Posts Tagged ‘sperm’

The Symphony of Surgery

Wednesday, November 25th, 2009
Tickle the ivories and delight the senses.

Tickle the ivories and delight the senses.

I spent an evening this past weekend listening to the mighty Berlin Philharmonic Orchestra, conducted by Sir Simon Rattle. Listening to their performance of Wagner, Schoenberg and Brahms left me utterly breathless. A magnificent musical experience. Why? Because every single musician thinks and responds incredibly quickly and appears to give their all to a whole that is far greater than the sum of the parts. The mastery of these technically demanding movements was superb and it was clear that this orchestra, led by a conductor filled with supreme passion, could turn on a dime at any moment.

Can a surgeon perform surgery like a world-class symphony performs music? Absolutely. While a resident in general surgery, I remember watching a pediatric heart surgeon name William Norwood at the Children’s Hospital of Philadelphia perform his own Norwood Procedure on children with malformed hearts. Dr. Norwood’s hypoplastic heart surgery on infants at the brink of death was exhilarating to behold. Appearing intense and focused, with no wasted movements of his ambidextrous hands, he could repair an aorta or pulmonary artery in a minute with either hand, throwing absolutely perfect sutures as rapidly as a sewing machine. All the while working on hearts the size of shrunken plums and veins slimmer than angel-hair pasta. A technical virtuoso. All while listening to Albinoni’s Adagio in G Minor.

Aside from sheer talent, what makes William Norwood and Sir Simon Rattle the giants that they are, is a vision of perfection and the ability to inspire the best from others. Helping others achieve more than they could otherwise is a key element of leadership, especially in the setting of complex team performances like heart surgery or Schoenberg movements.

Inspired by these maestros, I too strive for perfection in my corner of the medical world, that of reproductive microsurgery. I view vasectomy reversal surgery as a craft best done by artisans. The chance to lead a roomful of others, throw 300 knots all with equal precision into an organ the size of spaghetti, gauge biology like a painter eyeing a still life, and help to create new life as a result. There is art in all that we do. Have you found your canvas?

A Short History of the Y Chromosome

Tuesday, September 22nd, 2009
The Y chromosome: diminutive but cool.

The Y chromosome: diminutive but cool.

Among the many chromosomes in a man’s body, the smallest one with the largest personality has to be the Y chromosome. With it, you are a male; without it, you are a female, with few exceptions. More than any other chromosome, it really defines who you are.

The Y chromosome controls other traits as well: hairy ears, tooth enamel, and stature to name a few. But for the longest time, the Y chromosome was also considered home to a lot of “junk DNA” that we thought had no purpose. We now know that much of this DNA has a purpose and that the Y is the home of many important male fertility genes.

Before its association with male fertility, the Y chromosome was widely considered a genetic black hole, a chromosome that evolved as a broken remnant of the X chromosome. We knew that the “maleness” gene was on the Y and a few other genes. However, since the Y chromosome has been fully undressed as a result of the human genome project, we now know that it is very unique, even special, and that it evolves in its own special way to keep men men.

The Y chromosome, and its neighbor the X chromosome, evolved into “sex” chromosomes hundreds of millions of years ago. This is important because many species do not have a chromosome for each sex like we do. Some species become male or female based simply on the environment in which they find themselves. Imagine that! A boy in the Artic but a girl in the Caribbean. At first, the original sex chromosomes probably evolved as a pair of two X chromosomes. Then, 150 million years ago, the Y chromosome made its break from the X chromosome. Basically, it stopped associating with it and this led to our current X-Y system of sex determination. I guess this is when men really became men.

As it works now, the single Y chromosome has no partner with which to swap genes when sperm are made (at a normal rate of 1200 sperm/heartbeat!) This “swap meet” of genes that occurs when new sperm are formed is an important repair process for the 22 other chromosomes and is absolutely critical for our evolution as a species. In fact, this is the source of our evolution. So, now that the Y chromosome has become isolated and less of a team player, is it doomed to extinction? More importantly, are men are doomed to extinction?  

So how does the Y chromosome survive and repair itself, living alone in isolation while the world is changing around it? Well, we now know that it manages very well on its own, thank you. And this has probably been true for about 5 million years. Although it no longer swaps genes with the X chromosome, from which it came, the human Y chromosome is able to swap genes with itself to discard bad genes. It’s called gene conversion and no other chromosome does it. Just the Y. How uniquely male.

Basically, essential Y chromosome genes are arranged in a series of eight “palindromes,” or mirror image sequences, each of which folds like a hairpin in which its two arms come together. Then the “DNA checkers” compare the two arms for any differences and convert a mutation back to the correct sequence, thus saving the Y’s genes from mutational decay. So, the older “junk DNA” thought to exist on the Y chromosome is now known to represent DNA that it critical for its survival. One man’s junk is another man’s treasure. And so it goes, the Y lives on, and men do too.

Baby Making Tips

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

The most fun he ever had without laughing

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

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

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

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

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

The Ailing Male Pill

Thursday, August 6th, 2009
What shape will the male pill take?

What shape will the male pill take?

A male birth control pill certainly sounds like a good idea. But after 25 years and millions of dollars of research, there’s still no pill. We put a man on the moon faster than we’ve invented a male pill.

The question isn’t really whether it can be done, because it can. The production of sperm is linked to testosterone levels in the body. When testosterone levels are too high, the body stops producing sperm. Witness the testis shrinking (atrophy) that occurs with anabolic steroid use. Such pills have been tested, and are successful. One problem, though, is that the ability of hormone-based male pills to work perfectly (which they really need to do) varies with a man’s ethnicity. Works for some, but not all. This issue alone may prove fatal for the male hormone pill.

Besides this, there is a litany of concerns regarding the physical side effects of a hormone-based male pill. Immediate concerns have been a big issue in past trials- adult acne, weight gain, moodiness and the like. But what about possible long term effects? The female contraceptive pill has been linked with higher rates of heart disease and breast and liver cancer in women. Although not completely comforting, at least we know these issues in women. But little to no research has addressed similar issues with long term “pill” use in men.

Despite all of this, there is still a healthy interest in a male birth control pill. Studies have shown that men in committed relationships are more interested than single men in a pill– no surprise here. Single men are interested in using condoms for the added bonus of protection against STDs. A male birth control pill might also be a better contraceptive alternative for men who want more control over family planning than that offered by vasectomy. That said, there is still the eternal question of whether or not a pill would sell successfully– would women, in the end, trust their partners to be consistent and compliant in taking the pill? The answer to this question varies from couple to couple, but to get a sense of things, ask yourself how often you fail to take something as simple and uneventful as a daily multivitamin to get an idea of the magnitude of this problem.

There simply aren’t enough options for male contraception on the market today. The main ones are abstinence, rhythm method, withdrawal, condoms, and vasectomy. Given this lineup, there is certainly room for more, and more reliable, contraceptives for men. One thing seems reasonable clear: given the safety and effectiveness of vasectomy, and fact that daily compliance is not needed to keep it effective, anything new has to be this good or better. How about a truly reversible vasectomy? Or a long term, implantable hormonal device? In the end, these are likely to become tasty alternatives to a male pill.

Pulling Out is In

Thursday, July 30th, 2009
Barrier contraception faces stiff competition...

Barrier contraception faces stiff competition...

Hold on now. Wait a minute. Don’t get too excited. If you thought “pulling out” was a feeble and ineffective method of contraception for the reckless and unprepared, well it is. At least at first glance. But given that at least 38 million couples use it worldwide, coitus interruptus warrants a second look. 

Coitus interruptus, with its ancient yet undistinguished history, is very easily dismissed as an effective contraceptive because of the widely accepted belief that the pre-ejaculate contains sperm. There is actually no conclusive evidence that this is the case. No one has actually found sperm in pre-ejaculatory fluid. In addition, it is all-natural, organic, hormone- and side effect-free, and affordable. It needs no tool that nature hasn’t already given us, except rigorous and unerring self-control. Well, in fact this is the big downside. Who has rigorous and unerring self-control? We are men, not robots. Pulling out doesn’t protect you from sexually transmitted diseases, either.

That said, a recently published study has shown for the first time in the modern era that withdrawal is more effective a contraceptive than one might think. Maybe we should look at the pull-out with a little more respect. The withdrawal method, when used with perfect technique, has a 4% failure rate. This falls behind vasectomy (0.1%), birth control pills (0.3%), IUDs (0.6%), and condoms (2%), but not by much. The actual (real life) failure rate is likely somewhere between 15-25%, which is really not far behind the actual failure rate of condoms, at 10-18%.  So withdrawal is not that bad after all, only a little less effective than condoms. Perhaps men deserve a pat on the back for this. Well done. 

However, if this were a contraceptive pill, a 15% failure rate would send its inventors back to the drawing board. For coitus interruptus is inherently flawed, and women who seek more control over whether or not they become pregnant are more likely to reject this method over the long term. One study revealed that women of higher economic status and education are more likely to insist upon a more surefire method of contraception. It appears that women simply don’t trust men’s timing, their control, and perhaps even the male sense of responsibility when it comes to contraception. They want more control in the matter. What does this mean for a male contraceptive pill? More on that next week.

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?