June 5, 2026 • 37 mins
Male infertility affects nearly 50% of infertility cases yet so many couples still believe fertility struggles are “a woman’s issue.”
This Men’s Health Awareness Month and Men’s Mental Health Awareness Month, we’re breaking the silence around one of the most overlooked conversations in reproductive health: male factor infertility.
In this powerful episode of Cry It Out Loud, we sit down with Dr. Russell Hayden, male infertility specialist, microsurgeon, and urologist at Shady Grove Fertility, to answer the questions so many couples are desperately Googling — but rarely talking about openly.
We dive deep into the science behind low sperm count, azoospermia, sperm DNA fragmentation, testosterone, varicoceles, lifestyle factors, recurrent miscarriage, IVF, ICSI, and unexplained infertility while also unpacking the emotional toll infertility takes on men and relationships.
Because behind the lab results is often a man silently carrying shame, pressure, grief, and mental health struggles no one prepared him for.
In this episode, we discuss:
• The most common causes of male infertility
• Why sperm health matters more than many realize
• DNA fragmentation, recurrent miscarriage & embryo quality
• Low testosterone myths and fertility misconceptions
• When men should seek fertility testing
• Male infertility treatments, surgery & IVF options
• Men’s mental health during infertility and TTC
• The emotional burden men often carry silently
Whether you’re trying to conceive, navigating infertility, IVF, recurrent pregnancy loss, or simply want answers, this episode is one every couple should hear.
Because infertility impacts families and men deserve support too.
Hosted by Chasing the Rainbows, a 501(c)(3) national nonprofit providing free daily support for infertility, pregnancy loss, infant loss, and pregnancy after loss.
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Episode Transcript
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(00:10):
Crying Out Loud, a podcast by Chasing the Rainbows with your
host Bernice Quisenberry. Today we're diving into a topic
that is often overlooked in fertility conversations but is
(00:31):
responsible for nearly half of infertility cases, and that's
male factor infertility. Joining us today is Doctor
Russell Hayden, a urologist who specializes in male infertility
and microsurgery at the Center for Male Fertility at Shady
Grove Fertility. Doctor Hayden's path to
reproductive medicine began during his graduate studies in
(00:52):
biomedical engineering at Johns Hopkins University, where he
became interested in the intersection of technology,
precision medicine, and creativeproblem solving.
He went on to earn his medical degree from Harvard University,
followed by residencies in general surgery and urology at
Massachusetts General Hospital. He then completed a fellowship
in reproductive medicine and microsurgery at Weill Cornell
(01:14):
Medicine, one of the leading training programs in male
fertility. His work focuses on diagnosing
and treating complex male infertility conditions,
including sperm retrieval procedures, advanced
microsurgical procedures that often involve operating under
magnification as high as 25 times finer than a human hair.
(01:36):
Doctor Hayden is a member of several leading medical
societies, including the American Urological.
Sorry, as I butcher that association, the American
Society for Reproductive to Protect the Medicine and the
Society for Male Reproduction inUrology and his he has published
research on a range of topics related to reproductive and
(01:57):
health. And Doctor Heaton, thank you so
much for being here and sheddinglight on part of fertility that
many families don't fully understand but plays a crucial
role in building a family. My pleasure, happy to answer any
questions you have. Fantastic.
Yeah, we have a lot from our listeners, from our lost
parents, so we'll just dive right in.
Many people, you know, still assume infertility is primarily
(02:19):
a woman issue. From a medical standpoint.
How often is male factor infertility contributing to
difficulty conceiving? Oh, it's much more common than
we all originally anticipated. And I always like to say it
takes 2 to tango. Each person is contributing 50%
of their DNA. There is definitely a factor of
(02:42):
sperm quality that goes into embryo development.
I am a firm believer in that andI think it's reasonable to say
that male factor is going to be 50% of cases.
Absolutely. Well, even, you know, between
the two, right, between the partners as well, you know, 1/3
it's female, 1/3 it's male. But then when they come
(03:03):
together, how that does play a role as well?
Yeah, we're seeing a lot of dualfactors, so to speak.
A little bit of inefficiency on the male side in terms of sperm
counts can really compound any issues on the female side and
make it really challenging to get pregnant.
Absolutely, yeah. And, you know, understanding,
(03:25):
too. So this is a big part of it is
understanding semen analysis. But what, you know, don't fully
understand is what those numbersactually mean when we get them
back and things like that. So can you walk us through sperm
count, morphology, DNA fragmentation, and what they
actually tell us about the fertility potential?
Absolutely. So the first thing I tell my
(03:47):
patients is expectations. The semen analysis is a crude
test. It remains the cornerstone of
how we assess a male's fertilitypotential, but it doesn't do a
great job telling us things likesperm quality, whether or not
the sperm work or not. It's essentially best used as a
(04:09):
lottery ticket counter, which matters because humans are
inefficient reproducers by theirnature.
You need a lot of lottery tickets to have an efficient
chance to routinely hit the egg during that ovulation window, so
I primarily use the semen analysis as a lottery ticket
(04:30):
counter. Your total modal sperm count is
the most important number on that entire report sheet.
That being said, when there's isolated deficits, say you have
a normal count but no motility, that's a big deal.
And that could be other issues related to plumbing or how the
(04:51):
factory makes sperm and that that requires a little bit more
of a subtle eye. Sperm morphology is not a good
test, and I don't want anybody being super anxious over sperm
morphology. They only count 200 cells
typically from the millions thatare there to create that number.
(05:15):
It is interuser dependent, meaning if you sit a different
andiologist down at that microscope, it may be a
different number that they generate.
Additionally, you Google this stuff, the most inflammatory old
studies that weren't done well are going to come up right off
the bat and this is where a lot of anxiety is created in my
(05:35):
couples. I don't like it.
The newer data that's done properly with large cohorts of
patients demonstrates that morphology, even when it's 0%,
essentially has very little impact on time to conception
compared to normal IUI, pregnancy rates, birth defects
(05:57):
are the same. That doesn't increase.
And even with IVFXC, if that's what you have to do, it appears
that the outcomes are about similar comparing 0% morphology
to normal. So for most individuals, I tell
them to completely ignore morphology altogether.
It sounds scary. It just didn't turn out to be as
(06:19):
useful as we all thought it would be 40 years ago.
Now DNA DNA fragmentation is a is a tougher topic.
There is a lot of mixed data outthere and your head will spin if
you Google this lot of conflicting reports.
There have been some some findings that have been readily
(06:43):
reproduced that I think we can hang our hat on at this point.
You can have a normal semen analysis but be completely out
of whack on your DNA fragmentation.
So we've seen that it's rare, but occasionally we'll we'll
find that's the problem. DNA fragmentation sounds, it
(07:05):
sounds important, like it's all about the DNA, but in reality,
it's just a measure of sperm damage.
We measure the DNA because the assay is easier to do it on
that. But if there's holes blown
through the DNA, there's holes blown through the tail, through
the membrane, through the motor.That global damage of the sperm
(07:26):
cell is really what we're assessing with DNA
fragmentation. The findings that have been
reproduced are that if you're excessively high on DNA
fragmentation, it is much harderto achieve a successful
pregnancy by natural conception.And in line with that,
intrauterine insemination is tough as well.
(07:49):
I always call IUI natural conception with a sperm Uber.
It's the same Physiology. A lot of men with elevated DNA
fragmentation may ultimately require IVF, and for most of
those guys they are going to have almost equivalent outcomes
to their normal counterparts. But occasionally we will have to
(08:12):
do something fancy, such as retrieving sperm directly out of
the testicle from the factory, where we know the DNA frag is
less if we're not doing well at IVF.
Interestingly, we now know that every sperm and every man has
damage. It is up to the egg to repair
(08:35):
that DNA damage before the embryo develops.
So if you do invest in adna fragmentation test, it's not
going to be 0, OK? It's going to be somewhere in
the low range hopefully. Yeah, that's so interesting.
And what so with sperm DNA fragmentation?
(08:56):
How might it contribute to also recurrent pregnancy loss?
Yeah. So I look at recurrent pregnancy
loss as recurrent miscarriage, right, exactly that's how you
would say it. So, but I also look at couples
who have essentially normal testing who are not getting
pregnant. I wonder if they're making
(09:17):
embryos, but they're passing andlooking like a period, right.
So I I also think there's a an overlap there of recurrent
pregnancy loss or recurrent miscarriage.
Yeah. We have found this is another
finding that you can hang your hat on, increase DNA
fragmentation. It's got to be pretty high, can
definitely increase your risk ofmiscarriage.
(09:38):
So I routinely send these in my RPL recurrent pregnancy loss
patients. Yeah.
Wow. Thanks, Russ, for that.
Yeah, because you know, one of the frustrating things, Well,
one. Yeah, like you were saying,
Google deep dives, right? When we're in an infertility
journey, we do that. So we're gonna research
everything from male factor, female factor, you know, all the
things. And when this stuff is coming
(09:59):
up, it's really scary because like you're saying, it's old
studies that are being found, the things that were clicked on
the most over the last 40 years.You know, all that is really
what's gonna show. And, you know, having things
available to us. Yeah, it's good, you know, if
you educate, to advocate for yourself, but if you do it with
the right things and the right knowledge and having it, that's
power, you know, versus finding those old things that make you
(10:22):
almost more high anxiety going into these situations with your
doc and going in like this is what we need to do.
And realistically, these tests aren't always needed.
No, they're not. In fact, the guidelines say the
DNA fragmentation should be considered optional.
We don't know where to put it yet.
Yeah. But I definitely think it plays
a good role in the evaluation for your recurrent miscarriage.
(10:45):
Yeah, for your unexplained, sometimes that's the right test
to obtain. But yeah, you got to be careful
with Google. It's driven by clicks.
And if an older study only has 10 patients in it, that's not
good data. No, absolutely not.
No. And thanks for pointing that
out. You know, something that's
(11:06):
really frustrating for couples, and we talk about this too, is,
yeah, they go home to Google, but also those, like, normal
results which still lead to infertility, you know, and when
couples are really struggling toconceive, what hidden or
advanced male factors might not show up on just basic testing?
There's a tremendous amount and honestly medicine has been slow
(11:28):
on the male side in terms of developing better tests.
DNA fragmentation has been around for a few decades.
It's probably the the most used fancy sperm test, I would say.
But the semen analysis, like I said before, is crude.
It's somebody looking through a microscope with their naked
(11:49):
eyeball. They can't tell you much beyond
the visual appearance of those cells and whether or not they're
moving. You know, the sperm has a lot to
do. It has to hone to an egg, so you
need progressive motility. It needs to fuse with the egg
fertilization, and that process also is dependent upon the egg
itself. There's newer reports that the
(12:11):
egg has to allow the sperm in, so to speak.
After that, sperm DNA is actually packaged completely
uniquely compared to every othercell in your entire body.
It is packaged tight. This is one of the smallest
cells we make that has to be unpackaged for the embryo to
(12:32):
develop. And we do see correlations in
terms of how DNA is packaged with male factor fertility.
I wouldn't say that I wouldn't invest in any commercial tests
right now for that specific typeof testing, but there are newer
tests coming online trying to assess the functional aspect of
(12:52):
sperm, not just how they appear.That's exciting.
But we are in very early days, and I caution my patients about
purchasing these fancier sperm tests.
They're hard to interpret without the depth of history
declaring their normal values. Yeah.
Absolutely and you know, one of the devastating along with a
(13:17):
lot, you know, when they're going, when a couple is going
through infertility is getting that diagnosis when there's no
sperm found in the ejaculate. You know, what are some main
causes of that and and what options exist today that many
patients might not realize are possible?
Yeah, it's not over, not yet. OK, This is one of my what I
(13:39):
specifically trained for. There are two causes.
Let's keep it simple. Either the factories online, but
the highways are down blockage, OK, or the highways are wide
open but the factory is down production.
OK, so we either have a production problem or a highway
(14:01):
problem, obstruction. You can usually determine which
one of the two it's going to be through a physical exam and a
basic hormone evaluation. We are pretty good at predicting
that. Both require slightly different
surgeries. If it's blockage, you're in much
better shape. Those are typically fantastic
(14:23):
sperm. Doesn't take much to get them
out. A blind man can hit the side of
a barn. OK with the rock.
You're chock full of it. We just got to get them out.
Unfortunately. You have to understand that
surgically retrieved sperm across the board only works with
IVF. It will not work with an
(14:44):
intrauterine insemination type deal.
OK, we learned that in the early90s and until ICSI came on board
in 1997, surgical sperm never worked.
OK. Now if it's a production
problem, the factory is down, then we'd have a lot more work
to do. I need to rule out some
chromosomal abnormalities that are common.
(15:08):
We can still find rare sperm in some of those men, but the
prognosis is much more guarded. It's tough.
It's a tough journey. The name of the surgery for that
is called a microtessie. And essentially what we're doing
is combing through attempting tofind ultra rare pockets of sperm
(15:30):
production. What we don't understand is why
they exist in the 1st place. Presumably the genetics are the
same throughout the entire testicle, but for some reason
most of the factory is off with the lights down and every once
in a while you'll come across a pocket where the factory is
going hog wild and completing fully mature sperm.
(15:53):
Realistically, I would have to see a patient before I gave them
a percent chance of of finding sperm, but it's about 55% for
most men based on prior literature.
So it's tough. I spend a lot of time with those
couples discussing donor backup as an option and talking to a
(16:15):
reproductive urologist in terms of donor sperm, I think is
useful. You know this, this is hard for
men. It's hard for couples to accept,
but sperm don't make the dad at the end of the day.
No, that's such a good way of putting it, Ross.
Absolutely. I know going into the donor
discussion, I can't imagine how tough that is to, you know,
(16:37):
enter with the couples as the physician.
Yeah, it's important to respect their autonomy.
You give them the data and I tell them you have homework to
do. Take the weekend and call me
back and tell me what you want, but I'm not going to force you
to use donor sperm. Yeah, yeah, absolutely.
(16:58):
Yeah. I mean, the whole aspect of
everything along this, you know,and getting those, you know how
it's delivered, having a physician like yourself who's
compassionate, caring and givingeverything up front like this is
what we're seeing. It's so important because, you
know, infertility in and of itself is the complex trauma
'cause it's like loss after lossand just you feel like your
(17:19):
bottoms just keep getting lower and lower in this journey and
like, oh, we're going to try this next.
We're going to do this next, youknow those things.
So having someone that is clearly transparent with you in
those moments is so vital and crucial so you can feel like I
can make the best educated decision as a couple.
You know, what we can do for ourfamily planning and what that
looks like and what we're comfortable doing and what we're
(17:39):
not, you know, based off of thatand the studies.
Yeah. I, I think it's important as a
physician to you don't hold anything back as transparent and
sometimes as brutal as possible is what you need.
You need the data to make your decisions and the data is either
(18:00):
good or bad, but you need it. And and so I think that
physician patient relationship is especially important in
fertility. And finding the one that you
relate the best with and and hasthat open communication like
you're saying, Ross, because they're alongside you the whole
time with your family planning and it.
And it takes a long time, yeah, going into fertility treatments
(18:23):
it it always takes longer than you expect.
Yeah, absolutely. Well, and having these
conversations is so vital up front and and earlier the
better, you know understanding that as well, you know, and the
the next question I was going toask was about the testing.
So I'm really glad that you wentinto that.
So thank you for that, Ross. And, you know, on top of
(18:43):
understanding the factory or thehighways, you know, those
things, you know, with production or distribution of
the sperm, what other, you know,lifestyle and environmental
factors really play a role in sperm health that, you know,
might be easier to change or, you know, help with this, like
toxins exposure, heat exposure, alcohol, cannabis, sleep, stress
(19:08):
and nutrition. You know, they're always the big
top ones I feel like we hear about all the time.
Yeah, so I always say the lifestyle of male reproduction
is the lifestyle of moderation. As long as you're not too
extreme on any end of the spectrum, you want to be in the
middle. That's where your body is happy.
So, for instance, going on a crash diet is a bad idea.
(19:32):
So if you need to lose weight, you should do it.
Low and slow crash diet is a controlled famine.
Humans do not reproduce during famine, That's on purpose.
Alcohol probably matters, but I typically need to see pretty
heavy drinking before it starts really impacting the semen
analysis. In general though, I'd like to
(19:55):
keep my patients below 4 to 5 drinks spaced out in a week.
Smoking is the worst you can do.This is probably the most
impactful lifestyle factor that you can change to improve your
sperm. Nicotine effects sperm, but it's
really all the other stuff that's coming out of the
(20:17):
combustion of that plant that ishighly damaging to sperm.
And we know that it increases DNA fragmentation.
We've measured OK Cannabis is the same thing.
I don't care about the THC as much as the other stuff coming
out of the burning plant. It's like 3 unfiltered
cigarettes now. There are THC receptors down
(20:41):
there. We don't know what they do.
It's probably a minor effect in terms of the active chemical,
but I still tell my patients, remove variables, cut that stuff
out, OK. In terms of diet, it's tough to
move the needle. You know you'll read these
studies, but the effect size is very small.
(21:04):
The truth is in Western society,we are all macro and
micronutrient sufficient. And I have guys who disappear on
me for six months and they go live the perfect lifestyle.
They hit the gym everyday, perfect Mediterranean diet,
taking their supplements, They come back, they repeat their
(21:24):
semen analysis. It's exactly the same.
And so it's very, yeah, it's tough to move the needle when
you're already doing OK. It's there are prescription meds
that can influence sperm production.
If you Google any prescription Med I guarantee you you will
(21:48):
find some sort of random animal study or vague human study that
links it to sperm. I don't want you to get too into
it until you talk to somebody like myself, but there are a few
bad players and I don't know if this is one of your future
questions, but testosterone replacement therapy is a
nightmare that is essentially going to be a male contraceptive
(22:14):
for most men. It turns sperm production off
and it can take a long time to get you back online.
Some men, it took me a year. So that is become,
unfortunately, very, very common.
It's being pushed on our population.
And you're not always counseled before you start testosterone
(22:37):
replacement therapy that it affects your sperm count.
And so a lot of folks are getting kind of bamboozled into
a difficult fertility situation.Absolutely and a year and
infertility is a long time when you're trying to and see if.
Yeah, anabolic steroids are the same thing.
If you're using those, it's liketestosterone on steroids, no pun
(23:00):
intended. Wow.
That was a big question. Did I miss any of those
segments? How about this is always a big
one, You know, everybody says like, just relax, you know, if
you didn't have stress. But it's hard not to stress when
you're in an infertility journey.
But how does stress and sleep really associate with it too?
(23:23):
Yeah, again, loose correlations.OK.
Every patient is hoping it's thestress.
It's not the stress. Yeah, you have very little
control of your sperm counts andwe all live stressful life
lifestyles these days. I do think a severe event can
(23:44):
temporarily affect your sperm counts, such death of a close
loved one for instance. Now sleep is interesting.
I think sleep's very important. We none of us have good sleep
hygiene it seems. But remember, the testosterone
axis is the, it, it, it cycles day-to-day.
(24:09):
If, if your days are different every single day of the week,
your body's having a hard time regulating that testosterone
cycle that kind of follows your sleep wake cycle.
So if not for general health, I think it's nice to review remove
that variable. I preach a lot of sleep hygiene
(24:30):
for my patients. I think it's very important.
Yeah, that's good to know, Ross.I mean, you don't hear about it
as often as you hear about the others that we discussed.
I feel like, you know, the alcohol, the cannabis, the
nicotine, they always get all the, you know, attention out
there. But, you know, sleep that
routine and having a really healthy sleep pattern, yeah.
(24:50):
Exactly. You got to sleep and.
That's something you can fix, you know, like that's something
you can do on your own, you know, figure it out and what
works for you. Yeah, right.
Yeah, taking that variable out, you know, what's interesting is
too something that, especially from the female perspective, is
our biological clock, right? And we're like, eggs are on a
timer, for lack of a better way of saying it.
(25:10):
But male age is discussed less frequently.
How does male age impact, you know, sperm quality, genetics
and pregnancy outcomes? Not very much as we as you would
expect, but it does matter. But the correlations are are are
pretty soft. It's just not like a huge change
occurs through 510 years, but there is a progressive drop with
(25:35):
age with testosterone and sperm counts.
The as you get older and older, there is concern that some of
these polygenetic diseases, likeautism for instance, may
slightly increase with male age.In terms of risk, I think it's
(25:56):
reasonable to assume that that makes sense, but I wouldn't say
that that should significantly influence your decisions because
the relt, excuse me, the absolute risk remains pretty
low, comparable to everyone else.
But This is why you see much older men able to start
pregnancies. Yeah.
(26:18):
Absolutely. That makes sense, you know, for
some men, infertility also has agenetic 'cause, you know, what
does types of genetic conditionsor chromosome abnormalities
affecting the sperm production. When you see that, Ross.
Yeah. So again, the science is
(26:38):
limited, but what I can tell youthere's something in the
genetics that's affecting you ifyou're having significant
diminished sperm counts or motility, OK.
We have spent millions upon millions in research through the
NIH, etcetera trying to identifythese genes.
(26:59):
It is an extremely complex system and we've just scratched
the surface. It takes hundreds of genes to
make a sperm as unique individuals.
We have a unique variant in eachone of those genes.
These genes come from far outstretches of your family
tree. You get some of them from great
(27:20):
great grandma on one side, greatgranddad on the other side.
It's the it's the unique mixtureof these gene variants, your
hand of cards that matters and is going to affect what I call
your factory efficiency. How much product can you make
right? That being said, there are a few
(27:41):
you you, if you Google this, there are some genes that have
been identified, but they're typically only applicable to
very small groups of people, very, you know, very specific
families that have a very specific problem.
The only real good genetic testing we have, and that is
pretty old and dated at this point, but we still use it, is
(28:02):
the chromosome analysis, AKA karyotype and the Y chromosome
micro deletion test. If you have asospermia, no sperm
in the ejaculate or you're or you're shooting very low sperm
counts, I will order these tests.
We need to rule them out. It will detect chromosome
rearrangements, Klinefelter syndrome, and loss of that
(28:26):
specific spot on that Y chromosome.
Think of your chromosomes like the Encyclopedia Britannica.
They're divided into volumes. As long as you have all the
text, you can be a totally normal human.
But if part of five is stuck to six, it makes it very difficult
(28:46):
to produce sperm because you gotto split these chromosomes into
separate cells so you can have that.
Klinefelter syndrome is a syndrome where you have an extra
X chromosome so you have XXYI believe it's far more common
than we all initially anticipated.
(29:07):
For most men you can't tell the difference until your
infertility diagnosis. Those men typically require a
microtessie if they have a shot to find sperm.
It needs to be ruled out if you're having zero sperm in the
ejaculate. the Y chromosome microdeletion is interesting.
This is not typically passed down because you typically don't
(29:28):
have any sperm or very low amounts of sperm so in the past
you would have been totally infertile.
It is a it is a hot spot on the Y chromosome that tends to fall
out easily and it happened rightat conception when egg and sperm
meet and This is why it's not carried down in families yet.
(29:51):
However, if I find sperm in a guy with AY chromosome
microdeletion and we make an embryo that's a boy, now it will
be passed down because he's going to get your Y chromosome.
So it's still a relevant measurebecause in some cases those
couples may gender select. Yeah, absolutely.
(30:13):
No. Lots to consider and think about
that. You have to in these instances.
Absolutely. Wow.
And you know, with that and witha couple who is on an
infertility journey or feel likethey've been trying to conceive
for months, maybe even years, when do you feel like, 'cause
(30:35):
obviously many couples focus first testing on the female,
even though it is easier to testin the male, right?
When should men be referred to amale fertility specialist rather
than just a basic semen test? Yeah, so first of all, a semen
test and typically 2, it's important to get more than one
(30:58):
for most guys because it is a very, extremely variable system.
You can have bad days, get a retest to make sure it's true or
not. You should have your semen
analysis done right away, immediately, right along with,
you know, as you start your journey.
That has to be factored in. I would say referral to a male
(31:21):
and fertility specialist is reasonable if sperm, if there's
a consistent defect either in count or motility, OK.
Obviously if there's ejaculatorydysfunction, that's an early
referral to right? We got to have ejaculate to get
pregnant. Yeah, absolutely.
(31:43):
And other sexual dysfunction we can address as well, but
ejaculatory reflex is the big one that needs to be intact.
That being said, I don't mind seeing folks with normal semen
analysis. I think there's a lot of value
in talking about lifestyle. Discussing the testing thus far,
(32:05):
and reviewing the data together in a shared capacity.
I think that's helpful. We can also discuss the fancier
sperm test if we want to go downthat route, which can I believe
can be a predatory market. You got to be careful how you
spend your money. So I can help guide you in terms
(32:26):
of I don't think that test is really ready for prime time yet.
Let's not utilize that one versus this one, which I think
is probably much more effective in guiding my patients.
So I think that's a reasonable thing to consider as well.
And for couples listening who may have just received a
(32:46):
diagnosis involving male infertility or are just starting
this journey, you know, what would you want them to
understand about how far treatments and technology have
come? Yeah, so I I always tell my
couples the testing is limited. Only interpret your tests with
(33:09):
what the test can actually tell you.
So if you have a normal test butyour morphology 0, you don't
know much about that about that male other than he has a normal
modal sperm count most likely. I wouldn't weigh into the
morphology too much. As I said earlier in the talk, I
(33:31):
think like I said, the semen analysis typically 2, I have a
low threshold to get three. You have to understand that the
male stock market really varies day-to-day, and so you can get
some wonky tests on your semen analysis.
Always repeat, always repeat. But overall, I think it's high
(33:55):
value still to see someone like me to review these things and
have a discussion. It's it's not much time.
And really, I always tell my folks, 90% of what I do is
education, 10% weird stuff. Yeah, yeah, it's good to know.
Yeah, Sir. Russ, what would you like to
leave our listeners with? And also, if you could change
(34:18):
one misconception the public hasabout male fertility, what would
it be? Yeah, I #1 the testicles on you
only contribute 3% of the volumeto the ejaculate.
If the guy is saying I have a normal looking ejaculate,
(34:40):
doesn't matter, you don't know if spermor is in there or not.
He needs a semen analysis. OK?
That's why after vasectomy for instance, the ejaculate looks
unchanged. OK, Abstinence interval is not
as important as we all think it is.
We we focus on it because it's one of the few things you can
control. But by and large it's not that
(35:03):
important. I what I would like to leave my
folks with is that you got to rule out a male factor and you
should do it early. It takes 2 to tango.
Just get the semen analysis, it's not a big deal.
I know. I think that's tough, especially
with males maybe to venture intorealizing there might be
(35:26):
something contributing or wrong that can be fixed or, you know,
not, but just to have those conversations.
And a lot of times, you know, our lost parents and couples and
the moms come to us, you know, and they're thinking it's a lot
of things are getting done on their side and the males are
more dragging their feet with things.
So to hear that rough is is huge.
You just got to do it, do your business.
(35:48):
Yeah, get it done. Get it done.
Thank you so much, Doctor Heyman, for being here, for
everything that you covered, youshared about male infertility.
Definitely encourage anybody listening that has follow up
questions or would like to do a consult with Doctor Russell,
please reach out to him. We'll put the contact
(36:09):
information and the description.So you have all of that.
And thanks again, Ross. Can't say that enough to you.
Absolutely, my pleasure. To everyone that is listening,
that is navigating infertility, recurrent pregnancy loss, any
type of pregnancy loss, infant loss, please know your story
matters, your baby matters, and your grief matter.
Healing doesn't always follow a timeline.
(36:30):
Trauma and loss don't have a schedule and you deserve
compassionate care through everystep of your journey.
If you need support, we have free daily support resources and
a community at Chasing the Rainbows.
Because every loss does matter. If this conversation resonated
with you, please share this episode with someone who may
need it and to hear it as well. And if you are looking for
(36:50):
support, want to volunteer, donate, host an event, please
visit chasingtherainbows.org. Thank you for being here, for
listening, and for continuing tobreak the silence around
infertility and baby loss. Until next time this is cried
out loud.
Crying Out Loud, a podcast by Chasing the Rainbows with your
host Bernice Quisenberry. Today we're diving into a topic
that is often overlooked in fertility conversations but is
(00:31):
responsible for nearly half of infertility cases, and that's
male factor infertility. Joining us today is Doctor
Russell Hayden, a urologist who specializes in male infertility
and microsurgery at the Center for Male Fertility at Shady
Grove Fertility. Doctor Hayden's path to
reproductive medicine began during his graduate studies in
(00:52):
biomedical engineering at Johns Hopkins University, where he
became interested in the intersection of technology,
precision medicine, and creativeproblem solving.
He went on to earn his medical degree from Harvard University,
followed by residencies in general surgery and urology at
Massachusetts General Hospital. He then completed a fellowship
in reproductive medicine and microsurgery at Weill Cornell
(01:14):
Medicine, one of the leading training programs in male
fertility. His work focuses on diagnosing
and treating complex male infertility conditions,
including sperm retrieval procedures, advanced
microsurgical procedures that often involve operating under
magnification as high as 25 times finer than a human hair.
(01:36):
Doctor Hayden is a member of several leading medical
societies, including the American Urological.
Sorry, as I butcher that association, the American
Society for Reproductive to Protect the Medicine and the
Society for Male Reproduction inUrology and his he has published
research on a range of topics related to reproductive and
(01:57):
health. And Doctor Heaton, thank you so
much for being here and sheddinglight on part of fertility that
many families don't fully understand but plays a crucial
role in building a family. My pleasure, happy to answer any
questions you have. Fantastic.
Yeah, we have a lot from our listeners, from our lost
parents, so we'll just dive right in.
Many people, you know, still assume infertility is primarily
(02:19):
a woman issue. From a medical standpoint.
How often is male factor infertility contributing to
difficulty conceiving? Oh, it's much more common than
we all originally anticipated. And I always like to say it
takes 2 to tango. Each person is contributing 50%
of their DNA. There is definitely a factor of
(02:42):
sperm quality that goes into embryo development.
I am a firm believer in that andI think it's reasonable to say
that male factor is going to be 50% of cases.
Absolutely. Well, even, you know, between
the two, right, between the partners as well, you know, 1/3
it's female, 1/3 it's male. But then when they come
(03:03):
together, how that does play a role as well?
Yeah, we're seeing a lot of dualfactors, so to speak.
A little bit of inefficiency on the male side in terms of sperm
counts can really compound any issues on the female side and
make it really challenging to get pregnant.
Absolutely, yeah. And, you know, understanding,
(03:25):
too. So this is a big part of it is
understanding semen analysis. But what, you know, don't fully
understand is what those numbersactually mean when we get them
back and things like that. So can you walk us through sperm
count, morphology, DNA fragmentation, and what they
actually tell us about the fertility potential?
Absolutely. So the first thing I tell my
(03:47):
patients is expectations. The semen analysis is a crude
test. It remains the cornerstone of
how we assess a male's fertilitypotential, but it doesn't do a
great job telling us things likesperm quality, whether or not
the sperm work or not. It's essentially best used as a
(04:09):
lottery ticket counter, which matters because humans are
inefficient reproducers by theirnature.
You need a lot of lottery tickets to have an efficient
chance to routinely hit the egg during that ovulation window, so
I primarily use the semen analysis as a lottery ticket
(04:30):
counter. Your total modal sperm count is
the most important number on that entire report sheet.
That being said, when there's isolated deficits, say you have
a normal count but no motility, that's a big deal.
And that could be other issues related to plumbing or how the
(04:51):
factory makes sperm and that that requires a little bit more
of a subtle eye. Sperm morphology is not a good
test, and I don't want anybody being super anxious over sperm
morphology. They only count 200 cells
typically from the millions thatare there to create that number.
(05:15):
It is interuser dependent, meaning if you sit a different
andiologist down at that microscope, it may be a
different number that they generate.
Additionally, you Google this stuff, the most inflammatory old
studies that weren't done well are going to come up right off
the bat and this is where a lot of anxiety is created in my
(05:35):
couples. I don't like it.
The newer data that's done properly with large cohorts of
patients demonstrates that morphology, even when it's 0%,
essentially has very little impact on time to conception
compared to normal IUI, pregnancy rates, birth defects
(05:57):
are the same. That doesn't increase.
And even with IVFXC, if that's what you have to do, it appears
that the outcomes are about similar comparing 0% morphology
to normal. So for most individuals, I tell
them to completely ignore morphology altogether.
It sounds scary. It just didn't turn out to be as
(06:19):
useful as we all thought it would be 40 years ago.
Now DNA DNA fragmentation is a is a tougher topic.
There is a lot of mixed data outthere and your head will spin if
you Google this lot of conflicting reports.
There have been some some findings that have been readily
(06:43):
reproduced that I think we can hang our hat on at this point.
You can have a normal semen analysis but be completely out
of whack on your DNA fragmentation.
So we've seen that it's rare, but occasionally we'll we'll
find that's the problem. DNA fragmentation sounds, it
(07:05):
sounds important, like it's all about the DNA, but in reality,
it's just a measure of sperm damage.
We measure the DNA because the assay is easier to do it on
that. But if there's holes blown
through the DNA, there's holes blown through the tail, through
the membrane, through the motor.That global damage of the sperm
(07:26):
cell is really what we're assessing with DNA
fragmentation. The findings that have been
reproduced are that if you're excessively high on DNA
fragmentation, it is much harderto achieve a successful
pregnancy by natural conception.And in line with that,
intrauterine insemination is tough as well.
(07:49):
I always call IUI natural conception with a sperm Uber.
It's the same Physiology. A lot of men with elevated DNA
fragmentation may ultimately require IVF, and for most of
those guys they are going to have almost equivalent outcomes
to their normal counterparts. But occasionally we will have to
(08:12):
do something fancy, such as retrieving sperm directly out of
the testicle from the factory, where we know the DNA frag is
less if we're not doing well at IVF.
Interestingly, we now know that every sperm and every man has
damage. It is up to the egg to repair
(08:35):
that DNA damage before the embryo develops.
So if you do invest in adna fragmentation test, it's not
going to be 0, OK? It's going to be somewhere in
the low range hopefully. Yeah, that's so interesting.
And what so with sperm DNA fragmentation?
(08:56):
How might it contribute to also recurrent pregnancy loss?
Yeah. So I look at recurrent pregnancy
loss as recurrent miscarriage, right, exactly that's how you
would say it. So, but I also look at couples
who have essentially normal testing who are not getting
pregnant. I wonder if they're making
(09:17):
embryos, but they're passing andlooking like a period, right.
So I I also think there's a an overlap there of recurrent
pregnancy loss or recurrent miscarriage.
Yeah. We have found this is another
finding that you can hang your hat on, increase DNA
fragmentation. It's got to be pretty high, can
definitely increase your risk ofmiscarriage.
(09:38):
So I routinely send these in my RPL recurrent pregnancy loss
patients. Yeah.
Wow. Thanks, Russ, for that.
Yeah, because you know, one of the frustrating things, Well,
one. Yeah, like you were saying,
Google deep dives, right? When we're in an infertility
journey, we do that. So we're gonna research
everything from male factor, female factor, you know, all the
things. And when this stuff is coming
(09:59):
up, it's really scary because like you're saying, it's old
studies that are being found, the things that were clicked on
the most over the last 40 years.You know, all that is really
what's gonna show. And, you know, having things
available to us. Yeah, it's good, you know, if
you educate, to advocate for yourself, but if you do it with
the right things and the right knowledge and having it, that's
power, you know, versus finding those old things that make you
(10:22):
almost more high anxiety going into these situations with your
doc and going in like this is what we need to do.
And realistically, these tests aren't always needed.
No, they're not. In fact, the guidelines say the
DNA fragmentation should be considered optional.
We don't know where to put it yet.
Yeah. But I definitely think it plays
a good role in the evaluation for your recurrent miscarriage.
(10:45):
Yeah, for your unexplained, sometimes that's the right test
to obtain. But yeah, you got to be careful
with Google. It's driven by clicks.
And if an older study only has 10 patients in it, that's not
good data. No, absolutely not.
No. And thanks for pointing that
out. You know, something that's
(11:06):
really frustrating for couples, and we talk about this too, is,
yeah, they go home to Google, but also those, like, normal
results which still lead to infertility, you know, and when
couples are really struggling toconceive, what hidden or
advanced male factors might not show up on just basic testing?
There's a tremendous amount and honestly medicine has been slow
(11:28):
on the male side in terms of developing better tests.
DNA fragmentation has been around for a few decades.
It's probably the the most used fancy sperm test, I would say.
But the semen analysis, like I said before, is crude.
It's somebody looking through a microscope with their naked
(11:49):
eyeball. They can't tell you much beyond
the visual appearance of those cells and whether or not they're
moving. You know, the sperm has a lot to
do. It has to hone to an egg, so you
need progressive motility. It needs to fuse with the egg
fertilization, and that process also is dependent upon the egg
itself. There's newer reports that the
(12:11):
egg has to allow the sperm in, so to speak.
After that, sperm DNA is actually packaged completely
uniquely compared to every othercell in your entire body.
It is packaged tight. This is one of the smallest
cells we make that has to be unpackaged for the embryo to
(12:32):
develop. And we do see correlations in
terms of how DNA is packaged with male factor fertility.
I wouldn't say that I wouldn't invest in any commercial tests
right now for that specific typeof testing, but there are newer
tests coming online trying to assess the functional aspect of
(12:52):
sperm, not just how they appear.That's exciting.
But we are in very early days, and I caution my patients about
purchasing these fancier sperm tests.
They're hard to interpret without the depth of history
declaring their normal values. Yeah.
Absolutely and you know, one of the devastating along with a
(13:17):
lot, you know, when they're going, when a couple is going
through infertility is getting that diagnosis when there's no
sperm found in the ejaculate. You know, what are some main
causes of that and and what options exist today that many
patients might not realize are possible?
Yeah, it's not over, not yet. OK, This is one of my what I
(13:39):
specifically trained for. There are two causes.
Let's keep it simple. Either the factories online, but
the highways are down blockage, OK, or the highways are wide
open but the factory is down production.
OK, so we either have a production problem or a highway
(14:01):
problem, obstruction. You can usually determine which
one of the two it's going to be through a physical exam and a
basic hormone evaluation. We are pretty good at predicting
that. Both require slightly different
surgeries. If it's blockage, you're in much
better shape. Those are typically fantastic
(14:23):
sperm. Doesn't take much to get them
out. A blind man can hit the side of
a barn. OK with the rock.
You're chock full of it. We just got to get them out.
Unfortunately. You have to understand that
surgically retrieved sperm across the board only works with
IVF. It will not work with an
(14:44):
intrauterine insemination type deal.
OK, we learned that in the early90s and until ICSI came on board
in 1997, surgical sperm never worked.
OK. Now if it's a production
problem, the factory is down, then we'd have a lot more work
to do. I need to rule out some
chromosomal abnormalities that are common.
(15:08):
We can still find rare sperm in some of those men, but the
prognosis is much more guarded. It's tough.
It's a tough journey. The name of the surgery for that
is called a microtessie. And essentially what we're doing
is combing through attempting tofind ultra rare pockets of sperm
(15:30):
production. What we don't understand is why
they exist in the 1st place. Presumably the genetics are the
same throughout the entire testicle, but for some reason
most of the factory is off with the lights down and every once
in a while you'll come across a pocket where the factory is
going hog wild and completing fully mature sperm.
(15:53):
Realistically, I would have to see a patient before I gave them
a percent chance of of finding sperm, but it's about 55% for
most men based on prior literature.
So it's tough. I spend a lot of time with those
couples discussing donor backup as an option and talking to a
(16:15):
reproductive urologist in terms of donor sperm, I think is
useful. You know this, this is hard for
men. It's hard for couples to accept,
but sperm don't make the dad at the end of the day.
No, that's such a good way of putting it, Ross.
Absolutely. I know going into the donor
discussion, I can't imagine how tough that is to, you know,
(16:37):
enter with the couples as the physician.
Yeah, it's important to respect their autonomy.
You give them the data and I tell them you have homework to
do. Take the weekend and call me
back and tell me what you want, but I'm not going to force you
to use donor sperm. Yeah, yeah, absolutely.
(16:58):
Yeah. I mean, the whole aspect of
everything along this, you know,and getting those, you know how
it's delivered, having a physician like yourself who's
compassionate, caring and givingeverything up front like this is
what we're seeing. It's so important because, you
know, infertility in and of itself is the complex trauma
'cause it's like loss after lossand just you feel like your
(17:19):
bottoms just keep getting lower and lower in this journey and
like, oh, we're going to try this next.
We're going to do this next, youknow those things.
So having someone that is clearly transparent with you in
those moments is so vital and crucial so you can feel like I
can make the best educated decision as a couple.
You know, what we can do for ourfamily planning and what that
looks like and what we're comfortable doing and what we're
(17:39):
not, you know, based off of thatand the studies.
Yeah. I, I think it's important as a
physician to you don't hold anything back as transparent and
sometimes as brutal as possible is what you need.
You need the data to make your decisions and the data is either
(18:00):
good or bad, but you need it. And and so I think that
physician patient relationship is especially important in
fertility. And finding the one that you
relate the best with and and hasthat open communication like
you're saying, Ross, because they're alongside you the whole
time with your family planning and it.
And it takes a long time, yeah, going into fertility treatments
(18:23):
it it always takes longer than you expect.
Yeah, absolutely. Well, and having these
conversations is so vital up front and and earlier the
better, you know understanding that as well, you know, and the
the next question I was going toask was about the testing.
So I'm really glad that you wentinto that.
So thank you for that, Ross. And, you know, on top of
(18:43):
understanding the factory or thehighways, you know, those
things, you know, with production or distribution of
the sperm, what other, you know,lifestyle and environmental
factors really play a role in sperm health that, you know,
might be easier to change or, you know, help with this, like
toxins exposure, heat exposure, alcohol, cannabis, sleep, stress
(19:08):
and nutrition. You know, they're always the big
top ones I feel like we hear about all the time.
Yeah, so I always say the lifestyle of male reproduction
is the lifestyle of moderation. As long as you're not too
extreme on any end of the spectrum, you want to be in the
middle. That's where your body is happy.
So, for instance, going on a crash diet is a bad idea.
(19:32):
So if you need to lose weight, you should do it.
Low and slow crash diet is a controlled famine.
Humans do not reproduce during famine, That's on purpose.
Alcohol probably matters, but I typically need to see pretty
heavy drinking before it starts really impacting the semen
analysis. In general though, I'd like to
(19:55):
keep my patients below 4 to 5 drinks spaced out in a week.
Smoking is the worst you can do.This is probably the most
impactful lifestyle factor that you can change to improve your
sperm. Nicotine effects sperm, but it's
really all the other stuff that's coming out of the
(20:17):
combustion of that plant that ishighly damaging to sperm.
And we know that it increases DNA fragmentation.
We've measured OK Cannabis is the same thing.
I don't care about the THC as much as the other stuff coming
out of the burning plant. It's like 3 unfiltered
cigarettes now. There are THC receptors down
(20:41):
there. We don't know what they do.
It's probably a minor effect in terms of the active chemical,
but I still tell my patients, remove variables, cut that stuff
out, OK. In terms of diet, it's tough to
move the needle. You know you'll read these
studies, but the effect size is very small.
(21:04):
The truth is in Western society,we are all macro and
micronutrient sufficient. And I have guys who disappear on
me for six months and they go live the perfect lifestyle.
They hit the gym everyday, perfect Mediterranean diet,
taking their supplements, They come back, they repeat their
(21:24):
semen analysis. It's exactly the same.
And so it's very, yeah, it's tough to move the needle when
you're already doing OK. It's there are prescription meds
that can influence sperm production.
If you Google any prescription Med I guarantee you you will
(21:48):
find some sort of random animal study or vague human study that
links it to sperm. I don't want you to get too into
it until you talk to somebody like myself, but there are a few
bad players and I don't know if this is one of your future
questions, but testosterone replacement therapy is a
nightmare that is essentially going to be a male contraceptive
(22:14):
for most men. It turns sperm production off
and it can take a long time to get you back online.
Some men, it took me a year. So that is become,
unfortunately, very, very common.
It's being pushed on our population.
And you're not always counseled before you start testosterone
(22:37):
replacement therapy that it affects your sperm count.
And so a lot of folks are getting kind of bamboozled into
a difficult fertility situation.Absolutely and a year and
infertility is a long time when you're trying to and see if.
Yeah, anabolic steroids are the same thing.
If you're using those, it's liketestosterone on steroids, no pun
(23:00):
intended. Wow.
That was a big question. Did I miss any of those
segments? How about this is always a big
one, You know, everybody says like, just relax, you know, if
you didn't have stress. But it's hard not to stress when
you're in an infertility journey.
But how does stress and sleep really associate with it too?
(23:23):
Yeah, again, loose correlations.OK.
Every patient is hoping it's thestress.
It's not the stress. Yeah, you have very little
control of your sperm counts andwe all live stressful life
lifestyles these days. I do think a severe event can
(23:44):
temporarily affect your sperm counts, such death of a close
loved one for instance. Now sleep is interesting.
I think sleep's very important. We none of us have good sleep
hygiene it seems. But remember, the testosterone
axis is the, it, it, it cycles day-to-day.
(24:09):
If, if your days are different every single day of the week,
your body's having a hard time regulating that testosterone
cycle that kind of follows your sleep wake cycle.
So if not for general health, I think it's nice to review remove
that variable. I preach a lot of sleep hygiene
(24:30):
for my patients. I think it's very important.
Yeah, that's good to know, Ross.I mean, you don't hear about it
as often as you hear about the others that we discussed.
I feel like, you know, the alcohol, the cannabis, the
nicotine, they always get all the, you know, attention out
there. But, you know, sleep that
routine and having a really healthy sleep pattern, yeah.
(24:50):
Exactly. You got to sleep and.
That's something you can fix, you know, like that's something
you can do on your own, you know, figure it out and what
works for you. Yeah, right.
Yeah, taking that variable out, you know, what's interesting is
too something that, especially from the female perspective, is
our biological clock, right? And we're like, eggs are on a
timer, for lack of a better way of saying it.
(25:10):
But male age is discussed less frequently.
How does male age impact, you know, sperm quality, genetics
and pregnancy outcomes? Not very much as we as you would
expect, but it does matter. But the correlations are are are
pretty soft. It's just not like a huge change
occurs through 510 years, but there is a progressive drop with
(25:35):
age with testosterone and sperm counts.
The as you get older and older, there is concern that some of
these polygenetic diseases, likeautism for instance, may
slightly increase with male age.In terms of risk, I think it's
(25:56):
reasonable to assume that that makes sense, but I wouldn't say
that that should significantly influence your decisions because
the relt, excuse me, the absolute risk remains pretty
low, comparable to everyone else.
But This is why you see much older men able to start
pregnancies. Yeah.
(26:18):
Absolutely. That makes sense, you know, for
some men, infertility also has agenetic 'cause, you know, what
does types of genetic conditionsor chromosome abnormalities
affecting the sperm production. When you see that, Ross.
Yeah. So again, the science is
(26:38):
limited, but what I can tell youthere's something in the
genetics that's affecting you ifyou're having significant
diminished sperm counts or motility, OK.
We have spent millions upon millions in research through the
NIH, etcetera trying to identifythese genes.
(26:59):
It is an extremely complex system and we've just scratched
the surface. It takes hundreds of genes to
make a sperm as unique individuals.
We have a unique variant in eachone of those genes.
These genes come from far outstretches of your family
tree. You get some of them from great
(27:20):
great grandma on one side, greatgranddad on the other side.
It's the it's the unique mixtureof these gene variants, your
hand of cards that matters and is going to affect what I call
your factory efficiency. How much product can you make
right? That being said, there are a few
(27:41):
you you, if you Google this, there are some genes that have
been identified, but they're typically only applicable to
very small groups of people, very, you know, very specific
families that have a very specific problem.
The only real good genetic testing we have, and that is
pretty old and dated at this point, but we still use it, is
(28:02):
the chromosome analysis, AKA karyotype and the Y chromosome
micro deletion test. If you have asospermia, no sperm
in the ejaculate or you're or you're shooting very low sperm
counts, I will order these tests.
We need to rule them out. It will detect chromosome
rearrangements, Klinefelter syndrome, and loss of that
(28:26):
specific spot on that Y chromosome.
Think of your chromosomes like the Encyclopedia Britannica.
They're divided into volumes. As long as you have all the
text, you can be a totally normal human.
But if part of five is stuck to six, it makes it very difficult
(28:46):
to produce sperm because you gotto split these chromosomes into
separate cells so you can have that.
Klinefelter syndrome is a syndrome where you have an extra
X chromosome so you have XXYI believe it's far more common
than we all initially anticipated.
(29:07):
For most men you can't tell the difference until your
infertility diagnosis. Those men typically require a
microtessie if they have a shot to find sperm.
It needs to be ruled out if you're having zero sperm in the
ejaculate. the Y chromosome microdeletion is interesting.
This is not typically passed down because you typically don't
(29:28):
have any sperm or very low amounts of sperm so in the past
you would have been totally infertile.
It is a it is a hot spot on the Y chromosome that tends to fall
out easily and it happened rightat conception when egg and sperm
meet and This is why it's not carried down in families yet.
(29:51):
However, if I find sperm in a guy with AY chromosome
microdeletion and we make an embryo that's a boy, now it will
be passed down because he's going to get your Y chromosome.
So it's still a relevant measurebecause in some cases those
couples may gender select. Yeah, absolutely.
(30:13):
No. Lots to consider and think about
that. You have to in these instances.
Absolutely. Wow.
And you know, with that and witha couple who is on an
infertility journey or feel likethey've been trying to conceive
for months, maybe even years, when do you feel like, 'cause
(30:35):
obviously many couples focus first testing on the female,
even though it is easier to testin the male, right?
When should men be referred to amale fertility specialist rather
than just a basic semen test? Yeah, so first of all, a semen
test and typically 2, it's important to get more than one
(30:58):
for most guys because it is a very, extremely variable system.
You can have bad days, get a retest to make sure it's true or
not. You should have your semen
analysis done right away, immediately, right along with,
you know, as you start your journey.
That has to be factored in. I would say referral to a male
(31:21):
and fertility specialist is reasonable if sperm, if there's
a consistent defect either in count or motility, OK.
Obviously if there's ejaculatorydysfunction, that's an early
referral to right? We got to have ejaculate to get
pregnant. Yeah, absolutely.
(31:43):
And other sexual dysfunction we can address as well, but
ejaculatory reflex is the big one that needs to be intact.
That being said, I don't mind seeing folks with normal semen
analysis. I think there's a lot of value
in talking about lifestyle. Discussing the testing thus far,
(32:05):
and reviewing the data together in a shared capacity.
I think that's helpful. We can also discuss the fancier
sperm test if we want to go downthat route, which can I believe
can be a predatory market. You got to be careful how you
spend your money. So I can help guide you in terms
(32:26):
of I don't think that test is really ready for prime time yet.
Let's not utilize that one versus this one, which I think
is probably much more effective in guiding my patients.
So I think that's a reasonable thing to consider as well.
And for couples listening who may have just received a
(32:46):
diagnosis involving male infertility or are just starting
this journey, you know, what would you want them to
understand about how far treatments and technology have
come? Yeah, so I I always tell my
couples the testing is limited. Only interpret your tests with
(33:09):
what the test can actually tell you.
So if you have a normal test butyour morphology 0, you don't
know much about that about that male other than he has a normal
modal sperm count most likely. I wouldn't weigh into the
morphology too much. As I said earlier in the talk, I
(33:31):
think like I said, the semen analysis typically 2, I have a
low threshold to get three. You have to understand that the
male stock market really varies day-to-day, and so you can get
some wonky tests on your semen analysis.
Always repeat, always repeat. But overall, I think it's high
(33:55):
value still to see someone like me to review these things and
have a discussion. It's it's not much time.
And really, I always tell my folks, 90% of what I do is
education, 10% weird stuff. Yeah, yeah, it's good to know.
Yeah, Sir. Russ, what would you like to
leave our listeners with? And also, if you could change
(34:18):
one misconception the public hasabout male fertility, what would
it be? Yeah, I #1 the testicles on you
only contribute 3% of the volumeto the ejaculate.
If the guy is saying I have a normal looking ejaculate,
(34:40):
doesn't matter, you don't know if spermor is in there or not.
He needs a semen analysis. OK?
That's why after vasectomy for instance, the ejaculate looks
unchanged. OK, Abstinence interval is not
as important as we all think it is.
We we focus on it because it's one of the few things you can
control. But by and large it's not that
(35:03):
important. I what I would like to leave my
folks with is that you got to rule out a male factor and you
should do it early. It takes 2 to tango.
Just get the semen analysis, it's not a big deal.
I know. I think that's tough, especially
with males maybe to venture intorealizing there might be
(35:26):
something contributing or wrong that can be fixed or, you know,
not, but just to have those conversations.
And a lot of times, you know, our lost parents and couples and
the moms come to us, you know, and they're thinking it's a lot
of things are getting done on their side and the males are
more dragging their feet with things.
So to hear that rough is is huge.
You just got to do it, do your business.
(35:48):
Yeah, get it done. Get it done.
Thank you so much, Doctor Heyman, for being here, for
everything that you covered, youshared about male infertility.
Definitely encourage anybody listening that has follow up
questions or would like to do a consult with Doctor Russell,
please reach out to him. We'll put the contact
(36:09):
information and the description.So you have all of that.
And thanks again, Ross. Can't say that enough to you.
Absolutely, my pleasure. To everyone that is listening,
that is navigating infertility, recurrent pregnancy loss, any
type of pregnancy loss, infant loss, please know your story
matters, your baby matters, and your grief matter.
Healing doesn't always follow a timeline.
(36:30):
Trauma and loss don't have a schedule and you deserve
compassionate care through everystep of your journey.
If you need support, we have free daily support resources and
a community at Chasing the Rainbows.
Because every loss does matter. If this conversation resonated
with you, please share this episode with someone who may
need it and to hear it as well. And if you are looking for
(36:50):
support, want to volunteer, donate, host an event, please
visit chasingtherainbows.org. Thank you for being here, for
listening, and for continuing tobreak the silence around
infertility and baby loss. Until next time this is cried
out loud.
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