Turek On Men's Health » birth rates

Rise of the Instant Family

Paul Turek, MD — Mon, 09 Jan 2012 16:00:47 +0000

IVF: The elephant in the nursery room

Using sex to conceive, the chance of having twins or higher multiple births is about 1-2%. With assisted reproduction, including intrauterine insemination (IUI) in the office and in vitro fertilization (IVF) in the lab, the chance of twins, triplets or high order births ranges from 30-50%. That’s quite a big difference!

Twins have fascinated us for eons. They run in families but a twin gene has not been found. More twin babies grow up to be left handed than you’d expect, and identical twins built of the exact same genetic blueprint have similar brain wave patterns and may think the same, but have different fingerprints.

Since records have been kept starting in 1915, our multiple birth rate has been stable at 1-2% throughout most of the last century. IVF arrived in 1978 and is now 33 years old and is now performed over 120,000 times annually. One would expect it to affect our birth rate numbers at some point. Well, the data is in and it has.

The Instant Family

The Centers for Disease Control and Prevention (i.e., CDC) just published the information on twin births over the last 3 decades (1980-2009). Here are the key findings:

The twin birth rate rose 76% over this time, from 19/1000 births to 33/1000 births.
In 2009, 1/30 U.S. births was a twin compared to 1/53 babies 30 years ago. Among multiple births reported in 2009, 96% were twins.
Twin birth rates increased by 100% in women ages 35-39 years and by over 200% in women ages 40 years and older.
If the twinning rate had not changed, almost 1 million fewer babies would have been born over the last 30 years.

Since only about 1/3 of the rising twin rate can be ascribed to older moms in the study, this leaves the rise of IVF and fertility treatments as the only elephant left in the room.

An Epidemic of Multiples

Although convenient for many couples as the entire family is complete with a single birth event, the twinning epidemic has other implications. Here are some of them that concern the CDC:

Higher risk to moms health (eclampsia, gestational diabetes)
Higher rate of premature births
Less healthy, smaller sized babies (about half of twins)

When I see those twin strollers while walking down the street, I think “chock it up to technology changing the face of humanity yet again.” For the couple pushing those strollers, you will never seen bigger, or more tired, smiles. In the words of Josh Billings: “There are two things in life for which we are never truly prepared: twins.” But there is something to be said for getting the family built in one fell swoop.

Recipe for Making a Walrus

Paul Turek, MD — Mon, 12 Dec 2011 16:00:06 +0000

Being kissed by a grateful, one ton walrus…

How do you help a 2700 lb Walrus conceive? Very carefully. In fact, only a handful of walruses have conceived in captivity over the last century. In the U.S., it is 10 to be exact. But Holley Muraco, a zoologist at Six Flags Discovery Kingdom in Vallejo, has changed all that.

Now a Published Recipe

Holley’s recipe for helping captive walruses to conceive will be published in a major scientific journal, and I am proud to have had a part in this.

Posted here about a year ago, Holley watched the mating patterns and hormonal levels of walruses over 7 years. She cleverly figured out that the male walruses in U.S. zoos, among the few species that breed seasonally, are not fertile at the same time that the female walruses are fertile. She attributed it to a breakdown in the normal breeding signals that are intricately tied to day-night rhythms in the arctic. California is simply not the same as the North Pole, where these animals have evolved over thousands of years. Right next door to Santa. In essence, when it comes to fertility, captive walruses are like ships passing in the night.

The Critical Observation

Nobody in history had observed walrus mating patterns like Holley has done. It’s no surprise either because walruses live in the arctic cold and breed underwater in bone chillingly cold seas. Her observations led her to a great idea: to hormonally shift the male walrus so that he achieves his peak fertility window exactly when the female walrus is fertile (which is once a year). Holley asked me for advice about drugs, doses and timing based on my experience with human male infertility. Ended up working splendidly with a walrus conception achieved naturally, without the fancy help of assisted reproduction!

The Outcome

From these early efforts, the pup that was expected this past May made it to full term, but was stillborn. It took several days for the unbelieving mother to give up the pup–an incredibly sad time. But, now it is possible for her to get pregnant again, as several other captive walruses around the country already are, after following the new recipe. This reminds me of how truly privileged I am because I have the opportunity to help couples conceive every day by helping nature do what it does best.

Press Release

Six Flags discovery kingdom Biologists Successful in Helping Walrus Conceive

Scientific breakthroughs beneficial in better understanding of walrus reproduction

VALLEJO, Calif. – January 19, 2012 – After several years of research, Six Flags Discovery Kingdom recently reached a scientific breakthrough with the conception of one of its Pacific walruses. In the last 80 years only 11 calves have been born in U.S. facilities. The results of the park’s groundbreaking efforts, lead by marine mammal reproductive specialist Holley Muraco, have now been published in the Journal of Andrology.

In this study, the breakthrough formula for walrus conception is revealed. By watching the mating patterns and hormonal levels of walruses over a seven-year period, it was determined that male walruses, one of the few species that breed seasonally, were not fertile at the same time as the female walruses.

The team was comprised of Muraco, Discovery Kingdom marine mammal trainers and staff veterinarians with fertility expertise provided by Dr. Paul Turek, a men’s health and infertility specialist, founder of The Turek Clinic in San Francisco and co-author of the study.

“We simply moved his fertile window to coincide with her fertile window, and let the usual magic happen,” said Muraco.

With Turek’s help, the Six Flags team hormonally shifted the male walrus’s fertile window to coincide with the females.

“When Holley asked me to help with the hormonal approach to moving the male walrus fertile window from spring to fall, I thought ‘let’s try what works with infertile men’ and sure enough, it worked,” said Dr. Turek.

What came to light was that the mating signals of walruses are crossed because their day-night circadian rhythms are different in captivity than in the wild.

“In essence, when it comes to fertility, captive walruses are like ships passing in the night,” said Muraco. “Reproduction in walruses is seasonal and is tied to light-dark cycles. Those cycles aren’t the same in California as they are in the Arctic.”

One reason this important observation took some time to figure out is because walruses live in the Arctic cold and breed underwater in bone-chillingly cold waters where few scientists have dared to go. Therefore, due to this inaccessibility, little is known of the walrus reproduction in the wild.

Additionally, it appears that the method used is generalizable to walruses in other facilities, as the Six Flags team has since helped walruses in other parks to conceive as well. The findings have proven significant; today, there are only 17 walruses in North American facilities, three of viable breeding age that reside in the Six Flags park.

“It’s a great feeling when we are able to improve the fertility of other species through natural methods,” said Dr. Turek, “as this is what we try to do in our clinics as much as we can.”

About Six Flags Entertainment Corporation

Six Flags Entertainment Corporation is the world’s largest regional theme park company with approximately $1.0 billion in revenue and 19 parks across the United States, Mexico and Canada. For more than 50 years, Six Flags has entertained millions of families with world-class coasters, themed rides, thrilling water parks and unique attractions including up-close animal encounters, Fright Fest and Holiday in the Park.

About Paul Turek, MD

Paul Turek, MD is founder of The Turek Clinic and a former professor and endowed chair at the University of California San Francisco. As a men’s reproductive health expert, he has pioneered innovative techniques for treating male infertility, including Testicular Mapping. In addition to his appointment to the Cooperative Reproductive Network Advisory Board, Dr. Turek sits on the Advisory Board for the Men’s Health Network, Fertile Hope and is President-Elect of the Society of Male Reproduction and Urology. He is Chief Medical Officer at MandalMed, Inc, and is also Past-President of the American Society of Andrology and of the Northern California Urology Society and is an Editorial Board member of several journals including Systems Biology in Reproductive Medicine, the Asian Journal of Andrology and the International Brazilian Journal of Urology.

A complete biography of Dr. Turek is available on Wikipedia at http://en.wikipedia.org/wiki/Paul_J._Turek.

About The Turek Clinic

The Turek Clinic, founded in 2008, is a men’s reproductive health practice specializing in male infertility, vasectomy, vasectomy reversal, varicocele repair and other minimally invasive procedures using innovative and cutting-edge techniques. For more information, visit www.TheTurekClinic.com, http://www.turekvasectomy.com or right here on Dr. Turek’s blog, http://www.TurekOnMensHealth.com/.

Wi-Fi, Sperm Counts and Fertility

Paul Turek, MD — Mon, 05 Dec 2011 16:00:03 +0000

Does the radiation danger icon apply to Wi-Fi?

Maybe it’s time to rename the “laptop” computer something else and keep if off our laps (how about mobile computers or “mobees”?). First we hear that they generate heat that elevates scrotal temperature, and now the Wi-Fi radiation itself may be a problem.

The Effect of Wi-Fi on Sperm

The Wi-Fi issue was published last week and has my patients all worked up. In this Argentinean study, researchers placed one half of the semen samples from 29 healthy men under a laptop connected to the Internet via Wi-Fi. They put the other half far away from a Wi-Fi equipped computer. A better control group would have been to keep the control sperm under the computer like the exposed sperm but with the computer turned on but disconnected to Wi-Fi. The temperature of the sperm dishes was kept constant, so any effect would not be thermal in nature. After four hours, 25% of the sperm exposed to Wi-Fi stopped moving forward, and 9% showed DNA damage. In contrast, only 14% of the sperm placed some distance from the Wi-Fi equipped computer stopped moving forward and 3% showed DNA damage.

Importantly, the proportion of sperm that was dead was exactly the same in each case, so the exposure did not actually kill the sperm. The biggest difference they found was that sperm exposed to Wi-Fi lost the ability to move forward purposefully. It would have been a better study if these sperm were then followed for 4 more hours without exposure to Wi-Fi to see if there was a recovery of motility. The authors “speculated” that Wi-Fi could affect male fertility.

An Alternate View of Wi-Fi and Sperm

Does this bench top test accurately reflect real life biology? Hardly. Is this the natural environment of sperm, bare-naked in a half ounce of fluid spilled onto a computer with Wi-Fi all around? No, but I guess it depends what kinds of websites the computer’s owner is perusing and what kind of personal activity that it generates. So, it’s really impossible to infer that a man using a laptop with Wi-Fi on his lap for more than four hours will be less fertile.

A lesson in electromagnetic fields (EMFs) might better convince you of this belief. The strength of Wi-Fi (wireless fidelity) and W-LAN (wireless local area network) electromagnetic fields is considered weak. Although Wi-Fi moves data quickly, it emits very weak signals that do not travel very far. Typically only 30 to 200 mW of power is emitted from Wi-Fi devices. For a comparison, below is a list of power levels associated with devises that we normally hold near our heads:

Blue tooth headset 100 mW
Cell phone 200-600 mW
CB radio 4000 mW

In addition, Wi-Fi operates at far lower power densities (2.4 to 5 GHz) than cell phones (900MHz to 1.9 GHz). Lastly, the power density, and therefore any effect, from Wi-Fi (as with any other form of energy) rapidly decreases with distance away from the Wi-Fi antenna, following the “inverse-square law.” Thus overall, the exposure from Wi-Fi is 10-fold less than cell phone exposure, as one normally does not hold the Wi-Fi antennae that close to the body – as is done with cell phones.

So if you want to, worry about cell phones and blue tooth headsets rather than Wi-Fi networks in terms of exposure and health. Honestly, there is no real evidence yet that exposure to radio signals from Wi-Fi adversely affects any health issue in the general population. Maybe if we wore computers like hats or kept them in our underwear we might be at risk…maybe. For now, put a pillow between your privates and your laptop.

Are Fathers Better Citizens?

Paul Turek, MD — Mon, 21 Nov 2011 16:00:01 +0000

What wouldn't you give to help one of these? (Source: Leonardo Da Vinci, 1468)

As a surfer, I remember charging pretty big walls of cold, wintery Northern California water with the goal of getting a fast, albeit short, adrenaline-stoked ride. Years ago on Thanksgiving, I was pummeled by a big swell to the point that I wondered whether I would make it out of the water alive. But once I married and had kids, the risk element of waves larger than a single story high became less attractive to me. It wasn’t worth it. Too much at stake. Does fatherhood also reduce other types of risky behavior?

Fatherhood is Transforming

It apparently does. It is well known that fatherhood can be “transformative” or “tempering” for men. But what shape that transformation takes has not been studied very much, despite the fact that unattached men are considered by some to be a source of society’s ““suffering” or “instability.” Loose cannons so to speak.

Fatherhood and High Risk Behavior

A newly published study has tackled this issue. It addressed the changing patterns of crime and substance abuse in new fathers, as these behaviors can threaten both health and society. Specifically, the study asked whether men are less likely to drink, use tobacco or commit crimes after they become fathers. In other words, do tough guys straighten out after having kids?

The authors followed over 200 men ages 12 to 31 who demonstrated high rates of juvenile delinquency in a metropolitan area. They were assessed annually for self-reported acts of crime and court records were reviewed for arrests. Self-reported rates of beer, wine, hard liquor, tobacco and marijuana use were documented, as were co-habitation, marital status and age at first fatherhood. And remarkably, this study was conducted over 19 years!

It has been previous shown that marriage itself and getting older can reduce men’s negative behavior, but this study clearly demonstrated a real association between fatherhood by itself and reduced crime and substance abuse patterns. And, the effects were large and long lasting. Of note, these changes were greater amongst the older men in the group (late 20’s and 30s) and were distinct from those changes expected as men age. Lastly, unlike marriage, cohabitation alone was not shown to reduce risky behavior in young men.

A Golden Opportunity to Help Men Help Themselves

Why is this important? One reason is because it suggests that first fatherhood may present a real opportunity to improve the health and behavior of young men. God knows that there are not many opportunities to do this with those who consider themselves otherwise immortal. New fathers might be more willing to hear messages and make life style changes when they are holding what might be their noblest work in their arms. And these changes in behavior could affect the health of the individual, his children and his family. After all, and I am not sure who said this, “A baby will make love stronger, days shorter, nights longer, bankroll smaller, home happier, clothes shabbier, the past forgotten, and the future worth living for.”

Timing (And Position) Are Everything

Paul Turek, MD — Mon, 18 Jul 2011 15:00:39 +0000

Does timing and position matter for sex like it does for surfing?

Missionary? Doggie? Cowgirl? Kneeling Lotus? Quarter moon? Full moon? No moon? Is there really a best lovemaking time or position to have a girl or boy?

History of Designing Sex for a Boy or Girl

Methods for determining baby gender are ancient, even prehistoric, and range from astrological, to dietary to positional. One of the earliest references to this concept is the Chinese Birth Gender Chart, said to have been discovered in a tomb near Beijing for where it lay for 700 years. It supposedly now resides in the Institute of Science in Beijing. It claims to predict the sex of the child from the month of conception and the age of the mother.

It has also been said the many myths about sex position and timing determining baby gender resulted from the mad rush of lovemaking that followed the end of the World Wars and the return home of soldiers. I’m sure this influx of war torn yet triumphant, and testosterone laden yet depraved men gave new meaning to the term “Honey, I’m home!” for many mid-century modern couples.

The Lovemaking Myths

Here are the most common myths regarding sexual position and timing to help get that boy or girl. Sorry, no pictures. I hear these from patients all the time, as they look at me bright eyed, with heads nodding, searching for my blessing.

Eat meat and salty food to get a boy.
Splurge on desserts to get a girl.
Both partners eat lots of fish and vegetables for a girl.
Make love standing or doggy style and during a quarter moon or at night for a son.
Use the missionary or cowgirl position and during a full moon for a daughter.
The Shettle method suggests having sex as close to ovulation as possible, for a boy, as boy sperm are less robust than girl sperm. Do the opposite for a girl.
If the male partner climaxes first, then a boy will be conceived. The opposite is suggested for a girl.

The Lovemaking Truths

Sorry to be the bearer of bad news. Despite all that you may have heard, there is no real data supporting the idea of a “best” position or time for sex to conceive a boy or girl. In fact, a prospective study of couples starting to conceive was actually published in 1995 in the New England Journal of Medicine that reported no relationship between the timing of intercourse and baby gender. Ah, but they did not study lovemaking position, thus keeping that myth and folklore alive! Come to think of it, that would be an interesting study to do, and one that I imagine would have no trouble enrolling subjects…

A Primer on Radiation

Paul Turek, MD — Sat, 26 Mar 2011 17:22:32 +0000

Are we at risk of nuclear fallout from Japan?

We are all concerned for the Japanese after their recent, unheard of, triple cataclysm of earthquake, tsunami and nuclear meltdown. The catastrophe was horrendous and the photo-footage of the disaster is mind numbing and knee buckling. And next on our minds, occurring on the heels of the Haiti earthquake is what’s next for Japan: infectious disease epidemics and, even more frightening, nuclear fallout. Although I’ve addressed the issue of the Chernobyl nuclear fallout on male infertility in prior posts, it’s fresh in our minds again after “3-11” in Japan.

Radiation is scary. You can’t see it but you know it’s there. It’s like the adult version of ghosts for kids. Technically, radiation is a simple form of matter or energy like any other and was first defined in the 19th century when Bavarian professor Wilhelm Roentgen discovered X-rays. Nuclear radiation, like X-rays, is a form of “ionizing radiation,” which is energy that strips orbiting electrons from atoms forming charged particles called ions and creating molecules called “free radicals.” These substances are damaging to living systems, as they don’t behave as their neutral counterparts do, and generally mess up the physics and chemistry of life.

The First List: Typical Radiation Exposure

We are all exposed to radiation every day as it a part of the normal environment in which we live. In fact, if you are interested in calculating your annual exposure to radiation, click on this EPA website. You’d be amazed at what actually contributes to our radiation exposure every day: breathing air at different altitudes, airplane flights, luminous watch dials, irradiated (sterilized) food, watching TV, using a computer, having teeth with porcelain fillings or crowns or a wearing plutonium pacemaker to name a few. For perspective, here is a list of radiation levels from just living and breathing and also from common medical procedures:

2.5 mSv= Annual natural exposure to radiation
1 mSv= Chest X ray
2 mSv= Head CT scan
3 mSv= Screening mammography
25-50 mSv= Full body CT scan

The Second List: Radiation Exposure and Disease

100 mSv= Radiation dose causing temporary loss of sperm counts
500 mSv= Radiation dose causing permanent male sterility
170 mSv= Average per person exposure to radiation in the Ukraine in the year of the Chernobyl meltdown (1986)
30 mSv= Average exposure in the Ukraine two years after Chernobyl (1988)
1000 mSv= (Single dose) causes non-fatal, temporary radiation sickness (nausea, vomiting, low white blood cell count)
1000 mSv= (Accumulated dose) significant increased risk of cancer, premature aging
10,000 mSv= (Single dose) fatal radiation sickness

The Third List: Japanese Radiation Levels

400 mSv/hour= Peak radiation levels at the Fukushima nuclear power plant, March 14, 2011
173-181 mSv= Range of exposures of three nuclear plant workers
20-50 mSv= Radiation levels in tainted milk from Japan
5-10 mSv= Radiation levels in tainted spinach from Japan
Unclear= Radiation levels in canola and chrysanthemum greens
Unclear= Levels of radioactive iodine in Tokyo tap water

The Anti Radiation Diet

We are certainly concerned for the Japanese in their time of need. Should we also be concerned about nuclear fallout 5000 miles away? All federal agencies and most experts feel we shouldn’t be. However, if that answer is just not good enough, consider the anti-radiation diet:

Miso soup
Kelp (natural iodine helps prevent the uptake of iodine-131)
Brassica vegetables (rutabaga, turnips, cabbage, sprouts, cauliflower and broccoli)
Beans and lentils
Potassium, calcium and mineral rich foods
High nucleotide content foods (yeast, sardines, liver, anchovies, mackerel)
A good multivitamin supplement enriched with antioxidants

Why Blueberries Matter

Paul Turek, MD — Sat, 19 Feb 2011 16:11:08 +0000

Blueberries: the #1 antioxidant fruit.

Once in a great moon, something comes around that changes the way you think about things. Galileo’s dismissal of the earth-centered universe, the invention of electricity and the desktop computer are but a few of these. Upon reading a recent meta-analysis of antioxidant supplements for male infertility, did my world-view change? Not really. But I did take notice.

What is a Meta-analysis?

A meta-analysis is a 100 year old statistical term used to describe a certain way of combining evidence that, when viewed separately, is relatively unconvincing. Meta-analyses seek to more powerfully estimate an effect or outcome than might be possible from a bunch of smaller studies, especially if there are differences in their design and execution. A big problem with meta-analyses is that their quality depends on the data that they analyze, and garbage in means garbage out. Not to bore you further, but this type of analysis has become very trendy in medicine lately as a way to figure out where truth rests at the moment on a particular subject.

Antioxidants and Male Infertility

Antioxidants have been the rage in the literature for years as cancer preventing and anti aging agents. In more recent studies in which placebo (sugar pill) controls were used, however, they haven’t looked so sharp. Like with cancer or aging, oxidants are thought to be a fundamental cause of male infertility as they clearly damage DNA, reduce sperm motility and otherwise render sperm dysfunctional. And these effects cannot be good for male fertility. In fact, many think that as much as half of male infertility is due to oxidative stress. But the role of antioxidants such as the water-soluble vitamins A, C and E, metals such as selenium and zine, and the natural antioxidants found in blueberries (anthocyanins), tomatoes (lycopene), other fruits, vegetables, nuts and tea (theaflavins) have not been found to reliably improve sperm quality or male fertility in small studies. Hence, in comes the meta-analysis to the rescue.

The Antioxidant Meta-analysis

This Cochrane review analyzed 34 randomized, controlled trials (2876 couples) in which male partners of infertile couples were given antioxidant supplements (or placebo) while their partners underwent assisted reproduction (no all natural conceptions here). Any type or dose of antioxidant was included and pregnancy and sperm outcomes tracked. In general, the studies that were reviewed weren’t stellar stuff, but the meta-analysis showed a 4 fold higher rate of live births among antioxidant users (based on 3 studies and 20 births). There was also a 4 fold higher rate of conceptions in the antioxidant group (15 studies, 96 pregnancies total). Finally, the meta-analysis suggested that there were significant improvements in both sperm concentration (from 7 studies) and motility (from 10 studies) with antioxidants, although this was much weaker than the pregnancy data.

T he Turek Clinic World View of Antioxidants and Male Infertility

My belief in antioxidant supplements for male fertility comes from simple reasoning:

Oxidants hurt cells.
Sperm are cells.
Antioxidants can protect cells from the oxidant-induced damage.
Antioxidants can therefore help decrease oxidative damage to sperm.

Along with the following observations, there comes a conclusion:

Probably the best antioxidants are found in the diet
Most men have terrible, antioxidant-poor diets
If men ate more fruits and vegetables, maybe fertility would improve
Barring this change in diet, men should view antioxidant supplements similar to the way women view “prenatal” vitamins, and take them.

One Child China

Paul Turek, MD — Mon, 14 Jun 2010 05:08:59 +0000

China: 5000 years old and on the move.

Just got back from China, from Beijing and Hong Kong to be exact. I lectured to several medical and academic institutions on where I believe men’s health is headed in the future. What I found was an audience eager to push the research frontiers in this field, however I also a sensed a lack of sufficient infrastructure to do this at the highest level. I paused for a moment to think about what was possible, since a monumental tidal wave of increased industrial productivity and change is occurring in China. For example, there are 1000 new cars being put on the road daily in Beijing alone! I sensed that when the might of China’s intellectual potential directs its energy toward medical research and innovation, the world will stand in utter awe at the prodigious output that will result.

Despite the fact that China’s culture is endowed with 5000 years of evolution and is responsible for helping to define human civilization, one thing really surprised me: its decision in 1979 to control its population by mandating a “One Child Only” policy. In the rest of the world, human reproduction is a basic right and for the most part, entirely unregulated. Under China law, families are allowed to have one child. After that, a vasectomy is performed on the male partner. Like it or not.

In addition to great control of population growth, the “One Child Only” policy has also led to the development of the wildly successful “No Scalpel Vasectomy” procedure. Now relatively common in the U.S., the “No Scalpel Vasectomy” is a quicker (10 minute), cleaner, less invasive and more comfortable innovation on a 100-year old American procedure.

But the curse of the “No Scalpel Vasectomy” is now being felt in China. Currently, it is difficult to find enough youth to fill jobs in urban areas within the massive and burgeoning Chinese economy. As a consequence, there has been a softening of the law such that couples that are both products of “one child” parents can now have two children. So can farmers, handicapped couples, and couples who work in “high risk” occupations like coal mining, heavy equipment operations and the like.

Even more fascinating is that infertile couples have a real reproductive edge over fertile couples under this law. How? Well, if they need assisted reproduction to help them conceive and they happen to have twins or triplets as a result (a 30-40% chance), they are not penalized for bearing “extra” children. Can’t help but think that this little known fact may partly contribute to the size of the massive, bustling IVF clinics that I visited in China last week. many of which are 4-10 times the size of U.S. clinics.

The Curse of Women’s Urine

Paul Turek, MD — Sun, 25 Apr 2010 22:21:26 +0000

Estrogens and the manly man.

There must be something in the air… or water. The Bolivian President Evo Morales recently asserted publicly that hormones found in mass-produced foods are “feminizing” men. Speaking about chicken in Bolivia, which he believes are “loaded with feminine hormones,” he suggested that when men eat chicken “they are diverted from their nature as men.” So, is this how metrosexuals came to be?

But wait, the Vatican commented on this issue a year earlier, although they blamed female hormones from birth control pills for the increased estrogens in ground water. Pedro Castellvi, writing in the Vatican newspaper L’Osservatore Romano in 2009, stated: “we have sufficient data to affirm that one of the reasons for the not insignificant rise in male infertility in the west, is the environmental contamination caused by the pill.” Actually, it’s not the birth control pill itself but the urine from women taking the pill.

In fact, to date, the urine of women taking birth control pills has been blamed for worsening sperm counts in men, the growth of female sex organs in male fish, breast growth in young men and the early onset of puberty in young girls. What next?

Can I add a little balance to this discussion? First of all, exactly what is happening to men in Bolivia such that the President is not happy with them? Are they more civilized and less disruptive? Second, male infertility is not necessarily increasing in the western world; it may even be true that men have lower sperm counts now than a generation ago not because they are less fertile but because women are more fertile. Third, estrogens are found everywhere in the environment including in many plants (phytoestrogens) such as soy and legumes, and are not produced exclusively from the urine of women. Fourth, the intersex conditions that have been reported in many animal species tend to be caused by a very specific exposure at a very specific time point during fetal development and have been linked to pesticides, bisphenol A, dioxins and other environmental contaminants (xenoestrogens). Fifth, did we somehow forget about the worldwide obesity epidemic in humans and the fact that fat converts male hormones to female hormones? Lastly, there is little evidence that substantially increasing a man’s estrogen levels as an adult will dramatically alter anything, except maybe waist size and color preferences. Where the truth lies in all of this is currently unknown, but it is hard for me as a urologist to see how women’s urine could be blamed for so much.

Weighing Your Options

Paul Turek, MD — Sun, 10 Jan 2010 17:05:57 +0000

Bacchus is no longer a role model…

What you weigh affects how your sperm play. And your fertility. Overweight men tend to have lower semen volumes, less sperm and more oddly shaped sperm. The same is also true for men who are too thin. So, along with the many other health hazards associated with obesity, add poor semen quality to the list.

Obesity in both sexes is known to be associated with heart disease, diabetes, hypertension, and metabolic syndrome among other nasty conditions that can shorten your life. Typically, obesity is measured with BMI or body mass index, which looks at weight in relation to height. Not a perfect measure, but reasonably accurate. Using this tool, the ideal BMI for men (and women) is considered to be 20-25. A Danish study of 1600 men showed that overweight men with a BMI > 25 had a 22% lower sperm concentration compared with healthy weight men. Interestingly, a BMI of <20 was also associated with poor semen quality. For optimal sperm production, then, it helps to be not too fat and not too thin.

But what about fertility? Is it also affected by obesity? Yup. Another recent study showed that for every 20-pound increase in a man’s weight, there is a 10% increase in the chance of infertility. And this remained true when other factors that might influence the results were accounted for, including obesity status of the women, the man’s age, cigarette smoking, alcohol intake, and solvent and pesticide exposure. In addition, obesity was associated with infertility in both older and younger men.

So what is it about weight that influences men’s sperm production and fertility? One theory is that sex hormone metabolism is altered by changes in weight. Sex hormones are the “fuel” for the engine (testis) to make sperm. Obesity increases fat stores and fat converts male hormones (testosterone) into female hormones (estrogens). Too much estrogen in men is bad for sperm production. Another theory posits that normal 2-degree difference in testis temperature relative to the body is lost with obesity, as excessive fat provides too much insulation and results in overheating. On the other hand, when a man is too thin, he may take on a “catabolic” metabolic state. With a body in “starvation mode,” fertility is not the first thing on its mind and sperm production and fertility suffer.

So, is the epidemic of obesity the reason why sperm counts have been falling in Western countries over the last 50 years? Maybe. But this problem is unique in that it is utterly and entirely preventable. Eat well and in moderation, sleep well and treat your body like a temple. You used to it for your own health; now do it for the health of your future family.

Are We Replacing Ourselves?

Paul Turek, MD — Tue, 08 Sep 2009 21:55:15 +0000

Where are you? Green means high and red means low.

When a couple decides to have children, they rarely, if ever, contemplate the effect this has on the nation. But population scientists do. The effect that birth rates have on society is critical—as basic as knowing whether a nation is sustaining their population or not. But, trying to figure out if birth rates are going up or down is also complex, not unlike taking our temperature by feeling our foreheads.

A good barometer of birth rate assesses the average number of births per woman, and is generally noted by country. For a country to sustain its population in the future, the replacement rate is 2.1, or 2.1 births to every woman. What has occupied the minds of population scientists over the past 20 years is the fact that birth rates have dropped around the world, especially in Europe, but also in China and Japan. Interestingly, many countries in Africa do not have this problem, with birth rates well above 4.

Also notable is the fact that in the past 20 years, the population of the world has dropped, falling an average of 1% per year. You can imagine how much this issue has occupied the minds of population scientists who seek to explain the phenomenon. Contributing factors include changing attitudes about family size, the cost of raising a child and the wider availability of contraceptives. The birth rate may also be dropping because child mortality on the whole has dropped. Or, because women who choose to have children later create a temporary lull in the birth rate. One concern with population drops is that countries whose populations become too small may not be able to afford to support its infrastructure, causing economic decline. So, on the one hand, it’s expensive to raise a child. On the other, it’s also expensive not to.

A recent study however, does show a change in these trends. Fertility rates now show a recent increase in developed nations. For years it has been thought that for some reason, developed nations, including most of Europe, have steadily dwindling populations. But this may not actually be the case. For example, in the 1970s, the US fertility rate was at a low of 1.74; lately it’s been relatively stable at 2.05. It appears that children are still wanted in a modernized world.

It’s quite hard to see these trends in my daily medical practice, as I perform as many vasectomies as I do vasectomy reversals. It’s even harder to render an opinion when the information is so diffuse and generational. So, to population scientist, I am a professionally “neutral contributor” to fertility rates. Like to think I do more good than that though…