Turek On Men's Health » conception

The Essential Beginnings of a Vitamin

Paul Turek, MD — Mon, 16 Apr 2012 15:00:57 +0000

Petroglyphs and Paleo: Inspiration for Essential Beginnings

Honestly, my opinion about nutritional supplements has evolved dramatically. Historically, the value of prenatal vitamins for women is well recognized and uncontested. For example, calcium keeps mom’s bones healthy as developing fetuses borrow mom’s calcium for their own bones. And iron prevents the anemia of pregnancy. Folic acid clearly prevents neural disorders and birth defects in children. No doubt, prenatal vitamins for women make sense.

Do Vitamins Treat Cancer?

However, with heart disease or cancer, the story is quite different. In 1998, the government set out to test herbal and other alternative health remedies to find the ones that work for cancer and other diseases. After spending $2.5 billion, the disappointing answer was that none of them help prevent or treat these diseases. As noted here several years ago, vitamins got an “F” for cancer. To top this off, newer data from just last month suggests that excess vitamins supplements may actually lead to an earlier death. Now what’s a guy to do?

Do Vitamins Help Men Conceive?

Thankfully, what is more encouraging is the value of antioxidant supplements for male infertility. In 2011, An august research group in England published a Cochrane Review that analyzed 34 studies of 3876 infertile couples using assisted reproduction to conceive. The meta-analysis found that the partners of men taking antioxidant supplements were 4-fold more likely to get pregnant and 4-fold more likely to give birth than couples in which the male partner was not taking supplements.

The Idea of a Male Prenatal Vitamin

This study changed my worldview to the following:

A large chunk of male infertility (maybe half) is due to what’s called “oxidative stress.”
Antioxidants are a good defense against oxidative stress.
The best antioxidants are found in the diet, and the Paleo diet appears to be the best.
Most men have terrible, antioxidant-poor, diets
If men ate more fruits and vegetables, maybe fertility would improve.
Barring this, men should view antioxidant supplements as prenatal vitamins.

The Essential Beginning

Motivated by this epiphany, I and several trusted colleagues, including fertility physicians and nutritionists, set forth to create a male prenatal supplement that would be better than eating airport food for fertility. We wanted it to be made in California and support the local economy, be certified-organic, and to reflect the latest findings in antioxidant research. It would contain vitamins, minerals and organics with high bioavailability, instead of just putting stuff on a label without regard to whether or not it is absorbed well by the body, like most other supplements. We wanted it to be available online, to avoid the middleman markup, and to be reasonably priced.

After a year of pretty intense work, it has arrived. It is called XY (your chromosomes, get it?). And not only that, we continued our research and developed an entire fertility product line for women all the way from pre-conception through breast-feeding with XX (women’s prenatal), Z (pregnant prenatal) and Z+ (post-natal and breast feeding).

Do all men need a male prenatal? Probably not, because as I said, nothing replaces a healthy antioxidant diet. But if you are like most of us, creatures of habit eating airport food and busting our chops to put food on the table daily, it is to you that I dedicate Essential Beginnings, XY.

Diabetes Mellitus: The Infertility Triple Threat

Paul Turek, MD — Mon, 26 Mar 2012 15:00:55 +0000

Colors as possibility. Feathers in a kite shop, Beijing, China

Based on the feedback received from doctors reading the blog, we are introducing a new feature: Case of the Month. This Case of the Month is an actual patient from The Turek Clinic. It is presented to recognize American Diabetes Association Alert Day.

The Case of Male Infertility

He is a 31-year old who has been trying to conceive with his 28-year old wife for 2 years. During this time, he has noticed a lower sex drive and has had trouble ejaculating. His medical history is negative except for a 6-year history of diabetes mellitus that is well controlled with insulin injections. Exacerbated, he states “I really don’t know what’s happening to me!”

Upon further questioning, the sex drive issue started even before they were trying to conceive. Regarding ejaculation, the patient states that his erections are not very strong and, although he has the sensation of climax, nothing comes out of the penis with ejaculation. In fact, he is concerned that things might be “backing up” in his body with these symptoms.

A Short Review of Diabetes

First identified as a disease of “sweet urine” in ancient times, diabetes mellitus a metabolic disease characterized by high blood sugar (glucose) levels. It is one of the most common medical diseases in the U.S., affecting 26 million adults and children or about 8% of the population. Among those affected, about 15 million are people of reproductive age.

Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. When the blood glucose rises, say after eating food, insulin is released to decrease the glucose level. In patients with diabetes, there is low or no production of insulin and therefore blood sugar levels are elevated. The sugars spill into the urine, hence the term “sweet urine.” Diabetes is currently a chronic medical condition that is not curable.

Can Diabetes Cause Infertility?

You bet. Diabetes causes male infertility in three ways:

Causes erectile dysfunction-by affecting the health of small blood vessels and lowering testosterone levels
Lowers sex drive-by lowering testosterone levels
Reduces ejaculate volume-by affecting the small nerves that control ejaculation and by lowering testosterone levels

Indeed, this patient had all three issues at the same time along with a low testosterone level. Fortunately, these symptoms are fairly easy to correct with oral medications:

Erectile dysfunction- Viagra, Cialis or Levitra can restore erections
Sex drive and low testosterone-Selective estrogen receptor modulators (i.e. off label use of clomiphene citrate) can correct testosterone deficiency
Ejaculate volume is low because it is emptying backwards into the bladder instead of forward into the penis. This can be treated with over the counter cold medication (alpha agonists) to restore the normal direction of ejaculate flow.

Sure enough, with this combination of pills, the infertility “hat trick” induced by diabetes was overcome and the patient was able to conceive naturally after several months. Another family holiday card on its way to The Turek Clinic this year!

Remember that about 1/3 of infertility is male driven. And diabetes is both a common and quite treatable cause of infertility. So, do yourself and your future family a favor and take the Diabetes Risk Test today.

A Year Without Answers II

Paul Turek, MD — Mon, 19 Mar 2012 15:00:18 +0000

Rug design courtesy of Rex Ray, San Francisco

This is the second of two guest posts from a patient who lives in Europe. He recently recontacted me about his experience with male infertility and how it affected him. Moved by his story and by his emotional fortitude, I asked him if he could share his remarkable journey with others. The first post is from March 12th.

I had to face the fact that I was my own worst enemy. This was an epiphany for me. By becoming a negative person, spontaneity and creativity had left me, high and dry. And gone with it was the ability to problem solve. For me, once of the hardest things that I have ever had to do in my life was to admit that I was the root of the problem, that I was responsible. The epiphany was that because I was the problem, I could also be the agent of change. I could own this. The rebuilding of me had to start with me.

It was at that point that I reached out to a psychiatrist, Our talks helped me find my way back. Honestly, I never knew that these sides of my character even existed, and was even less aware that they would belch from my soul as they did. These sessions allowed me to vent my feelings and, over time, I felt better and better. It felt like I could take the 800-pound gorilla to the doctor’s office and leave it there. And, funny enough, the “gorilla” began shrinking in size with each session, almost to the point of becoming a small, friendly monkey. And although even cute little monkeys can be annoying, these sessions helped me enormously by providing tools and methods to help me better understand, accept and manage such strong feelings.

Modern societies of any culture, Western or Eastern, are not great at raising men to be in touch with their emotions. And realizing that you are infertile is a very hard blow to one’s manhood on many levels. One of the most concerning issues was worrying about what others were thinking or knew about my situation. Early on, it bothered me to think that they would find out. As I began to heal, however, I began to care less and less about what others thought. I simply can´t control other people’s minds and have no interest in doing so. I also realized that those who are close to me all know about the infertility and nothing has changed between us and how the view me as a person. The rest I leave in God’s grace.

Another realization over the last year is that infertility is not a disability in life. It is in fact the way that I was created. It is part of me. It is who I am. And although I can’t change it easily like, say, losing weight or getting more exercise, I can certainly change how I view it. I can shape my future in any way that I wish. I am the master of me.

The road I took that year was no easy one, but I made it through the year. Leaving this behind me, I can now move forward in my life. I have faced the demons and have come to terms with my reality. I now look upon the future with renewed eyes and see a future filled with happiness despite the fact that I cannot have children.

Please let us know if you would like to continue a discussion of these issues in an on-line forum…

A Year Without Answers

Paul Turek, MD — Mon, 12 Mar 2012 15:00:30 +0000

"Elemental" Courtesy of the Artist: A.J. Russell

This is a guest post from a patient who lives in Europe. He recently recontacted me about his experience with male infertility and how it affected him. Moved by his story and by his emotional fortitude, I asked him if he could share his remarkable journey with others.

“The day we met with Dr. Turek was a week filled with hope and happiness. Almost a year earlier, on the same day, I went through a biopsy with the result that there were no sperm. So when we found out about Dr Turek, this really felt like the last chance, the last hope. Therefore the decision to travel across the world to see him was an easy one. The visit and procedure went well, but, again, the result from mapping showed no sperm. And no answer as to why this is.

It has been a year since I spoke with Dr. Turek about these results, a year characterized by disappointment, anger, sadness and worst of all, no answers. There were simply no answers to be found. Why me? Why now? What now? Literally a thousand questions ran through my head interfering with my daily life, keeping me up at night and affecting my relationships. I had never felt anything like this before.

I wanted so badly to not feel alone in this. I wanted someone to understood my plight, without me having to explain every small detail, because you can´t explain this feeling.

I needed to talk about it. I just couldn’t bury it. But, who was I going to talk to? And what would I talk about? I felt isolated as there appeared to be a big taboo regarding this topic. Anyone I spoke to told me focus on other things in life. But how are you supposed to do that when all you think about is the fact that you can’t have your own children? I knew no one with a similar experience who would step forward and talk about his experiences and feelings. Google searches were pointless, as the Internet does not care and information on coping is useless.

That year was best characterized by the feeling of being lost and trying to find my way in darkness without a map or light. I felt that I was in a deep, dark place, especially when I tried to look forward into the future.

Feeling alone, I began suppressing everything. All feelings, thoughts and discussions were avoided. I told my close family that I did not want talk about this matter anymore. It was a buried subject for me, never to see the light of day again. The reason for this was that talking about this issue within the family only made things worse. One problem with this approach was that the bright spots in my life also suffered along side. The subject became an 800-pound gorilla that, although ignored, never left the room. Maybe the gorilla was bigger than 800-pounds as the family dynamics changed greatly.

Then I became angry, sometimes uncontrollably. This was when I could see that I was approaching rock bottom. The slightest annoyance, comment or action sent me into a furious rage where I often exploded at whomever was next to me. Many times it was my wife, which led us to the brink of divorce. We were both tired of fighting and there appeared to no other solution to end the fighting but dissolving the marriage. This moment was a real eye opener for me.

What helped keep me going to some degree during this time was my job. As a futures trader, my work was very involving and in the moment. Believe it or not, it was also logical and predictable, in a mathematical sort of way. It could be explained and reasoned with and while doing it, I could leave all my troubles behind. But I couldn´t hide in my job forever.

I turned the corner at rock bottom when I realized that if I did not start controlling my emotions and start being honest with myself, my life as I knew it would change dramatically. It was on that day, a very cold one in December, that I realized that I was just too exhausted to continue to fight with myself and others. I couldn’t bear to face another year continuing on the same as the last. So, I stopped lying to myself and began to face the reality of my emotions.”

The second and final part of this guest series will be available Monday, March 19th.

Patient Testimonial: Dr. Turek, “The Miracle Worker!”

Paul Turek, MD — Thu, 08 Mar 2012 20:33:46 +0000

We get a a lot of very special, personal and wonderful news from our patients at The Turek Clinic. Sometimes they are generous enough to share their stories with us. With their permission, we’d like to share their story here – in their own words.

Introducing Cole Michael!

“Here is our story! Please let me know how I can share it with future patients

My wife and I are thrilled to report that we just had our first baby boy!

“Cole Michael” was born on February 28th, 2012 weighing 8 lbs. 1 3oz. and measuring 21.5 inches long. Both mommy and baby are doing great.

Dr. Turek is an ‘angel’ from God that performed a miracle for me and my growing family. A brief history: I went through a divorce 4 years ago that left me with two beautiful boys, and a vasectomy. Shortly afterwards, I met the love of my life. After dating for 11 months we got engaged and decided that we wanted children of our own so I called up my urologist (the same one that performed the vasectomy) and scheduled the surgery to have everything undone.

He assured me that he had done this type of surgery before with enough success to have me commit to moving forward with him (you would think the one that closed it up could open it back up… I was so wrong)! The surgery was very painful; a lot of bruising and I had a huge hematoma that stretched from the top of my right hip bone down to the bottom of my buttocks. The recovery lasted two full weeks – I couldn’t get off the couch for the first week because the pain and swelling was so horrendous. But I kept saying to myself, ‘it will all be worth it if I can get viable sperm again.’ Needless to say, the surgery was unsuccessful and left me with residual amounts of pain, scaring, and a $7,500 bill to pay.

My fiancée and I were very disappointed and desperate to have the procedure done correctly. I went back to my doctor and expressed my deep concern of the outcome of the surgery and the only thing that he could recommend is that I should consult with Dr. Turek in San Francisco. Dr Turek specializes in fixing vasectomies that didn’t take the first time. He’s world renowned, and has an impressive track record of successful outcomes. I just wish he would have referred me from the start versus trying to perform it himself and leaving me nothing to show for it but a lot of pain.

So I took his advice and immediately went on The Turek Clinic Web site. I was very impressed and immediately scheduled a consultation with Dr. Turek. I told him my story: 4 year old vasectomy, with an 8 month old failed vasectomy reversal. Dr. Turek said, “This is my area of expertise. I like challenges so lets see what we can do.” And after going over his success rates it was clear that he is the one that should have been doing this procedure from the very start.

I had the surgery performed in January 2011, was married June 4th, 2011 and we had our first baby February 28, 2012. What an amazing blessing to be celebrating our first wedding anniversary ‘with’ our beautiful baby boy!

There are three things that make Dr Turek the leader in this type of procedure:

Pain management: It’s amazing when the surgery is done correctly the first time how much ‘less’ pain medicine is needed and how the recovery was expedited (I had very little swelling and only had to use the pain medicine for two days).
After care is unparalleled: Dr. Turek is there from surgery all the way up to conception and his staff are amazing. Constant support and communication through: office visits, email and phone calls.
Positivity! Dr Turek’s clinic gave my wife and I a feeling of hope and optimism from day one.

We feel so blessed to have Dr. Turek in our lives and its amazing to think how gifted his talents are to bring life to parents when at one time there was no hope. He is our angel!!”

Kind regards,
Mike and Rachel
Roseville, California

You can read more from our patients on our testimonials page.

Patient Testimonial: Dr. Turek, “The Miracle Worker!”

Paul Turek, MD — Thu, 08 Mar 2012 20:16:10 +0000

Introducing Cole Michael!

We get a a lot of very special, personal and wonderful news from our patients at The Turek Clinic. Sometimes they are generous enough to share their stories with us. With their permission, we’d like to share their story here – in their own words.

“Here is our story! Please let me know how I can share it with future patients

My wife and I are thrilled to report that we just had our first baby boy!

“Cole Michael” was born on February 28th, 2012 weighing 8 lbs. 1 3oz. and measuring 21.5 inches long. Both mommy and baby are doing great.

There are three things that make Dr Turek the leader in this type of procedure:

Pain management: It’s amazing when the surgery is done correctly the first time how much ‘less’ pain medicine is needed and how the recovery was expedited (I had very little swelling and only had to use the pain medicine for two days).
After care is unparalleled: Dr. Turek is there from surgery all the way up to conception and his staff are amazing. Constant support and communication through: office visits, email and phone calls.
Positivity! Dr Turek’s clinic gave my wife and I a feeling of hope and optimism from day one.

We feel so blessed to have Dr. Turek in our lives and its amazing to think how gifted his talents are to bring life to parents when at one time there was no hope. He is our angel!!”

Kind regards,
Mike and Rachel
Roseville, California

You can read more from our patients on our testimonials page.

About Dr Turek

The Incredible (Renewable?) Egg

Paul Turek, MD — Mon, 05 Mar 2012 18:32:47 +0000

The human egg: a thing of beauty…now a renewable resource?

It’s hard to keep up anymore; things are changing so quickly in fertility medicine. Just in the last week, a Harvard researcher discovered stem cells in the human ovary and a 66 year old just became a mom to twins in Switzerland. There goes the rug, being pulled out from under our scientific feet yet again.

Testicular Stem Cells

A couple of years ago, we published a paper confirming the presence of cells in adult men that were long though to exist: testicular stem cells. These are “multipotent” cells unlike most other cells in the body: they not only renew themselves, but they can also become sperm and may even be coaxed into becoming other organs in the body. The really convenient thing is that they are not derived from embryonic stem cells (a political minefield) a fact that makes them prime candidates for stem cell-based treatments in the future.

The Dogma About Eggs and Ovaries

But eggs are not sperm. Sperm are made constantly throughout a man’s life, like blood cells, and therefore it makes sense that there are stem cells running the show. However, for at least as long as I have been in medicine, it has been thought that women are born with all of the eggs they will ever have, some 1-2 million, and lose them throughout life, most obviously through monthly ovulation, until they are gone. The basket empties of eggs somewhere in the 40’s for most women, about 10 years before menopause. This lack of new egg production has led to the belief that, unlike within the testicle, adult stem cells do not exist in the ovary.

Ovarian Stem Cells

But Dr. Jonathan Tilly at Harvard thinks otherwise. He believes that women indeed have adult stem cells in the ovary that might be able produce new eggs during a woman’s lifetime. And maybe even after her traditional reproductive window has closed.

Dr. Tilly first showed this in mice and published it in 2004. He recently extended this work to women by locating an incredibly scare biological resource: fresh ovaries donated by Japanese women undergoing sex change procedures. Within this tissue, he found cells that showed classic stem cell characteristics using genetic markers. But this only means that they “look” like stem cells. To prove that they can “act” like real stem cells, he isolated these cells in a Petri dish and watched them turn into real, live, immature eggs. More convincingly, he then transplanted them into mice and they continued to develop into even more mature eggs, passing through meiosis in some cases which is a characteristic process occurring only in eggs and sperm.

So what are the implications of this technologically mind-bending work? Hard to know, but down the line it may mean that women may be able to make new eggs when we thought that they couldn’t. Maybe their baskets never really empty of eggs and that their fertility can be extended beyond what we now think is possible.

Regarding the 66 year old women who just had twins…it’s not clear to me how many genetic parents were involved, how long it took, and how heroic the effort was, but I can guarantee you that she will have her hands way too full for the next several years to keep up with this science.

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.

A Dozen Funny Reasons for Vasectomy

Paul Turek, MD — Mon, 16 Jan 2012 16:00:38 +0000

Funny, but not the typical scene of a vasectomy at The Turek Clinic. Photo courtesy of the movie.

As a vasectomist, I realize that a vasectomy, that iconic way to stop family building in its tracks, is not simply a 10-minute procedure. In a man’s life, it is a significant cultural event. I dare you to describe a more personal, scary and misunderstood part of a man’s body with which to meddle. And, recall that men don’t give birth, so their bragging rights after a vasectomy are somewhat limited.

Why do Men Get Vasectomies?

I ask most patients why they are considering a vasectomy. The responses vary, but can be very amusing. Here are a dozen of the funniest answers I’ve heard in my practice:

My wife said: “the factory is closed,” so I’m here.
I was told that they broke the mold after they made me, but I want to make sure of it.
My wife said: “It’s your turn now.”
After this, I won’t ever have to say I’m sorry again.
I’m married! Condoms are sooo high school!
Have you seen the movie ‘One Fine Day?’ That’s why I’m here!
Every time I look at my wife, she gets pregnant.
Apparently, sacrificing some limbs just isn’t the same…
She told me: “Enough, get your wings clipped already!”
I was told that I can shoot the gun all I want and no one will get hit.
I heard that it’s easier than getting your teeth pulled out…
My wife told me that it’s time for juice without seeds.

So, here’s to the most effective contraceptive ever developed and hats off to those men who chose the “emission impossible” way to an unburdened and unbridled sex life.

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.

The Artificial Testicle: Funded!

Paul Turek, MD — Mon, 02 Jan 2012 16:00:01 +0000

Whole Earth Catalog: the old Google, according to Steve Jobs

It is the stuff of dreams in academic medicine: an NIH (National Institutes of Health) research grant. Get one of these and you’re pretty much assured of getting tenure and succeeding at any major U.S. university. It is the ultimate stamp of approval from the government and society that your thoughts and ideas have merit and value.

And I was just awarded one!

NIH Funds the Artificial Testicle

Yes, the federal grant that we submitted recently to build a human artificial testicle was funded. To be clear, this grant is not about creating a testicular implant for a man who is missing a real one. We did that a decade or so ago. This award is to develop a sperm making biological machine. I wrote it along with Dr. Connie John, CEO at MandalMed, Inc., a biotechnology company in the Bay Area. We now have a couple of years to create human artificial sperm in a dish, or more formally, a “bioreactor.” A fancy dish to be sure.

You’ve seen the posts on how successful this research has been in mice models using various stem cells as a starting point: embryonic stem cells, adult stem cells and early germ line (spermatogonial) stem cells. In labs all over the world, real, live, fertile sperm have been made in animal models from each of these stem cell precursors. Honestly, given this success over the past several years, surely we can figure out how to do the same in humans.

Why Do I Need NIH Funding?

Funny thing is, I am not in academic medicine anymore. No tenure to deal with and no need to prove anything to anyone but myself and to legions of loyal patients who depend on cutting edge innovation for their infertility care. Personally, feeling the suffering of patients with infertility is far more motivating than doing science for the sake of science, or for the sake of tenure.

Not to compare myself to Steve Jobs in any way, but I can’t help think one of his favorite mottos from the Whole Earth Catalog. This is what guided him in his quest to build a better computer for everyone: “Stay hungry; stay foolish.” It feels absolutely fabulous to be able to dream it, write it and finally to do it. The essence of science for the good of people.

Press Release

Effort to Build Artificial Testicle Awarded NIH Grant

Released: 1/9/2012 1:45 PM EST
Source: The Turek Clinic

Proposal to make human sperm from stem cells receives government funding

Newswise — SAN FRANCISCO, CA. January 9, 2012. Dr. Paul Turek, Director and Founder of The Turek Clinic, a men’s health medical practice, and Dr. Constance John, chief executive of MandalMed, Inc, a San Francisco-based biotech company, were recently awarded a Small Business Innovation Research (SBIR) grant from the National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health (NIH) to construct an artificial human testicle and research how sperm are made from stem cells.

“Fertile sperm can be made from various stem cells in mice, but making human sperm from these same sources has been elusive,” says Turek, a practicing male infertility specialist in San Francisco. In this project, they will try to produce mature human sperm in a live laboratory model of a human testicle.

This work extends on previously published research by Dr. Turek on human testicular stem cells, the forerunners of sperm. Dr. John is an expert on human Sertoli cells, which critically nurture sperm as they develop in the testicle. “This grant is quite an honor and comes after several years working together on this idea,” notes Turek. “We have assembled a great group of scientists who are very committed to its success.”

A functioning artificial testicle has important implications for the field of reproductive biology. It could shed enormous light on the intricate details behind the mysterious and complicated process of spermatogenesis or sperm production. Even further, it could be used to later develop patient-specific, fertile sperm for men who simply do not make sperm due to genetic or acquired causes.

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, www.TurekVasectomy.com, or Dr. Turek’s blog (here).

About MandalMed, Inc.
MandalMed is a privately held biotechnology company located in San Francisco- the home of more bioscience companies than any other region in the world. MandalMed’s mission is to develop pharmaceutical products of worldwide significance. Areas where there is a great need for better treatments, including cancer and neurological conditions, are the targets of MandalMed’s research and development programs. For more information, see www.MandalMed.com.

The Wall of Holiday Cards

Paul Turek, MD — Mon, 26 Dec 2011 16:00:32 +0000

The Turek Clinic Team and the wall of holiday cards

I always tell grateful patients that the kindest thing that they can do for me is to send a holiday picture of the family. We have a wall in the clinic that is dedicated to this once a year event.

Well, you have outdone yourselves this year! The wall is full of cards and The Turek Clinic Team loves it. We received cards with photos of little kids, bigger kids, ultrasound photos of kids yet to be, dreams of kids and much more. Each telling their own story. What a way to fuel the fire of desire to continue to do what we can to help build families all over the world. Magical. So, thanks and

Have A GREAT Holiday!

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.

Why is Awake the New Sleep?

Paul Turek, MD — Mon, 28 Nov 2011 16:00:01 +0000

Sleeping Beauty definitely gets enough sleep (Source: Disney)

It was no surprise to me to read a recent study that showed that when Stanford men’s basketball players got more than 10 hours of sleep nightly, their on-court performance improved dramatically. They ran faster sprints, took more accurate shots and were less fatigued. Another example of more sleep translating into improved awake performance.

Facts About Sleep Deprivation

According to a recent national survey and the American Academy of Sleep Medicine, here are the current facts about sleep:

Adults should get 7-9 hours of sleep nightly.
Short sleep is defined as less than 6 hours of sleep.
Almost half (48%) of Americans say that they are not great sleepers.
More than 35% of Americans get less than 7 hours of sleep.
On average, “good” sleepers get 1-hour more sleep every night than poor sleepers.
13% say that they never get a good night’s sleep.
1 in 20 Americans have fallen asleep at the wheel while driving in the past month.
1 in 5 Americans have sex less often or have lost interest in sex because they are too sleepy.
In general, we sleep one hour less every night with each passing generation.

Sleep as Oxygen

During sleep, body temperature falls, muscles relax, the heart beats more slowly, blood pressure and pulse rate fall, and breathing slows. Clearly, sleep is more than simply rest and relaxation. It is a time of growth, recuperation and repair. Losing sleep may not physically kill you like being oxygen-deprived, but short sleep patterns are linked to depression, obesity, heart disease, loss of sex drive, attention disorders and a higher likelihood of developing a work-related disability. One Swedish study even showed that sleep deprived people look tired and less healthy and therefore less attractive to others.

Not only that, it’s not that easy to bounce back after losing sleep. The impairments caused by sleep-deprivation remain even after sleeping in for a day. Full recovery after sleep deprivation may take several nights of extended sleep.

So why does our society applaud those who stay up working all night rather than sleeping? Sleep deprivation is no badge of honor; it’s a threat to your health. Maybe this is why the Guinness Book of World Records refuses to recognize any record claims for lack of slumber. In my view, sleep ranks up there with nutrition and exercise as important pillars for a healthy, long and fulfilling life.