Posts Tagged ‘sperm count’

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No Men. Just Sperm.

Thursday, July 9th, 2009

Does this look like a real sperm? Do you believe in UFO's?

Does this look like a real sperm? Do you believe in UFO's?

We saw it coming. We created stem cells from testis tissue and published it earlier this year and I mentioned previously that it should be possible to do the opposite and create sperm from stem cells. Well, as announced yesterday from a research group in Britain, that possibility is closer to becoming a reality. Sperm created in a Petri dish. Artificial sperm.

Published yesterday in the journal Stem Cells and Development, this is being hailed by the press as “breakthrough” research. Now call me cautious, or call me a stem cell biologist, but I get suspicious when that term is used to describe medical research. More on that later. The technique, discovered by a team of biologists at the University of Newcastle in England and led by Dr. Karim Nayernia, purports to have created actual moving sperm from human embryonic stem cells. Not in a testicle, but in a laboratory dish. This group has some amount of “street cred” as they had previously published a paper in which mouse embryonic stem cells were used to produce in a dish. In fact, these sperm were injected into mouse eggs, formed mouse embryos and baby mice. However, a close look at the small print reveals the mouse pups all had “growth abnormalities” and died after birth.

Now back to being Mr. Cautious. If you look closely at the figures and video in the human paper, you might not be convinced that these are actual sperm. Pictures are a little too fuzzy. Kind of UFO-like. Could they really be neurons instead of sperm? Also, the sperm neither look nor move quite like what we would expect with normal sperm. Finally, some of the “reporter” genes that are used to classify the genetic origin of the cells are not working all that perfectly. Why didn’t the researchers provide more convincing evidence of the universally recognized elements of a sperm including the acrosome, midpiece with mitochondria and characteristic axonemal structure? Oh, and where are the controls?

There is no doubt that Dr Nayernia will face scrutiny for this work, as he has before. And this is all good. Because if the scientific world believes that it is true, then this is an amazing feat of science with enormous potential. For such acceptance to occur, a confirmatory study by another group will likely be necessary. Maybe ours, as we are investigating the same concept but in a radically different and much more feasible way—by trying to create an entire artificial testicle instead.

There are other meaty issues surrounding this research. Is it safe? Is it practical? Remember how inefficient it was to clone Dolly the lamb? Inefficiency runs rampant in any reproductive process. As an example, say that you discovered that humans can reproduce through sex and tried to license the process. With a 20% efficiency rate, you would probably be denied the license. On the other hand, if it is really true, this work has demonstrated the enormous potential of embryonic stem cells, as making a sperm is about as complex a process of cellular transformation that you will find in the body. Making bone, cartilage or heart cells should be much easier. Will it ever get to the point in which a healthy child might be conceived in this way? If that happens, then I might start thinking more about the real role of man in mankind. But not sooner. After all, if men become redundant in the reproductive process, who will replace men’s uncanny knack for opening jars?

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Posted in male infertility | 24 Comments »

Breakfast: The Best Fuel For the Engine

Monday, June 29th, 2009

Run clean, run hard, run fast...with breakfast

Run clean, run hard, run fast...with breakfast

Most Americans wake up, rub the sleep out of their eyes, clean up and rush out the door. Breakfast is an afterthought. But soon after that, stomachs start to growl for some food energy. But by now it’s gotten a bit too late, and no oatmeal or egg will suffice. It’s time for doughnuts, or candy at the receptionist’s desk, or the potato chips in the vending machine.

There’s a good reason for this behavior. It’s called blood sugar. And blood sugar is at its lowest upon waking. Hypoglycemia is associated with slowness, dullness, sleepiness, crankiness, and it sparks feelings of hunger. For sugar. And once we have it, we feel sated and comfortable again, not to mention more awake, because sugar gives us a burst of adrenaline. Tasks are done with a flourish. Until about 10 o’clock in the morning. Then there’s another crash.

The high levels of sugar in our blood cause the pancreas to secrete insulin. With the help of insulin, sugar moves from the blood stream into the body’s cells to do work. This lowers blood sugar levels again, and the body goes back to feeling irritable and hungry. And so we make a midmorning beeline for the Jelly Bellies to receive another jolt, another spike in our blood sugar, and the vicious cycle continues. In the end, this cycle causes weight gain and fatigue, and affects overall and sexual health.

One thing can help with this, and that’s something called “breakfast.” Statistic after statistic tells us how important breakfast is, especially one that contains whole grains and protein. The Imperial College of London found that people who ate breakfast were far less likely to give in to fatty foods later in the day. Another study showed that drinking fat-free milk at breakfast helped people to feel fuller, more satisfied and to eat fewer calories at lunch. Yet another study reported that people who ate two eggs for breakfast lost 65% more weight and felt more energetic than people who ate bagels for breakfast. And the list goes on. Suffice it to say, starting the day with a good breakfast should help you to actually lose weight and improve your overall health and sex life. It is by far the most important meal of the day.

Eating a proper breakfast, before you get too hungry, makes it easier to resist sugar cravings and helps you make healthier choices at lunch and dinner. Stick to whole foods and grains as much as possible, and include protein in your breakfast. A well designed breakfast takes longer to digest and will cause less of a spike in your blood sugar. Apples or bananas paired with almond or peanut butter, for instance, could pass for breakfast. Whole grain toast with nut butter; yogurt and fruit with a handful of nuts; even a protein shake can make the grade. Opt out of the French toast and go for the scrambled eggs. Another trick is to make breakfast more convenient than a trip to Starbucks. Get it into your system before a croissant does. Trust me, the rest of the day will be a cakewalk.

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Testosterone, Steak and Eggs

Monday, June 15th, 2009

One strong arm does not a man make...

One strong arm does not a man make...

Testosterone is one misunderstood molecule. It has such great influence over the human body that it has gained a reputation, a mystique. Society associates testosterone with Arnold Schwarzenegger (circa 1980s), with strength, virility, aggression, violence, square jaws and six-pack abs. We also tend to blame it for certain male tendencies and traits in our society, as well as certain medical disorders, although there is little scientific basis for this reasoning.

Testosterone is the major sex steroid hormone in men, and its effects are wide-ranging and powerful. It will make a boy into a man, for one thing. It sparks the development of facial and pubic hair, Adam’s apples, deeper voices, bigger muscles, broader chests. In the adult male, testosterone is necessary for sexual desire, erection maintenance, and sperm production. It also affects other body functions not directly related to sex–important ones–such as maintaining a normal blood count, bone strength, muscle mass and mood.

Testosterone might explain the perpetual sexual desire of a sixteen year-old whose previously unannointed body is now seeing it for the first time, but it does not explain away acts of violence. One popular belief is that excessive testosterone can make one uncontrollably aggressive. However, men actually tend to feel moodier and more anxious with lower testosterone levels, and there are reports that testosterone treatment can disperse these negative feelings. Also, studies show that there is a higher correlation between acts of violence and a past history of violence, than between violence and testosterone levels.

It is also untrue that high testosterone levels cause male pattern baldness and prostate cancer. Baldness is not a sign of virility, and is not associated with high testosterone levels. It is associated with genetics, specifically from the mother’s side of the family (male pattern, crown centered baldness) or the father’s side (overall baldness). Prostate cancer, meanwhile, appears to be associated with low levels of testosterone, and not high ones. So, basically, despite being the cause of hairiness, sweatiness, smelliness, and horniness, testosterone is very good for men.

Does it deserve the bad rap it gets? Taken appropriately, as replacement for naturally low levels, testosterone is not dangerous, nor is it illegal. If taken as a supplement, things are different. Anabolic steroids are synthetically produced variants of natural testosterone. Some common street or slang names for anabolic steroids include arnolds, gym candy, pumpers, roids, stackers, weight trainers, and juice. There are about 100 different types of anabolic steroids circulating nowadays and you will get over 1 million hits on Google by entering “buy steroids,” if you’re interested. When anabolics are taken as a supplement to boost normal testosterone levels, they can lead to some interesting side effects: shooting blanks instead of having a normal sperm count, getting tender breasts when you really don’t want them, and acne like when you were fourteen. Here’s where the bad rap enters the picture. And with steroid abuse, all bets are off regarding the healthy benefits that normal testosterone balance has on cholesterol balance, liver and heart health, blood pressure and mood. So be just like the power hitter Jim Thome, who said: “The strongest thing I put into my body is steak and eggs.”

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You Are The Pill That You Eat

Tuesday, June 9th, 2009

Amber waves of grain, the stuff of our Neolithic ancestors

Amber waves of grain, the stuff of our Neolithic ancestors

At some point as we evolved, well after the Neolithic period, we started thinking that there must be a better way to get nutrients, something faster and more efficient, than through the food we have eaten for tens of thousands of years. Our fantasy of the future was encapsulated with TV shows like The Jetsons and Star Trek, where roast chickens and earl grey tea were produced by the touch of a button. Nowadays, grocery stores offer fruit smoothies, breakfast bars, energy drinks and microwave pizzas, so we can fuel up quickly and efficiently. Why sit down when you can eat while running? We take vitamins with the idea that we can rectify any potential deficiencies and even prevent illness, with the swallow of a pill. How simple, how easy, how efficient.

As a society, we are in love with “nutriceutical” supplements. About half of all adults take a multivitamin everyday and it is estimated that $75 billion worldwide is spent annually on nutriceuticals. And nonvitamin and nonmineral natural product use is so prevalent in the U.S. (40% of Americans) that the National Institutes of Health has even commissioned a new branch devoted entirely to the pursuit of complementary and alternative medicine research. This effort will undoubtedly unleash the true potential of alternative medicine. But let’s drill down on vitamins for a minute. What does the evidence really show? Well, it appears that taking vitamin supplements may not as beneficial as previously thought. Several major studies have now shown that vitamin supplements do little to prevent cancer and heart disease, while other studies report that vitamins and antioxidant supplements may actually increase cancer rates. One study concluded that folic acid supplements actually increased rates of precancerous colon polyps, and another study linked beta-carotene to higher lung cancer rates. Are vitamins then, failing us as supplements?

No one discounts the necessity of vitamins for our body’s function. Indeed, many diseases are associated with a deficiency in one or another vitamin. But we do place rather high expectations on vitamins. It’s rather narrow-minded of us to tout only a few particular nutrients in food and assign them letters of the alphabet, when many others may be just as essential to our primitive bodies, yet are unfamiliar to us intellectually. Vitamins do not exist in a void, but are part of a complex mixture of substances called food that is the real stuff of life. If anything, the fact that vitamins are getting an F in cancer prevention suggests that the way that they are absorbed in a pill is not the same as the way we extract them from whole foods that we eat.

My patients frequently ask me what supplements they should take to enhance their sexual health or fertility. The truth is that because sexual health is so thoroughly intertwined with overall health, I emphasize a whole-body approach. I don’t recommend a specific course of supplements, but antioxidants may have some value. If they wish to take a supplement, they may, but the important thing is that they get all nutrients necessary for their bodies to function optimally. The real solution to this is a well-balanced diet low in fat and sugar, emphasizing whole grains, fruits, and vegetables. That said, I do realize how resistant many people can be to changing their diet. If a patient feels they must take a supplement to compensate for poor eating habits, I steer them towards whole food supplements that contain a larger and more complex spectrum of nutrients than that found in traditional multivitamins. In all honesty however, I firmly believe in carrots from the earth and apples from trees, just like our Neolithic ancestors did.

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Men, Oysters and Sex

Tuesday, April 7th, 2009

The Miraculous Oyster

The Miraculous Oyster

The eating of an oyster is a tale of seduction. Crack open its rocklike shell at its most fragile point and it gives easily, revealing the delicate tissue at its heart. Eat it raw and it tastes of the soul of the ocean that made it. To many, it’s food pornography. An aphrodisiac.

But oysters don’t make you a sex machine. It’s a just a myth. There is simply no scientific evidence that these tender sea dumplings help maintain erections, improve stamina, or enhance arousal. They may make you think about sex. Which is as good an aphrodisiac as any.

Despite the sexual innuendo inherent in these mollusks, there is a lack of scientific support that oysters are sexual performance boosters. Oysters do support a healthy body, and so a healthy sex drive. Along with being a protein source, they are rich in zinc, a deficiency of which can cause impotence. Zinc is also a necessary building block for testosterone, so it supports a healthy libido and sperm production. But zinc is common enough in other foods, such as chicken and turkey, and no one considers poultry an aphrodisiac. In rat studies, oyster extracts lower cholesterol levels and blood pressure, but changes in mating patterns have not been investigated. And at least one human clinical trial reports an improvement in cholesterol in healthy men with an oyster-rich diet. However, like in the rat study, sexual activity and performance were not examined.

That said, oysters contain something that can’t be scientifically quantified. Romance. And that’s a vitamin for the soul as well as the body.

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Posted in male infertility, sexual health, testosterone | 6 Comments »

Once Upon a Time in Barcelona

Thursday, March 26th, 2009

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

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

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

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

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

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

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What we found: Male infertility and Cancer

Thursday, March 19th, 2009
The genetic complexity of sperm and precursor cells when the chromosomes are painted is similar to that of constellations of planets and stars, and look very similar.

The genetic complexity of sperm and precursor cells when the chromosomes are painted is similar to that of constellations of planets and stars, and look very similar.

So what did we find?

The study showed that men who are infertile have a much higher risk (3 times) of developing testis cancer later in life than the average citizen. And this was based on some serious number crunching. We worked from a huge database of over 51,000 infertile couples who sought care over a 22 year period in California.  The male partners were cross referenced with a California cancer registry to figure out who among them developed testis cancer as they got older. Among infertile couples in whom the male partner was not the reason for infertility, the future risk of testis cancer was the same as in the general population. However, among infertile men who were themselves the cause of the infertility, the risk of future testis cancer was 3 times higher.

So what does this really mean? Well, first of all, it confirms studies from Europe that have suggested the same thing is happening there. This confirmation in a U.S. based study is important, because the rate of testis cancer in many European countries is much higher than it is in the U.S. It also implies that there may be a connection of some kind between male infertility and testis cancer.

But what kind of connection could exist between male infertility and testis cancer? Well, environmental exposures might link these two conditions. However, the kinds of substances that could do this are still unclear. Estrogenic compounds such as bisphenol A, phthalates and pesticides have garnered much press lately as they alter sexual development in animals, but have not been definitively linked either to testis cancer or human infertility.

The connect, I think, may be even more basic: it probably involves genes and gene mutations. About 10 years ago, we and others reported that severely infertile men have more trouble than other men in properly repairing the daily breaks and kinks that occur in everyone’s DNA with daily use. Because faulty DNA repair is clearly associated with cancer in humans, this led us to surmise back then that infertile men with faulty DNA repair might have a higher risk of cancer later in life.  And voila! The results from the recent research appear to support this idea. 

For the time being, the risk holds only for testis cancer, but who know what future research will show? Based on this, I recommend that all infertile men certainly be evaluated by a urologist with a good history and physical examination. They should also be taught testicular self examination as a screening tool to detect testis cancer.

Infertility as a window into men’s health?  As a shift in thinking, it certainly does shine a new light on the problem.

 

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Posted in Uncategorized, male infertility, testis cancer | 1 Comment »

Male Infertility and Cancer Later On

Saturday, February 28th, 2009

Every day I try my best to help men who walk through our clinic doors achieve the full potential of their reproductive and sexual health.  That covers a lot of ground mind you, from counseling on sexual dysfunction, to testing, to actual surgeries like a vasectomy.  I also see lots of patterns.  The one that kept bothering me – like an itch I couldn’t quite scratch – was the fact I kept seeing infertile men who had other medical issues that, at first blush, seemed unrelated.   It wasn’t just a patient here or there, it was all the time.

But the common wisdom has been that male infertility is a benign condition.  It is something that occurs in otherwise healthy men, making it harder for them to have a baby, but has no other real health implications. 

What we are taught often causes us to look something and see it in only one dimension, when in fact if it were turned slightly differently we would see that there is a completely other side to it.  In medicine, breaking out from what is taught, from what is ‘common wisdom,’ is particularly hard because we are a consensus-driven fraternity where the truth can take years to uncover and even then is often inconclusively viewed.  You don’t – at least I can’t – just one day see something and suddenly shift the paradigm in your head.

So it took some time for the light bulb to finally go on for me.  But when it did, it was an “aha” moment.  What if, instead of being a benign condition, infertility was a “window” into men’s health?  What if we could look at it as a signal that other conditions could occur or might happen, that are just as important, later in life?  If that were the case, could we use it as an early-warning tool to help prevent future disease? 

That insight became the hypothesis for a series of studies that I and several of my colleagues at UCSF Medical Center – Thomas J. Walsh, Mary  Croughan, Michael Schembri, June M. Chan (a really incredible team that any researcher would be proud to share a challenge with) – put together to understand the link between male infertility and other diseases.  The team was meticulous in the design and implementation of the study, and the results were nothing short of astounding. 

The results will take some time to explain, so I’ll save them for my next posting. 

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