.

Paul Turek:

I offered a men’s health tuneup to auctions in LA, in San Francisco, so it’s a tuneup and it’s a tire with a wrench. Usually the partners bid for it, and the guy comes in and we taught oil is testosterone. We do a tuneup on them. We check them all out. It’s really fun. It’s really fun. And women love it, and the guys actually like it. It makes sense to them.

Lorne Brown:

Right. You meet them where they’re at. That’s what I hear and 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 an artificial testicle? I can’t remember. Are you involved in that, about some type of apparatus to study sperm? Is that you?

Paul Turek:

Yeah, that’s what the NIH grant was for. 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 world class people-

Lorne Brown:

What do you hope to do? With this, how would this-

Paul Turek:

So the earliest cell would… if you don’t have sperm in your testicle but you have some of the earlier germ 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 can grow it in a dish. That is basically an embryonic stem cell for men. That is the equivalent of an embryonic stem cell. [inaudible 00:22:15] and I published that. It can do lots of things. It could 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 who don’t have sperm but have some of the earlier cells, we could take that cell, take it out, shake it out of the testicle, put it in this chamber, this micro-fluidic chamber and grow it. Well, we got to figure out why it didn’t grow. 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, Renee is the leading genetic male infertility specialist in the world who invented the Y chromosome deletion, she feels and I agree that there’s probably, of 2,000 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. It’s the master switch thing. So we’re going to figure out all 2,000, but basically focus on the top hundred, which will probably be 99%. And if we find that this spermatogonial stem cell is missing one of these important genes, that’s why it’s not progressing, then in a dish, you could add it with mRNA technology, which is simply off the shelf. You could make all the mRNAs, have them in a drawer and simply add it to the cell like you have a vaccine.

So CRISPR technology can be used to create these cells, mRNA technology can use to be modified 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 micro-fluidic 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, what 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’s 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 that testicle removed now because it’s going to form cancer or is it going to 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 ex vivo and you throw it and it forms a little tumor in the little device, you throw it in the trash can.

Lorne Brown:

Okay. And that’s why you want the funding for-

Paul Turek:

Yeah, I’m not stopping with this. Right. And I’ve got the dream team on it. 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 regulation. We don’t know what the FDA will think about this. We don’t know if it’s regulatable at all because it’s IVF, and IVF isn’t really regulated, but stem cell stuff might be.

Lorne Brown:

Now I want to take a turn to your mapping because that’s something, 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 most clinics currently doing and why are you excited about this procedure?

Paul Turek:

So back in the nineties… now, I like to get pushed against the wall because when I get pushed into the wall, 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 Schlagel, Peter Schlagel at Cornell has saw the same patients and we’re both kind of people who 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 [inaudible 00:25:54] have sperm in them.” And that’s called micro-dissection, testicular 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 testosterones and we 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 in things. And the person, Britmer 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.

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 micro-dissection does that. You open the testicle, you look for 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 noninvasive, so it’s done with needle aspiration, it’s diagnostic only. With micro-dissection, 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 is 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 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 for the Swedes is they were putting the people, girls or boys under anesthesia, and then sticking a needle to 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 in [inaudible 00:28:26] of 95 to 100% with procedures that don’t necessarily have to be micro-dissection 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 testes 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 test testosterone. I think it’s the bomb. I think it’s just a workhorse. 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 that can 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 I published a paper. We haven’t done a randomized trial to compare the two techniques. Schlagel and I constantly argue 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 do something else or take some medication.

So a couple of men last month, the maps were showed sperm, but very few, the rest of the panel 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. It’s fantastic what you can do with information. And micro-dissection 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 aren’t, what is there? Are there early spermatogonial stem cells there? Are there primary [inaudible 00:30:32] 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 this cell right now to make sperm in a dish,” boom. Call them up, say, “You’re on.” So it’s about the future, too, so you get great information going forward.

I can’t think of a reason not to do it. It’s powerful. 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 micro-dissections because we don’t know which ones better.” And I published it and the answer was if you failed a micro-dissection 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, they’re all templated, you can compare one or 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 doing a good job micro-dissecting 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, “Let’s improve, guys. We’re doing big things here. We’re doing herding testicles. Let’s do the best job we can.” I’m not trying to say anything’s better and it’s not. It’s not a randomized trial. I’m just trying to say, “Let’s constantly improve on what we do. Let’s just not sit there.”

Lorne Brown:

And so this is another noninvasive way to find sperm, especially for men that look like they don’t have sperm.

Paul Turek:

Right.

Lorne Brown:

On the theme of noninvasive-ness then for helping families 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. You talked about eating well, antioxidant therapy. So there’s things that guys can do that are very noninvasive, and then obviously there are some data on using acupuncture, Chinese herbal medicine, as well. Lots of noninvasive ways to do this. And sounds like you’re a fan of this noninvasive way of diet, lifestyle. Get healthy, keep your car running good.

Paul Turek:

Oh, absolutely. Absolutely. I mean, 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 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 behaviors.”

So when I seek 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 of you’re going to need IUI.”

I think it is a failure when they go to IVF. That’s how strongly I view this. 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 are not that severe cases, to me it’s a failure. If we have to do that, then I failed and I’d say-

Lorne Brown:

You’re not saying it’s a failure for the man or the couple, you’re saying you as a-

Paul Turek:

Failure for… yes.

Lorne Brown:

For the doctor, for you, that you weren’t able to help repair it.

Paul Turek:

Right, without IVF.

Lorne Brown:

Without IVF. Got it. So that’s a good challenge because-

Paul Turek:

I love IVF, but that’s my opinion on it.

Lorne Brown:

And most people, IVF gives them babies, but if they don’t have to go through IVF, that’s what they prefer. Most people prefer-

Paul Turek:

IVF is the only therapy in medicine where you treat the opposite sex for your problem.

Lorne Brown:

Right. And what you’re saying is it’s male factor and 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 men. We have another podcast on men’s health here by Dr. Olivia Pojer on Spermageddon, where she goes much more into dietary therapy and supplements. And then with Dr. Turek, we’ll put in the show notes how to contact him, his blog and his website. But he has mapping 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 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 problem and a solution that doesn’t require IVF.

Paul Turek:

And 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. 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 the people I have on faculty, and I was still in a suit, just a suit as a private practice guy, but man, Lou DePalo stood up and said, “This meeting was inspired by a conversation I had with Paul Turek 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 that’s all epidemiology needs confirmation, but it has been published basic science, suggesting the relationship. There’s something larger going on here.

Lorne Brown:

Great contribution, because that’s the philosophy in my clinic, is 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, is the healthy lifestyle and preventing disease and death on their way to fertility.

Paul Turek:

It’s a foot in the door. Getting guys who are infertile in for care and making it a good experience for them is a foot in the door we’ve never had before for their care, their general health. Never had it.

Lorne Brown:

All right. Dr. Paul Turek, 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, but if you could kind of list them off for us.

Paul Turek:

I mean, the site would be theturekclinic.com, www.theturekclinic.com. You can call us, (415) 392-3200. 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 turekonmenshealth.com, Turek on Men’s Health. And there’s ways to connect. You should actually sign up for it and just get it delivered every week to your, just get it delivered. It’s a lot of fun. Four minute read, should make sense to almost anybody. Usually women read it and then just print it out and give it to their husbands and say, “Read this.” But I’m very excited. The one that’s coming out in February, I just wrote on a plane. It’s called Will My Son be Infertile Too?

Lorne Brown:

Will My Son be Infertile Too? All right. And where can they find that? Because this is going to come out after February, so it’ll be out already. So where-

Paul Turek:

Yeah, so it would be turekonmenshealth.com.

Lorne Brown:

Turekonmenshealth.com.

Paul Turek:

Or Turek Blog on Google.

Lorne Brown:

All right. Paul, thank you once again. I always enjoy our conversations. We’ve been doing this, by the way, for years, everybody. We did the Integrated Fertility Symposium, we’ve had you on our community lectures for the profession. 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.

Paul Turek:

Yeah, you bet. I think my tires are holding air.

Lorne Brown:

His tires are holding air, so it’s perfect timing so he can get back into his vintage car. What is it there? What is it?

Paul Turek:

It’s an Alfa Romeo GTV from the seventies.

Lorne Brown:

There you go. Still working.

Paul Turek:

But I’ve had it since… I’ve had it for 35 years.

Lorne Brown:

Awesome. 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 interview. All right, Paul. Take care. Enjoy your evening.

Paul Turek:

Take care, Lorne. Take care.

Lorne Brown:

Bye.

Paul Turek:

Bye.

Speaker 3:

If you’re looking for support to grow your family, contact Acubalance Wellness Center. At Acubalance, they help you reach your peak fertility potential through their integrative approach, using low-level laser therapy, fertility acupuncture, and naturopathic medicine. Download the Acubalance fertility diet and Dr. Brown’s video for mastering manifestation and clearing subconscious blocks. Go to acubalance.ca. That’s acubalance.ca.

Lorne Brown:

Thank you so much for tuning into 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 choosing to live consciously on purpose. I would love to continue this conversation with you, so please direct message me on Instagram @LorneBrownOfficial. That’s Instagram Lorne Brown Official. Or you can visit my website, lornebrown.com and acubalance.ca. Until the next episode, stay curious and for a few moments, bring your awareness to your heart center and breathe.