Turek On Men's Health » Fertility Preservation

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…

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.

Your Hair or Your Hormones

Paul Turek, MD — Mon, 30 Jan 2012 16:00:25 +0000

Be nice to have Superman's hair…but at what price? (Courtesy; MovieBlog.com)

It’s the perfect drug for 40 million men in America who are going bald. Take it once a day to keep the hair on your head and shrink the prostate, which also commonly bothers men as they age. It’s a pill that has been used by at least 2 million reproductive age men over the last decade. But is it too good to be true?

The Best Hair Pill Yet

This magic pill is finasteride (trade names; Propecia, Proscar, Avodart). It represents a class of drug called the 5-alpha reductase inhibitors. These pills act as enzyme blockers: they prevent the male hormone testosterone from converting to its metabolite dihydrotestosterone (DHT). Although testosterone is responsible for a lot of our “male” features, DHT is more potent than testosterone for scalp hair and our internal reproductive organs (prostate, seminal vesicle). These drugs work by lowering DHT production and protect the gloriously youthful hair on our heads and the enviable ability to write your name in the snow while urinating.

And these drugs work well. More effective than topical or “rub in” medications, finasteride is great for what’s called “male pattern” hair loss which is due to a receding hairline or balding on the top of the head. In essence, it slows the growth phase of hair in these areas. However, it doesn’t treat hair loss on the sides or temple area.

Finasteride, Sex and Male Fertility

Although it may keep you looking like Clark Kent, many male infertility specialists, including myself, have concerns about finasteride. First, there is a 10% chance of sexual side effects that include erectile and ejaculatory dysfunction and lowering of sex drive. These issues can be subtle while on the pill but become very obvious when men stop it; many of my patients have noted a sexual “curtain being lifted” or “coming alive” after discontinuing the pill.

Second, there is an even more profound concern about finasteride among specialists: male infertility. Before it received FDA approval, the drug trials showed that it lowered ejaculate volume but did not change sperm count or motility on semen analysis testing (actual human fertility studies are not routinely required by the FDA). Now that it has been on the market for 10 years, though, impressive declines in semen quality have been observed and published with finasteride by many of us. This effect is not subtle either, as patients with complete sterility (azoospermia) have had recovery of their sperm counts after stopping finasteride!

There are several clues that this effect on fertility was possible. The rabbit studies done for FDA approval of the drug actually showed this effect. At 3 months, there was no effect on rabbit fertility. But, when followed longer, rabbits showed significant decreases in natural fertility. In addition, while I was writing a recent reproductive physiology chapter for Campbell-Walsh Urology, our leading urology textbook, I researched at what levels the 5-alpha reductase enzyme is found in the human testis and epididymis. Lo and behold, there are gobs of this enzyme in these important organs for sperm production and maturation, implying that the blocking agent finasteride would have an effect. So now what do we do?

At this point, controlled clinical trials are needed to prove this effect on fertility. For the time being, current thinking is that finasteride may not dramatically change sperm production in healthy men, but can impair semen quality in infertile men. Typically, the effects of medications on male infertility are reversible. So, to be proactive men should consider stopping the pill at least 6 months prior to trying to conceive. And, have confidence that she loves you just as much for other reasons. As Telly Savalas once said: “We’re all born bald, baby!”

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.

An Ounce of (Fertility) Prevention

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

Kokopelli, the ancient fertility symbol.

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

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

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

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

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

Preserving Male Infertility

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

Restoring Male Infertility

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

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

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

The Recipe for Man Made Sperm

Paul Turek, MD — Mon, 08 Aug 2011 15:00:32 +0000

Will stem cell "recipes" become as tried and true as the ones in this book?

Stem cells rock. While the stock market tumbles, stem cell science is sizzling. I know, you’re thinking: what is he talking about? No diseases have been cured with new stem cell technologies. But, from what’s being discovered almost weekly now, I can tell you that male infertility is likely to be one of the earliest boxes ticked on the “Diseases to Cure” list for stem cells.

Sperm from Stem Cells

Honestly, stem cells appear to be great to use to create sperm. Just a few posts ago, I shared the exciting findings from a group in Japan who took stem cells from newborn mouse testicles, placed them in an “organ culture” system (basically Jell-O), and grew mature, fertile sperm in the laboratory. Over the past 2 years, my colleagues at Stanford have also shown that human embryonic stem cells can be pushed along the path toward sperm in a dish. They also showed that adult stem cells from places like skin can also be driven in the same direction. Not all the way to mature sperm, but certainly more than half the way.

Overcoming Sterility in Mice

Last week, researchers at Kyoto University in Japan brought man made sperm closer to reality…at least in mice. I know many of you aren’t really worried about infertility in mice, but we have to start somewhere.

In a study published this past week, they took embryonic stem cells from mice, the mother of all cells, and watched them closely as they began to develop into other cell types (i.e. differentiate) in a dish. After several days, they plucked out rare and transient downstream stem cells called the primordial germ cells and transplanted these cells back into sterile baby mouse testicles. And sperm were made. Good sperm. Genetically intact and fertile sperm. Sperm that led to offspring that were also naturally fertile. And they did the same experiments with adult stem cells and got the same result, eliminating the need to use embryos at the start.

Please realize that this success did not happen overnight, but was the result of good, wholesome science and lots of sweat equity. And not all the results were rosy: primordial germ cells are rare, short lived and inefficient. In addition, when slightly different cells were injected into testicles, benign tumors formed, the scourge of stem cell science. So now you understand why mice experiments come first.

Stem Cells and Human Male Infertility

Imagine this: A boy has cancer and gets cured by being pounded with chemotherapy. Easily enough treatment to sterilize him for life. After that, his testicles could make sperm, but the “seeds” (early germ cells) that develop into sperm have been wiped out. Solution? A skin biopsy. Turn it into an adult stem cell and inject it right back into his testicles. And ta da! Sperm. I can’t stop thinking about how possible all of this is, as stem cell recipes are perfected. As Ted Allen, The Iron Chef once said: “There are two words to improve any dish: Ba-Con.”

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…

I’ve Been Googled!

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

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

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

The Google Invitation

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

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

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

Google Health

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

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

Advice to Google on Sexual Health

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

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

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

Mice Sperm in a Dish

Paul Turek, MD — Sat, 09 Apr 2011 15:11:11 +0000

If they just would have included a photo of the finished product…

It’s not the mother load of discoveries in our field, but it’s pretty close. It tells us that the mother load is definitely out there…and within reach. Yup, the good news is that real. live, old-fashioned sperm were made in a dish… at least for mice.

The Holy Grail: Artificial Sperm

For the 55,000 reproductive age cancers survivors annually in the U.S. and a host of other men who are sterile due to injury, genetics, exposures and the like, this is good news. Despite the availability of utterly fantastic reproductive technologies like sperm mapping, in vitro fertilization and intracytoplasmic sperm injection, some men still do not have sperm to use them. The standard of care in reproductive medicine today is a sperm: a mature one, with a tail, and hopefully moving or at least alive.

And the sperm can come from anywhere. Often, men with no sperm in the ejaculate will have sperm within the reproductive organs such as the testicle or epididymis. These sperm work great to help them become fathers. But there are many other men do not have any sperm, anywhere, especially men with childhood cancers who were blasted with sterilizing treatments before they even reached puberty and made their first sperm. Clinically, I see these patients all the time and this is the crowd of men I am very motivated to help in my short time on this good earth.

The Finding: Functional Sperm for Mice

The recipe to produce functional sperm from stem cells precursors has eluded researchers for 50 years. There have been many false starts, including the last one in 2009 out of Newcastle that was published and then retracted from print by the editors one week later. But, a group from Yokohama City Japan nailed it and recently published functional mouse sperm from testis stem cell precursors.

From reading the paper, it is clear that it took several years of constant, diligent work to find the key ingredients to make it happen. In my opinion, the secret sauce was that our recent, vastly improved understanding of stem cell biology really enlightened the science. They took testicular tissue from newly born mice that contained only stem cells (no sperm, just sperm precursors) and put them in a jello-like environment. Getting them to grow was the trickiest part and finding the right food was also critical.

How is This Sperm Different?

What made this paper great was that the scientists made reproductively “competent” sperm. They took the artificially created sperm and used them with high technology approaches to create baby mice. Then, they let the baby mice grow up and mate. Remarkably, the offspring of these mated mice were normal. Can’t ask for much more from a sperm now can we? Many have tried, including some of my closest colleagues, but no one has gone this far before. Bravo!

So now, all we have to do is replicate this in humans, something that I have been pursuing for several years with colleagues. What is so uplifting for me about this paper is that it seems that making human sperm in a dish is really more evolutionary than revolutionary science. I better go buy some more of that midnight oil….

Giving Up the Gavel

Paul Turek, MD — Sat, 02 Apr 2011 14:07:43 +0000

A gavel with teeth for this President…

In two days, I will hand over the gavel. It’s actually a meat tenderizer that I bought to run the meetings this year and it worked just great. A gavel with teeth. Regardless, I surrender it with mixed feelings. On one hand, a year as President of one of America’s leading academic societies is a lot of work. On the other, though, I feel like I am just getting started and that the ship is now running fast with sails full. As we all know from politics, systems with rotating leadership all have their virtues and vices.

The American Society of Andrology

The Society that I lead is the American Society of Andrology. It was founded in 1975 and has about 700 members, most of whom are academic researchers. I guess I have a soft spot for nerdy scientists who care about men’s health. Honestly, though, this group is unique. This week’s annual meeting in Montreal brings together a top-notch group of scientists and clinicians from around the world whose expertise, interest, friendship and collegiality lend to a remarkable cross-fertilization of science and medicine.

What the Heck is Andrology?

My mother still asks me this question. Andrology is the study of men’s health and, in particular, the male reproductive system. It involves all aspects of reproductive fitness, including fertility and infertility, erections, hormones and sexuality. As a reflect upon the Society’s position in the academic world, my elevator pitch is that this Society’s focus is on “The Science of Men’s Health.”

President’s Tribute

The year has been a good one: restoring falling membership, bringing financial stability, initiating a strategic plan and an endowment campaign, and brokering the merger of the Society’s academic journal with that of its European counterpart, the European Academy of Andrology, to ensure its future livelihood.

But, as with most endeavors, the people make the party and I must admit, my colleagues rose magnificently to execute the demanding projects that I put forth this year. And this means a whole lot. In fact, this and only this is substance of my final toast, a limerick, at the Welcome reception tonight. I probably shouldn’t leak it here early, but for you dear reader I submit:

There once was a crazy society,
Subscribed to by much notoriety,
Its goal, so sincere,
To study things dear,
Like sex, with the utmost sobriety.

But not only sex does it foster,
There is but a much longer roster:
Like sperm, prostate, erections,
And most epididymal sections,
And diseases like clap and zoster.

And don’t forget contraception,
The inimitable acrosome reaction,
And ejaculation that’s early,
With low libido that’s surely
A sign of hormonal malfunction.

So as we meet here in old Montreal,
Let’s remember these orders so tall:
To discuss, think and debate,
With friends old, new and irate,
The science to which we are called.

The Condom Cha Cha

Paul Turek, MD — Mon, 13 Dec 2010 04:17:23 +0000

Sometimes doing the dance gets old…

It is hilarious and it happened again recently. I had just finished his quick and painless no scalpel vasectomy and was about to hand him his signed “diploma” (really) for “meritorious performance and uncommon bravery” when he said it. Just as the others had said it, with that screechy, high-pitched, Vienna Boy’s Choir voice: “Nice job doc; it didn’t hurt a bit!”

Even though it was made in jest, this comment suggests there is something about the culture of men that equates vasectomy with castration. The truth is that vasectomy is the most successful contraceptive available bar none and, unlike female oral contraceptives, requires virtually no compliance to maintain its effectiveness. It does not alter sex drive, erections, sensation, ejaculate volume or testosterone levels. In fact the way testosterone leaves the testis to supply the rest of the body is through an entirely different route (the bloodstream) than that taken by sperm (the vas deferens).

Nevertheless, something is removed, or different, after a vasectomy. Maybe it’s as simple as shooting blanks instead of having both barrels loaded. Maybe it’s the association of virility with the ability to sire offspring that defines Western culture, although you wouldn’t know this based on the meager birth rates in Western civilization of late. Maybe it’s the utter irreversibility of the decision to have a vasectomy performed. Whatever it is, it bubbles up and surfaces now and again in the gesture and guise of this faint, prepubertal voice.

Because of this subtle yet pervasive response to vasectomy that I have gleaned from patients, I now make it a point to counsel men before the procedure not only about what actually gets altered (fertility) with vasectomy but also what is preserved, which is essential maleness. In fact, many men feel liberated afterwards, not only from the anxiety of unwanted pregnancies but also from the “Condom Cha Cha” of their acne-filled youth to which they might prefer never to return.

I also discuss the fact that men should feel comfortable with the idea that vasectomy is a reasonable form of contraception for the “near future” as the idea of it being drop dead permanent can be seriously off-putting to many reasonable candidates. Simply stated, men’s lives are not filled with that many decisions that hold an equal weight of sheer permanence as that of vasectomy. This is also where the concept of sperm banking and sperm retrieval enter the conversation as ways to preserve or restore fertility after vasectomy. And, given the fact that 5-7% of U.S. men choose to have a vasectomy reversal in the U.S. alone is strong testament to men’s desire to continue to exercise reproductive choice in the face of what was previously understood to be a permanent decision.

So, my take on the shrill, jocular “thanks” occasionally offered after vasectomy is that it represents the well-informed response of the emancipated man who accepts that his manhood has nothing to do with how far his sperm travel.