Archive for the ‘male infertility’ Category

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Infertility: Window into Men’s Minds

Monday, July 13th, 2009

It's true...it hurts to be infertile. Like any other disease.

It's true...it hurts to be infertile. Like any other disease.

Recently, sitting face to face with an infertile patient, I asked him what the first thing was that came to his mind after being told that he had no sperm count. After a short silence in which his eyes gazed downward and then back again toward me, he stated, quietly “I thought it might be the end of my family lineage.”

Facing a diagnosis of infertility is one of the loneliest experiences a man can have, as evidenced by a study I recently co-authored with Drs. James Smith and Patty Katz at UCSF. Published in The Journal of Sexual Medicine this week, it found that men with a diagnosis of male infertility suffer intense negative sexual, personal and social strains that might be considered typical for other medical illnesses, including cancer. It affects not only their self esteem, but their sexual confidence and sexual function. Think about it. Men find the inability to sire children a real and palpable blow to their manhood and self-identity. The impact of this diagnosis is easily comparable to the mortal challenge associated with a cancer diagnosis. Infertility causes an immense strain to their relationships both with their partners and socially. Adding to the strain, this diagnosis is as taboo as syphilis or AIDS. The ramifications for the rest of his life are significant, especially if his lifelong assumption was that having kids is normal, expected, eventually, would not be a problem. Infertility is often one big secret that is kept from the rest of the world, making the patient, and his partner, feel isolated and desperate.

I have seen this distress in my practice, day in and day out, for years. Finally, through this study, some proof has surfaced that male infertility is one of the toughest challenges a man can face in life. The funny thing is, male infertility is not as uncommon as one might think. It affects 10% to 15% of reproductive aged couples worldwide. About half as common as diabetes. But far more silent a disease than diabetes. The bright side is that it is treatable in many cases.

So what should men do if they have a diagnosis of infertility? First, get information so that you can make decisions and get control of the situation. You need to “own” it, and this is a great start. Learn through websites such as ASRM.org and SSMR.org, or TheTurekClinic.com and see a urologist or specialist. Also, talk openly with your partner and people you trust, and get the support that you need. Decide with your partner who needs to know about this and who doesn’t. Keep the lines of communication open with your partner, as this can be the most significant threat your relationship will ever see. Keep doing the things that you do best, as these are not likely the cause of infertility and can keep the balance in your life. Importantly, take time to “blow off” stress through exercise, sports, yoga, massage or whatever works for you. Maintain that critical balance as you tackle this issue like you have tackled others, and as you will tackle future issues.

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No Men. Just Sperm.

Thursday, July 9th, 2009

Does this look like a real sperm? Do you believe in UFO's?

Does this look like a real sperm? Do you believe in UFO's?

We saw it coming. We created stem cells from testis tissue and published it earlier this year and I mentioned previously that it should be possible to do the opposite and create sperm from stem cells. Well, as announced yesterday from a research group in Britain, that possibility is closer to becoming a reality. Sperm created in a Petri dish. Artificial sperm.

Published yesterday in the journal Stem Cells and Development, this is being hailed by the press as “breakthrough” research. Now call me cautious, or call me a stem cell biologist, but I get suspicious when that term is used to describe medical research. More on that later. The technique, discovered by a team of biologists at the University of Newcastle in England and led by Dr. Karim Nayernia, purports to have created actual moving sperm from human embryonic stem cells. Not in a testicle, but in a laboratory dish. This group has some amount of “street cred” as they had previously published a paper in which mouse embryonic stem cells were used to produce in a dish. In fact, these sperm were injected into mouse eggs, formed mouse embryos and baby mice. However, a close look at the small print reveals the mouse pups all had “growth abnormalities” and died after birth.

Now back to being Mr. Cautious. If you look closely at the figures and video in the human paper, you might not be convinced that these are actual sperm. Pictures are a little too fuzzy. Kind of UFO-like. Could they really be neurons instead of sperm? Also, the sperm neither look nor move quite like what we would expect with normal sperm. Finally, some of the “reporter” genes that are used to classify the genetic origin of the cells are not working all that perfectly. Why didn’t the researchers provide more convincing evidence of the universally recognized elements of a sperm including the acrosome, midpiece with mitochondria and characteristic axonemal structure? Oh, and where are the controls?

There is no doubt that Dr Nayernia will face scrutiny for this work, as he has before. And this is all good. Because if the scientific world believes that it is true, then this is an amazing feat of science with enormous potential. For such acceptance to occur, a confirmatory study by another group will likely be necessary. Maybe ours, as we are investigating the same concept but in a radically different and much more feasible way—by trying to create an entire artificial testicle instead.

There are other meaty issues surrounding this research. Is it safe? Is it practical? Remember how inefficient it was to clone Dolly the lamb? Inefficiency runs rampant in any reproductive process. As an example, say that you discovered that humans can reproduce through sex and tried to license the process. With a 20% efficiency rate, you would probably be denied the license. On the other hand, if it is really true, this work has demonstrated the enormous potential of embryonic stem cells, as making a sperm is about as complex a process of cellular transformation that you will find in the body. Making bone, cartilage or heart cells should be much easier. Will it ever get to the point in which a healthy child might be conceived in this way? If that happens, then I might start thinking more about the real role of man in mankind. But not sooner. After all, if men become redundant in the reproductive process, who will replace men’s uncanny knack for opening jars?

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Stem Cells, Snake Oil and You

Monday, May 18th, 2009

Stem cells are past the snake oil stage of medical treatment

Stem cells are past the snake oil stage of medical treatment

We’re way past bottled snake venom now. The new miracle medical cure lies deep within us, in our stem cells, if we can only figure out how to tap into them. 100 days into President Obama’s term, and it seems that the scientific community here in the U.S. might just be getting the fuel it needs to make major headway. The ban on using federal research money for stem cell research has partially been lifted, and I imagine that more funding is to come. A wise investment, I say. The potential for stem cells in medical care is simply enormous. I say this without hint of idealism, or romance, since I myself have seen what stem cells can do in my research with Stanford.

True stem cells are “pluripotent.” That is, they have the ability to become all of the different types of cells in the body. They could be used to rebuild or replace damaged tissue that is difficult or impossible for our own bodies to repair. Take nerves for example. If nerve cells degenerate, as occurs say with multiple sclerosis, one could apply stem cells to replace those degenerated nerve cells. These same stem cells could also replace damaged tissue associated with lung cancer, or Parkinson’s disease, or diabetes. Many conditions, including these, can currently be medically controlled, and made easier to live with, but they can’t be cured. Stem cells may change all that. For example, if eyesight has been lost due to corneal damage, we may be able to use stem cells to grow a new cornea, and restore lost vision.

There are many hurdles to overcome, some of them highly technical problems dealing with how to get from point A to point B. And cells that come from someone else can potentially be rejected. Even still, there are questions that may never be satisfactorily answered, ethical and cultural questions. Truly pluripotent stem cells are currently taken from embryos. When embryos get older, we call them fetuses, and when they are born, we call them children. The meaning of taking basically the seedling of a human being to treat another isn’t easy for some people to swallow. For others, the idea of cell-based therapy goes against deeply rooted notions of what is natural on this good earth. How you feel about this reaches into the most sacrosanct places in the heart and mind.

But there are other possibilities besides taking stem cells from embryos. “Adult” stem cells are stem cells made not from embryos, but from the tissues of fully grown adults. Bone marrow is a good example. Within bone marrow, special cells exist that can create all the cells within your blood. It could be that almost every tissue in the adult body has some kind of adult stem cell within it. Such cells might be able to be harvested from the same patient who needs treatment. Manipulated in a dish, they could be coaxed into other tissues, just like embryonic stem cells. This would avoid the issue of rejection discussed earlier, as well as the ethical questions raised from using embryonic stem cells. Currently, this coaxing is only possible with the help of viruses that introduce specific pluripotency genes into the adult cells and transform them into embryonic like cells. But who knows what tomorrow will bring? As I said, I have seen the potential already in a petri dish. More on that in my next posting.

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Men, Oysters and Sex

Tuesday, April 7th, 2009

The Miraculous Oyster

The Miraculous Oyster

The eating of an oyster is a tale of seduction. Crack open its rocklike shell at its most fragile point and it gives easily, revealing the delicate tissue at its heart. Eat it raw and it tastes of the soul of the ocean that made it. To many, it’s food pornography. An aphrodisiac.

But oysters don’t make you a sex machine. It’s a just a myth. There is simply no scientific evidence that these tender sea dumplings help maintain erections, improve stamina, or enhance arousal. They may make you think about sex. Which is as good an aphrodisiac as any.

Despite the sexual innuendo inherent in these mollusks, there is a lack of scientific support that oysters are sexual performance boosters. Oysters do support a healthy body, and so a healthy sex drive. Along with being a protein source, they are rich in zinc, a deficiency of which can cause impotence. Zinc is also a necessary building block for testosterone, so it supports a healthy libido and sperm production. But zinc is common enough in other foods, such as chicken and turkey, and no one considers poultry an aphrodisiac. In rat studies, oyster extracts lower cholesterol levels and blood pressure, but changes in mating patterns have not been investigated. And at least one human clinical trial reports an improvement in cholesterol in healthy men with an oyster-rich diet. However, like in the rat study, sexual activity and performance were not examined.

That said, oysters contain something that can’t be scientifically quantified. Romance. And that’s a vitamin for the soul as well as the body.

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What we found: Male infertility and Cancer

Thursday, March 19th, 2009
The genetic complexity of sperm and precursor cells when the chromosomes are painted is similar to that of constellations of planets and stars, and look very similar.

The genetic complexity of sperm and precursor cells when the chromosomes are painted is similar to that of constellations of planets and stars, and look very similar.

So what did we find?

The study showed that men who are infertile have a much higher risk (3 times) of developing testis cancer later in life than the average citizen. And this was based on some serious number crunching. We worked from a huge database of over 51,000 infertile couples who sought care over a 22 year period in California.  The male partners were cross referenced with a California cancer registry to figure out who among them developed testis cancer as they got older. Among infertile couples in whom the male partner was not the reason for infertility, the future risk of testis cancer was the same as in the general population. However, among infertile men who were themselves the cause of the infertility, the risk of future testis cancer was 3 times higher.

So what does this really mean? Well, first of all, it confirms studies from Europe that have suggested the same thing is happening there. This confirmation in a U.S. based study is important, because the rate of testis cancer in many European countries is much higher than it is in the U.S. It also implies that there may be a connection of some kind between male infertility and testis cancer.

But what kind of connection could exist between male infertility and testis cancer? Well, environmental exposures might link these two conditions. However, the kinds of substances that could do this are still unclear. Estrogenic compounds such as bisphenol A, phthalates and pesticides have garnered much press lately as they alter sexual development in animals, but have not been definitively linked either to testis cancer or human infertility.

The connect, I think, may be even more basic: it probably involves genes and gene mutations. About 10 years ago, we and others reported that severely infertile men have more trouble than other men in properly repairing the daily breaks and kinks that occur in everyone’s DNA with daily use. Because faulty DNA repair is clearly associated with cancer in humans, this led us to surmise back then that infertile men with faulty DNA repair might have a higher risk of cancer later in life.  And voila! The results from the recent research appear to support this idea. 

For the time being, the risk holds only for testis cancer, but who know what future research will show? Based on this, I recommend that all infertile men certainly be evaluated by a urologist with a good history and physical examination. They should also be taught testicular self examination as a screening tool to detect testis cancer.

Infertility as a window into men’s health?  As a shift in thinking, it certainly does shine a new light on the problem.

 

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