Turek On Men's Health » Testis Cancer

It’s in the Steak

Paul Turek, MD — Tue, 21 Feb 2012 16:00:48 +0000

Hope is a core value of children (Drawing courtesy Sophia Turek, age 7)

In quiet moment on the couch, I recently asked my 8-year old daughter what the word “hope” means to her. “If life were a meal, hope belongs in the steak,” she said.

The food metaphor didn’t surprise me, as with most kids her age, she thinks about it a lot. What did interest me was that, in her view, hope takes center stage. It’s not the cupcake for dessert. Or a sweet milk shake, or potato chips. To kids, hope is serious stuff, right smack in the middle of the main meal. Just a hunch, but I am convinced most adults would not put it there.

A Telling Telephone Call

He called from Kentucky. Having read about our recent research story about obtaining grant funding to build an artificial testicle, he wanted to know more. As a cancer survivor, he had no chance of fathering a child. He asked great questions about where the research was going and the expected time line for generating sperm from stem cells. I answered frankly as I am not a fan of dangling carrots or pipe dreams in front of others. He listened intently and thanked me kindly. I asked him to keep in touch, and that was that.

Little did he know such brief but meaningful conversations stokes my fire and fuels me to imagine, begin, execute and finish such far-fetched research projects.

Little did I know how that single, brief exchange also affected him. The next day, the Clinic received a new Yelp review (don’t get me started on this…just compare the visible reviews on the page with the invisible “filtered” accessed at the bottom). Curious, I read it. It blew me away. It went something like this (edited for brevity):

“H-O-P-E; that’s what Dr. Turek has given me; new found hope…..” After a 16-year nightmare with testicular cancer, once in 1996 and again in 2002, a good friend of mine forwarded me the most shocking, exciting, uplifting, inspiring article I had EVER read. I anxiously and carefully read it word for word, line for line, as I could not believe what my eyes were reading and my mind was comprehending. My instinct, was to call Dr. Turek’s office immediately as I was yearning for more information.”

“After talking with his office staff, a phone conference was scheduled for Dr. Turek and I within the next 3 days…Dr. Turek gave me “me” and he gave the rest of the testicular cancer world a vision that we never imagined possible… I will strive daily to do everything in my power to assist Dr. Turek in seeing this miracle discovery come to life. I will do whatever, whenever, whereever it takes to be a part of this life changing miracle. I am inspired, encouraged, and relieved with the hope of tomorrow for me and for others.”

For the first time in years, the man from Kenucky felt a ray of hope. And in some small way, his life is different today than yesterday.

Hope not Hype

So what is it about being an adult that takes the hope out of our “steak?” Why do long, strong doses of reality make it harder to dream the unimaginable? There is so much promise in hope that I, for the record, refuse to give it up. I agree with the old French Proverb that “hope is the dream of a soul awake.” You can expect more of the unimaginable out of me before my time is up on this good earth.

An Ounce of (Fertility) Prevention

Paul Turek, MD — Mon, 17 Oct 2011 15:00:19 +0000

Kokopelli, the ancient fertility symbol.

“I’ve been told that my cancer is now cured… how do I get my fertility back?

Patients ask me this question weekly all the time and I am glad to help. Some of the most satisfying medical moments I’ve had are associated with these patients.

But when I hear this call for help, it also reminds me how medicine has been remiss in preventing the infertility in the first place. We can do better and we can do it right now.

The topic of fertility preservation is the substance of my recent lecture at the annual meeting of the American Society of Reproductive Medicine (ASRM) in Orlando, Florida. This well-attended course focused on the prevention, treatment and restoration of male fertility in the setting of sterilizing treatments typical of cancer therapy.

The goal of my lecture was to review and update providers on current and future strategies for the preservation and restoration of male fertility. Here are some of the ideas discussed. I’ve also included a link to the lecture slides if you are so inclined.

Preserving Male Infertility

Sperm banking. A 200-year old technique that is the purest form of preventative medicine, it is vastly underutilized, not covered by insurance, and not routinely offered to many cancer patients before treatment. What gives? Here is where we need to do the most work in this field.
Sperm Harvest. For 15 years, it has been possible, nay routine, to harvest sperm from men who want children after having a vasectomy without reversing the vasectomy. This same technology is easily applied to men before, during and after sterilizing cancer treatments. One very successful example of this in my practice is fine needle aspiration “mapping” of testicles for sperm in cancer survivors. Indeed, no-touch, metabolic imaging for sperm may be the ultimate iteration of this concept.
Electroejaculation. Based on decades of successful use in spinal cord injured men, artificial stimulation of ejaculation can be a very effective way to bank sperm or restore fertility in men or post pubertal teens who have had nerve damage to reproductive organs from cancer surgery.
Shielding Sperm Production. Physical shields are routinely used to block the effects of aberrant X-rays from hurting sperm production during treatment. In animal models, hormonally induced shut down of sperm production can protect the testicle during the storm of chemotherapy as well.

Restoring Male Infertility

Stem cell transplantation. Currently possible in animal models, this involves taking the delicate testicle stem cells from either pre- or post-pubertal boys or men and freezing the cells before cancer treatment. Subsequently, the stem cells are thawed and replaced back into the testicle to restore sperm production after the cancer is cured.
Sperm Maturation in a Dish. A variant of the above, also demonstrated in animal models, this technique involves maturing stem cells harvested from the testicle before cancer treatment in the laboratory all the way to their final form: a sperm with a tail.
Sperm from Stem Cells. Yet another variant of the above that has been demonstrated in animals, this involves growing usable sperm from early, pluripotent stem cells such as embryonic or adult pluripotent stem cells. One example would be to take a skin biopsy from a sterile man, coercing them to become adult stem cells and then push those cells to sperm in a dish. Truly, a fantastic outcome of America’s investment in stem cell technology.

Fertility Restoration after Cancer: Current and Future Therapies by Paul J. Turek MD, FACS, FRSM Director, TheTurek Clinic, San Francisco (WARNING: Images in slides not appropriate for all audiences due to subject matter)

View more presentations from Dr. Paul Turek | The Turek Clinic

Cancer’s Second Hit

Paul Turek, MD — Mon, 15 Aug 2011 15:00:15 +0000

A holder of "two hit wonders" of a different kind

“This is as hard on me as having cancer was. The difference is that being infertile is not life threatening; having cancer is.”

These are the words of a young cancer survivor sitting in my office who is now dealing with infertility, a common consequence of cancer treatment. Yes, he is very happy to be alive. Yes, he is grateful for each new day and knows exactly what it feels like to look death in the face and skirt it. But, what is also clear is that the infertility hurts, hurts a lot, and hurts all over (again).

Surviving Cancer: The Numbers

Thankfully, surviving cancer is now quite common. Over 80% of childhood cancers are overcome and well over a million people in the U.S. are alive 25 years after cancer treatment. This means two things: 1) cancer defines quality of life among many of us, and 2) cancer and reproduction are bed partners in younger survivors.

The Effect of Infertility on Life

It is my belief that infertility affects a man’s quality of life as profoundly as cancer does. My patient’s statement is simply another reminder of this truth. But this is hard to prove, because the “tools” and “instruments” used to assess the impact of cancer on quality of life do not exist for infertility. And, for academic reasons, they are hard to compare mano e mano.

As a start, we studied how infertility affected men who were not necessarily cancer survivors. In 357 infertile couples, we looked at the “strain” (personal, social, sexual, and marital) caused by having a male factor infertility diagnosis. Importantly, these men underwent formal face-to-face interviews and filled out questionnaires as they were battling the infertility problem. In this way, the immediate impact of having the diagnosis was assessed in couples and not the memory of infertility, which is often softened by time.

What we learned was that infertile male partners had a lower personal and sexual quality of life compared to men without male infertility. Examples of how we defined personal issues are: lack of control, missing something in life, inability to meet life goals, or feeling defective. Examples of sexual issues are: level of sexual enjoyment, perceived attractiveness to partner, failure with sex because of fertility problems, and persistent thoughts of having a child during intercourse. I would wager that cancer affects personal and sexual quality of life in similar ways.

Infertility: An Owner’s Checklist

So, being infertile matters to men. And it matter a lot, sometimes more than anything else. What can you do about it? Here’s the checklist for surviving infertility:

Get information. It helps control of the situation. You need to “own” it.
Talk openly with your partner and trusted others. Get the support you need.
Keep the lines of communication open with your partner. This may be the most significant threat your relationship will ever see.
Keep doing the things that you do best. They are not likely the cause of infertility and can keep the routine in your life.
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.

The Google Wrap (Up)

Paul Turek, MD — Sat, 18 Jun 2011 16:06:40 +0000

Google: Feels like college all over again…

Got a slice of Google life this week with a lecture and lunch on the Googleplex campus. Here’s the Google wrap up. Now, this is a company with great ingredients for a healthy work life: Yoga and massage classes, personal trainers, free bicycles, three squares a day, an on-site doctor, haircuts, car washes, dry cleaning, rubber exercise balls everywhere, and health and wellness lectures at lunch. In the words of CEO Eric Schmidt “The goal is to strip away everything that gets in our employees’ way.” Nothing like the corporate America of yesteryear. Truly, a very tasty wrap.

The Guy’s Guide to Maintaining Sexual Health Talk

My talk was well attended and, as far as I could tell, no one fell asleep. Maybe it’s because I kept up the pace. Or, maybe the young Googlers were riveted by my relatively disruptive philosophy how best to identify and care for men’s sexual health issues. If you just can’t wait for the YouTube video to be posted on Google Health in a week or two, here’s the meat of it:

Young men are medically underserved in America.
One problem that contributes to this is that their care is fragmented and reductionist in nature since it is provided by various doctors.
One helpful solution would be to train more men’s health specialists who “own” all aspects of young men’s health.
Another problem is that men do not have biological reminders, or biomarkers, of their health, unlike the menstrual cycle in women.
Importantly, sexual health issues such as low sex drive, erectile dysfunction and infertility are intimately relatedto overall health. Examples:
- Men with erectile function are twice as likely to have heart attacks later in life.
- Men who are infertile are 2 to 3 times more likely to get testis and prostate cancer, respectively, later in life.
Maintaining good overall health is a great way of optimizing sexual health. The reverse is also true.
Sexual health issues should therefore be considered natural biomarkers of overall health for men.
If we educate men about such natural biomarkers, then they may assume more “ownership” of their health and live healthier, productive and maybe longer lives.

Googlers Care

I have to admit the Googlers surprised me, right off the bat, at start of the talk. Watch the YouTube video and you’ll see. Not surprisingly, when I asked the audience how many of them get regular oil changes for their cars (not knowing that Google provides this service for them), most of them raised their hands. However, when I asked how many of them had been to a doctor in the past year for a personal checkup…again the majority raised their hands. More than I had ever seen among young men. This is a good sign, to see men taking equally good care of their bodies and their cars. I see this as a powerful first step for men to achieve “ownership” of their personal health and wouldn’t you know it, Googlers are leading the way. Happy Father’s Day.

The Talk:

Video -

Slides -
The Guy’s Guide To Maintaining Sexual Health By Paul J. Turek, MD

View more presentations from Dr. Paul Turek | The Turek Clinic

I’ve Been Googled!

Paul Turek, MD — Sun, 12 Jun 2011 06:24:46 +0000

Lecture in the Palazzo Vecchio: Where do you go from here?

I’ve given countless lectures in innumerable countries over the last two decades, but I am most excited about the one I am giving next Wednesday. Google has asked me to speak to them during Men’s Health Week. Right down the road at the Googleplex in Mountain View, in the very heart of Silicon Valley.

The Google Invitation

I was enamored when asked to speak at the Palazzo Vecchio in Florence, beneath Vasari paintings. I was excited to lecture at the University of Istanbul and spend a day staring at the timeless space that is the Hagia Sophia. And I still jump at the chance to advise our government (the NIH) on matters of men’s health as I feel I may actually be influencing the direction of medical care in our country.

But an “ask” at Google, although not as architecturally or nationally historic, is still an important one, because I may, in some small way, directly influence health care attitudes and awareness among a group (young men) that I consider “medically underserved” for various reasons.

Google didn’t exist 14 years ago. Five years ago, the word “Google” was included as a verb in legendary and authoritative Oxford English dictionary. (“He’s been googling all day.”) Lately, I have the impression that Google may be taking over the earth as we know it. A lecture at Google therefore, offers not only the opportunity to bring medical awareness directly to men, but to a population of men who either are or will be primary “influencers” of other men.

Google Health

Although collectively they may understand all of the secrets of the digital universe, at the end of the day, Googlers still eat, sleep and procreate like the rest of us. Google Health, guided by the moniker “better health comes from better information,” is a recent health and wellness initiative at Google that has taken this quite seriously. It offers nifty tools for anyone to maintain their medical record, set personal goals, track progress with personalized tools, and share health information if they desire.

Personally, I think this is an excellent program for young men since, as a group, they 1) tend to feel immortal and 2) absolutely live for numbers and data. And what numerical trend in their lives is more important to realize and act upon than that suggested by their own bodies? It’s similar to the vintage Maserati with gauges that actually work.

Advice to Google on Sexual Health

My advice to them during Men’s Health Week is contained in a talk entitled “A Guy’s Guide to Maintaining Sexual Health.” What do I mean by sexual health? Issues with erections, sex drive, hormones, fertility, testis cancer, contraception and sexually transmitted diseases. Here are the main points that I’ll make:

Having sexual health issues is an easy way to keep from feeling truly immortal.
Most sexual health issues are easily treatable.
Sexual health is intimately tied to overall health
Therefore, a better understanding of sexual health issues will help you on the path toward immortality.

Remember, your body is the only place you have to live; don’t treat it as though you are renting it. I will see you on Wednesday.

The Solitary Life

Paul Turek, MD — Sun, 24 Oct 2010 05:00:42 +0000

Freed from the confines of the solitary.

He called me from rural northern California and the phone conversation went something like this:

“Er… hello. I…I was wondering if you could help me.”
“Sure, sir, how can I help you?”
“Well…I’m single and haven’t dated in 20 years, but would really like to.”
“I’m not so sure that I am the one to ask on matters like that!”
(Laughs nervously) “I just haven’t had the nerve to date anyone.”
“If you are worried about your erections, I can certainly help with that.”
“No…no…it’s more that I’m worried that they will find out…” (goes quiet)
“Find out what, if I may ask?”
“Well, that I only have one ball left” said the Solitary Man.

And so it goes. A man is his mid-40’s diagnosed with testicular cancer in his 20’s and cured by removal of his right testicle. And now, after leading a solitary life for 25 years, he wants his sex life back. Surely, losing a testicle wouldn’t affect a man that much.

An unusual story? Not at all. In 1996, I led the study team that investigated the safety of using a newly designed testicular implant in boys and men who had never had, or had lost, a testicle. At this time, the FDA required extensive safety data on all new implants because of the cancer scare associated with leaking breast implants in the past. That same scare led to the pulling of all kinds of implants off the market, including a tried and true testis implant that had a perfect track record. Several years later, collaborating with 14 university medical centers nationwide, I published the research that showed that the new testis implant was entirely safe and it became the first (and still only) FDA-approved implant to replace this organ.

Proving that it was safe is only half the story though. It was also effective, very effective. What does that mean? For the study, we had men complete validated psychological questionnaires, termed “instruments,” that addressed confidence, self-esteem and body image before and after implant placement. We asked questions that no one had ever asked these men before. And what we learned was impressive: Men felt better about themselves, were more confident, and felt whole again. And these gains translated into real changes in their lives, both socially and professionally.

I recently placed the testicle implant that I had designed and studied into The Solitary Man. I put it right where his original testicle was before it was removed and placed it in less than an hour. He went home the same day and I saw him again 3 weeks after the procedure.

If it weren’t for the Pendelton wool shirt and boot jeans, I might not have recognized him; he was a changed man. He had a grin from ear to ear, a deep sparkle in his eye and a new bounce in his step. I asked him how he was doing and he responded, almost wet eyed: “I’m dating again.” Miracle? No. Magic? Yes.

Weed Worries

Paul Turek, MD — Sun, 17 Oct 2010 14:25:22 +0000

An international symbol of peace…or cancer?

A good rule to follow in medicine when evaluating whether research should be translated into clinical care is “reproducibility.” Good research, that is research that is likely to end up as “true fact” in the long run, is reproducible…not just by the original researchers, but also more importantly by others in the field. In med speak, where the number of syllables matters greatly, we call this “independent confirmation.”

The legalization of pot has been in the news quite a bit lately, especially in California. So hasn’t interesting research linking pot use to testis cancer. I have been tracking this research since 2009 when a study first associated pot use with higher testis cancer rates. Clinically, it suggests that pot use is a “risk factor” for testis cancer. Recently, another research group has confirmed this finding in different men in a different place. Independent confirmation. Two for two. Now that gets my attention.

Testis cancer is the most common cancer in young men ages 15-35. Of real concern is that the rates of testis cancer are rising 3-6% annually since the 1970’s in the US and even faster in Europe. It is usually caught early and is highly curable, but it should be avoided at all costs. It brings along with it other multi-syllable words like “orchiectomy” (testis removal), “chemotherapy,” “radiotherapy,” “infertility,” and “hypogonadism” (low testosterone) which are all as ugly as they sound. Currently, there are few known risk factors for testis cancer except a history of an undescended testicle or other condition resulting in abnormal testis development, a family member with testis cancer, being Caucasian, and possibly infertility. Sooner rather than later, we may need to add chronic or frequent pot use to the list.

How much pot is risky? Both studies showed that long-term pot use (greater than 10 years or since adolescence) and greater than once weekly users had twice the rate of testis cancer as nonusers. In the more recent study, daily marijuana use tripled the risk of testis cancer. And the strength of these links held strong when other lifestyles issues such as alcohol and tobacco use were considered.

How does pot increase the risk of testis cancer? Not clear really, but pot does contain potential “carcinogens” (another big word) like tobacco and can alter testosterone balance. Both of these can unfavorably alter the testis environment in a critical way.

At this point, being the prevention guy that I am, I recommend stashing the sweet Lucy, junking the joint, cutting the grass, pitching the pot, winging the weed, burying the bammy and heaving the hemp. It’s just not worth it.

A Good Planet is Hard to Find

Paul Turek, MD — Sun, 01 Aug 2010 17:33:30 +0000

Just say no.

Most couples in most countries will conceive within a year of trying. Families in the Ukraine take an average of 2.5 years, according to a new U.S. publication. Why? Radiation discharged from the ill-fated nuclear explosion at nearby Chernobyl in 1986 is the likely culprit. Male infertility is the consequence.

We know that sperm production is exquisitely sensitive to radiation, and we actually know how sensitive it is to this exposure. Believe it or not, this was demonstrated in a series of never-to-be-repeated experiments conducted in the 1960’s right here in America. Recall that this was the time of the Cuban Missile Crisis and extreme Cold War tension. The Walla Walla experiments in Washington state involved irradiation of 64 prisoners with various dose levels at Washington State Penitentiary to find the dose that would sterilize them. A similar, second set of prisoner experiments were also conducted at Oregon State Penitentiary during the same period. These studies on “volunteers” demonstrated two things: 1) prisoners do not have the free will to be considered for scientific experiments and 2) the testis is very sensitive to radiation.

How sensitive? Let’s use a chest X-ray for comparison (0.1 mSV). When 15 mSV (150 chest X-ray equivalents) of radiation was aimed at the testis, sperm counts fell. When 50 mSV (500 chest X-rays) were used, it caused temporary sterility. And after 500 mSV (5000 chest X-rays) of radiation, permanent sterility resulted.

So, it is not surprising that a nuclear explosion in the Ukraine occurring 24 years ago over a fallout area 1/3 as large as Iceland’s recent Eyjafjallajokull volcano (19,000+ square miles) might have an effect on human fertility in the surrounding area. Those exposed to radiation as children are now grown, have survived their thyroid cancers, and are trying to reproduce.

As a scientist and doctor, teacher, humanitarian and ethicist, I find this world an often frightfully complex place, mainly because of a failure to learn and grow from our mistakes. Haven’t we realized that good planets are hard to find? In the case of Chernobyl, and in the words of Alan Eddison:

Modern technology

Owes ecology

An apology

Genome: Repair Thyself

Paul Turek, MD — Mon, 22 Mar 2010 05:02:15 +0000

How damaged is your genetic sheet metal?

Imaging parking your car at home after work and all the nicks and scratches are removed while you sleep, before heading to work the next day. All shiny and new, polished even, while you sleep. Believe it or not, this is normally what happens to your genes and chromosomes on a minute-to-minute basis. DNA mismatch repair is a constant and vigilant process, occurring in all cells of the body. Why the biologic vigilance? Well, It keeps us whole, healthy and cancer free.

About 11 years ago, we published a paper showing for the first time that infertile men can’t repair the errors normally encountered in their DNA as well as normal men. This was startling news in part because it implied that infertile men may be more likely to develop other problems later in life, including cancer. Why cancer? Because the development of cancer has been associated with the inability to normally repair the frequent daily errors that occur to one’s DNA as the body’s cells divide and renew.

Today, however, we know much more. We know that testis cancer is 3-fold more likely to occur in previously infertile men than in fertile men as they age. And our latest research has shown that prostate cancer, thought to be a disease exclusive to older men, occurs more seriously and more commonly in previously infertile men.

So what does this mean? Is male infertility the first sign of a larger problem in our species? It is the ultimate medical problem of a species trying to reproduce? Well, honestly it isn’t entirely clear. However, to me it indicates that male infertility should certainly be considered an insurable and real medical condition that should be taken as seriously as a heart attack. Even more worrisome is the issue of whether the use of sperm from severely infertile men is putting their offspring at even higher risk of medical issues than that experienced by their fathers.

So do not ignore the infertility issue when it strikes and get that male partner evaluated by a specialist. Teach him to perform testicular self-examination, a simple maneuver performed once monthly in the shower that has far more potential to extend his life than even exercising or weight control. Educate him about prostate cancer so that he does not ignore the powerful screening tools available to find it early. The age of innocence is over. The warning signs are now clear; get men the care that they deserve.

Keeping the Family Jewels Shining

Paul Turek, MD — Sat, 02 Jan 2010 18:47:05 +0000

Heirlooms for the species.

As a living, breathing being on this good earth, we tend to take things for granted. The ability to have offspring can be one of them. That is, until the day that a serious medical condition like cancer rears it ugly head and puts childbearing at risk. In addition to the sterilizing effect of cancer treatments, the mad rush to treat the disease often marginalizes efforts to preserve fertility. Fire all the canons and check for collateral damage later.

Fertility preservation seeks to protect men, adolescents and children from a common, serious and impactful side effect of cancer treatment: infertility. The goal of fertility restoration is to empower patients who are cured and potentially infertile to bear children. These related fields have burgeoned recently because medical care is now shifting from curing cancer to improving the quality of life among survivors. And without a doubt, for many, fertility is a key quality of life issue at some point. Thankfully, exciting new methods of restoring fertility have already been developed and even newer technologies are under study.

Classic techniques for fertility preservation in men include gonadal shielding and sperm banking. Gonadal shielding uses lead-based devices to protect the testicles from being struck directly by sterilizing radiation treatment. Sperm banking is the process of freezing healthy sperm before cancer treatment begins for later use to conceive. But there is more. For patients who are too young to bank sperm, for those who have precious little time to bank sperm, or for those who have no ejaculated sperm to bank, testis sperm retrieval by biopsy (TESE) or needle aspiration (TESA) for banking is now possible before cancer treatment. In fact, in some cases of testis cancer, it is possible to remove only the cancerous nodule instead of the whole testis, or to freeze sperm from the testicle after it is surgically removed. These are now routine ways to preserve fertility in men.

Fertility restoration for men has also seen real advances lately. Sperm “mapping” is an innovation that I developed for men who survive cancer treatment but have no sperm in the ejaculate. It non-invasively and non-surgically deciphers whether there are small numbers of mature sperm in the testis, too few to get into the ejaculate, but usable nonetheless. In men who sustain nerve injury from cancer surgery and who are unable to ejaculate, a special medical instrument can produce an ejaculate for fertility purposes in a process termed electroejaculation. Techniques such as these are valuable tools to help men deemed “sterile” after cancer treatment to become fathers.

One of the most exciting areas of fertility restoration involves stem cell technology. Yes, the “promise” that we have all heard about stem cells curing disease will likely find its way into the fertility field as well. In pre-pubertal boys with cancer, ejaculated sperm is not present. Despite this, it may be possible to freeze the early stem cells from the testicles of boys before sterilizing treatment. After thawing, these “adult” stem cells may later be used to create sperm after further growth in a Petri dish or after transplantation back into the same individual. Also on the horizon is our ability to take skin cells from a sterile man, convert them into an embryonic-like stem cells and then “drive” these cells to become mature sperm in a dish–a true “artificial testicle.” So, with the belief that hope can cure misery, the world of science has taken fertility research from science fiction to reality. Not convinced? Stay tuned!

What we found: Male infertility and Cancer

arthurofsun — Thu, 19 Mar 2009 17:35:25 +0000

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.

Male Infertility and Cancer Later On