Posts Tagged ‘Assisted Reproduction’

Newer Entries »

Baby Making Tips

Wednesday, August 19th, 2009
The most fun he ever had without laughing

The most fun he ever had without laughing

You might have “practiced” the art of baby making for quite a while. But have you actually tried to make a real baby? What does it mean when a couple says they’re “trying”, besides jettisoning the condoms, scheduling free time, and practicing your “sore throat” voice for calling in sick to work. No one teaches you the nitty gritty of baby making in sixth grade sex ed classes. So, here are some of the finer points.

First of all, your chances of conceiving decrease if the two of you are under stress. Frequent travelling, major life changes, a long sickness, being vetted for the Supreme Court, running a start up with a gazillion hours weekly, are terrible for getting one “in the mood.” If the body is under stress, it’s in the primitive “fight or flight” response, and it’s not exactly in the mood to reproduce. So to improve your chances, decrease your stress level by eating well, sleeping well, staying healthy and relaxed, and treating your body right. If you are chronically overworked, you may consider decreasing or delegating your responsibilities. If this isn’t possible, force your body to relax with exercise, yoga, massage or acupuncture. Also, quit smoking, drink no more than two glasses of alcohol daily and avoid hot tubs and hot baths (showers are fine).

Like many things in life, timing is everything. Eighty percent of pregnancies occur when sex takes place before or during ovulation, which is the time when a woman’s ovary releases an egg for fertilization. But how to tell when ovulation is occurring? The most accurate way would be with an “ovulation predictor kit” purchased at any drugstore. Like a pregnancy test, it uses urine to determine if ovulation is about to occur. The old-fashioned method, which also works well, would be to pay attention to her basal body temperature. To do this, she should take her temperature first thing in the morning, for a string of consecutive days during the middle of her monthly cycle. There should be a dip in her temperature, followed by a rise. This indicates ovulation.

Once you know that the egg is on its way, intercourse is best performed every other day. Men need time between ejaculations to “reload”, and daily intercourse may not give a man enough time to do so (sorry guys). As for the act itself, studies have shown that no particular position is best. Research is suggesting that the two of you can bend yourselves into pretzels, if desired, with no effect on your chances of conceiving or on the gender of the child.

Baby making is a special experience. And, it’s fun! As Woody Allen said in the movie Annie Hall, ”…sex is the most fun I ever had without laughing.” If you think about it, what I am suggesting is that you and your partner make it a habit to take the best care of yourselves, just as you are going to take the best care of your child. Set the example for the new family and enjoy the ride!

Tags: , , , , , , , , , ,
Posted in Uncategorized | 4 Comments »

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.

Tags: , , , , , ,
Posted in male infertility | No Comments »

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?

Tags: , , , , , , , ,
Posted in male infertility | 24 Comments »

How Are Stem Cells Like Wine Grapes?

Wednesday, May 27th, 2009

Stem cells, like wine grapes, need tender nuturing to reach their potential.

Stem cells, like wine grapes, need tender nuturing to reach their potential.

Silicon Valley started in a small garage across the way from Stanford University by one man named Hewlett and another named Packard. There’s an historic plaque on that garage now, and a worldwide industry surrounds it. Stem cell research has just as much potential.

Last week, I mentioned that I was a believer, that I have seen things happen in stem cell research that others haven’t. Collaborating with Renee Reijo Pera, PhD at Stanford, we have been developing adult stem cells that would not involve embryos, or viruses, and that would not be rejected from the body. It all started when we put our heads together and thought hard about how sperm are made and how stem cells are grown. From this line of thinking, we concluded that the adult human testicle would be a great place to create a stem cell. Why? Because the first thing a developing embryo does as it begins to grow is to set aside cells and designate them as “germ” or reproductive cells. Much later on in fetal life, other tissues develop. So, germ cells are special and very closely related to embryonic stem cells; that is, they are very “stem like.”

The next problem, and a big one at that, was how to take adult stem cells and “reprogram” them to become embryonic-like stem cells. This took the better part of four years to figure out. And, like your grandmother’s great apple pie, the secret is in the recipe. Indeed, we found that just the right combination of feeder layers (a layer of cells in a petri dish which help the stem cells to develop) and bathing solutions were instrumental in nurturing these rare testis stem cells to become embryonic-like in a laboratory dish. I developed a lot of respect and a certain fondness for these rare and special cells through this process of discovery. The care lavished on them reminds me of winemakers and their finicky pinot noir vines, which require the right conditions and care to produce their transcendent fruit. Both require a delicate touch.

So, slowly, with persistence, we were able to generate a very “stem like” adult germ cell in a dish starting from a testicle. We showed that, like a real embryonic stem cell, this cell could begin to form the different layers of the body, including nerve, in a dish. What is still not clear from all of this work is exactly what kinds of body tissues can be made from this cell. Can we make an entire heart? How about a clavicle? Or can we just make sperm? This is what the next four years of research are for. In any case, this discovery may help to bypass the whole moral debate surrounding embryonic stem cells. There would also be no viruses to worry about, nor tissue rejection issues to dodge, because your body would simply be rebuilding itself.

Understand that this research is still in its infancy, but it’s a whole new world of medicine, where whole organs may be regrown, and sight and fertility restored. With more time, this kind of research may be as earthshaking as the discovery of antibiotics a century ago. Stem cell research is likely to be even more transformative than this. May the wonder and awe from scientific discovery never end.

Tags: , , , , , ,
Posted in Uncategorized | 8 Comments »

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.

Tags: , , , ,
Posted in male infertility, sexual health, testosterone | 1 Comment »

Once Upon a Time in Barcelona

Thursday, March 26th, 2009

The Sagrada Familia, A Gaudi inspired sand castle-like cathedral in the center of Barcelona Spain

The Sagrada Familia, A Gaudi inspired sand castle-like cathedral in the center of Barcelona Spain

While in Barcelona recently, meandering through the Parc Guell and Sagrada Familia, the weight of what happened earlier that day hit me. I reveled, as anyone might, in the outlandish works of Gaudi, but a part of me remained sober, due to my participation in a debate at a men’s health conference. By the end of it, I realized that men in this country simply don’t get the treatment they deserve.

Are infertile men better served by fixing their infertility problem, or bypassing the problem and using IVF instead to build a family? My opponent was a well-known men’s health specialist from Germany. We butted heads on a variety of issues. But we strongly agreed that although some cases of infertility may not be treatable, all cases merit a thorough evaluation. This is because the cause of infertility could be an underlying medical problem with serious ramifications. Infertility can be a window into a man’s future health. Men not only deserve such an evaluation, they are owed it.

To provoke my opponent and cause a little drama, I said that IVF was the worst thing to happen to men’s health in the U.S in the last thirty years. Most infertile men in America receive only a semen analysis, and never get a proper examination. I estimated that only ten to twenty percent of U.S. men with infertility receive a formal urologic evaluation. The fact is that most infertile men stateside simply get no real medical care.

My audience’s visible disbelief at these statements revealed the huge divide between socialist health care systems in Europe and our own. In Germany and Spain, it is not simply advised, but mandated that both infertile partners receive a full workup, prior to considering treatment. Why pay through the nose for IVF when you may not need it? I had no idea that European countries’ approach to men’s health was so progressive. Surely, for the sake of men’s health, a similar mandate is a fundamental and worthwhile goal of any proposed national health care package in America.

Tags: , , , , , ,
Posted in Uncategorized | 3 Comments »

Newer Entries »