Episode 11: Male Factor Infertility: Challenges, Solutions, and Knowledge for Guys

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Episode Summary:

Male fertility potential is influenced by genetics, lifestyle, environment, and health. Learn the statistics and basics, hear about the great strides medicine has made treating male-factor infertility, and check out the tips, support information, and resources discussed in this episode.

Episode Guests:

 Thomas Walsh, M.D., Associate Professor of Urology, University of Washington School of Medicine, and Director of the Men’s Health Center, U.W. Urology. 

Annie Kuo, Washington State Ambassador for RESOLVE, the National Infertility Association, Director of Public Relations, University of Washington Department of OBGYN

During This Episode We Discuss:

  • Male infertility: incidence, diagnosis.
  • Lifestyle changes to improve fertility, treatment options
  • Is the incidence of Male Factor infertility increasing?
  • Impact on relationships

Quotes (Tweetables):

“15-17% of couples of reproductive ages will experience infertility, and about half of those couples will have some male factor, about 20 – 30% of those will be male factor alone, the rest will be contributory.”

  “Men who lead an incredibly sedentary lifestyle have lower sperm counts on average.”

“We know men who smoke tobacco at threshold levels have lower sperm counts.”

Tom Walsh, M.D.     

 “There’s really no symptoms to male infertility.”

“Some studies have shown that infertility is as stressful as cancer.”

Annie Kuo

Recommended Resources:

Episode Transcript: 

Richard Pelman MD (00:06):

A baseball game, a day in a park with friends and family, fishing in a remote stream, work, travels, providing for loved ones, or heading out for adventures. Whatever you do, whatever you enjoy, you need your health. The Original Guide to Men’s Health is presented by the Washington State Urology Society to help take you through the steps necessary to get the most out of life. If you have invested in a retirement plan for your future, why not invest in your body. After all, it makes better sense to retire healthy and enjoy your future. These podcasts are a guide for how to take care of yourself. If you take care of your car and maintain it, why not do the same for your personal machine, your body. If you know you should, but haven’t yet, the information in these podcasts contains some easy recommendations for where, when, and how to get started. Follow the podcast as we explore men’s health with renowned experts and embark on a journey towards better health.

Richard Pelman MD (01:29):

On today’s episode of the Original Guide to Men’s Health, we’re fortunate to be with Dr. Tom Walsh. Tom is an associate professor of urology at the University of Washington and director of the University of Washington Men’s Health Center. Dr. Walsh received his MD from Northwestern University and served his urological residency at the University of Washington. He then completed a fellowship in male infertility and erectile dysfunction at the University of California, San Francisco, where he then served as the director of the UCSF Center for Male Reproductive Health. He then returned to the University of Washington and is mentioned as currently the director of the UW Men’s Health Center. We also are fortunate to have Annie Kuo. Annie Kuo is Washington State’s ambassador for Resolve: The National Infertility Association. In 2015, Annie brought Resolve’s presence back to Seattle by launching a monthly general infertility support group that she hosted for four years.

Richard Pelman MD (02:30):

Since then, the number of peer-led support groups in Western Washington has grown to 10, all run independently by volunteers. Annie currently convenes the group for third party reproduction in Ballard. She has noted that male factor infertility is absolutely half of the hundreds of patients she has met. She also supports the infertility community through legislative advocacy at the federal level. This May will be her fifth time at the Infertility Advocacy Day in DC, where she helps lead the training of advocates. Professionally, Annie is Director of Public Relations for University of Washington OB GYN. She’s on the UW Men’s Health Council and raises awareness about men’s health with the Department of Urology. So welcome Dr. Walsh and Annie. Today we’re going to address infertility, and I always like to start with what is infertility. So we’re going to be speaking about male-factor infertility, understanding that it takes two. So Dr. Walsh, give us a little background in what you consider male-factor infertility.

Thomas Walsh MD (03:34):

Well, so infertility, by definition, is the inability of a couple, despite appropriate effort, to conceive in a one-year period of time. It’s a little arbitrary, but it’s what’s clinically significant to couples. We consider male-factor infertility when there’s an identifiable cause on the male side that we can clearly determine is at least somewhat causative. And if you were to break down statistics regarding infertility in the United States, about anywhere from 15-17% of couples of reproductive age will experience infertility and we believe that about half of those couples will have some male-factor. Maybe 20-30% will be male alone and the rest is contributory or multifactorial between the couple.

Richard Pelman MD (04:30):

I’ve seen some patients who hadn’t even attempted fertility yet, but are interested in finding out if there’s going to be an issue. Is that appropriate for them to start at that point?

Thomas Walsh MD (04:40):

Absolutely. Those are my favorite people. You know, I’ll let Annie chime in, but I’m pretty sure there used to be a school house rock about this, something about, the more you know. I don’t know whose phrase that was but the more informed I think couples can be heading into their reproductive years, the more control they have and the more options they will have.

Annie Kuo (05:02):

People who are interested in learning about their fertility before they’ve even tried to conceive seem like they’re very fertility-conscious and aware, and that’s refreshing because I can’t tell you how many guys I know who haven’t even tried to get someone pregnant, and they’re like, “that’s not going to be a problem for me.” But there’s really no symptoms to male infertility. You can’t tell from an erection or ejaculate that you don’t have sperm. You can’t tell from any particular physical symptoms that there might be an issue. It’s only until you have a medical test that you can find these things out or, you know, find them out for sure.

Thomas Walsh MD (05:44):

I mean, what I would say is that there clearly are some medical conditions that men may have been informed by their parents. They may know from their experience in the medical world that this is something that could contribute to infertility. There are conditions that boys are born with. They undergo corrective surgery. They may have some idea that there could be an issue. Shockingly, there are many young men who have these conditions and have never been taught that they may contribute to their infertility. So there are some health conditions and it’s worth talking about them and that men will absolutely experience them in fertility. The earlier they come to somebody’s attention like me, the faster we can help them, or at least assuage their fears and and create a plan for them.

Annie Kuo (06:35):

That is true. I have come across some men in our groups who said they had undescended testicles, or they had some birth defect, so they knew early on and had conversations with their partners that there might be issues trying to conceive. So that came from early in there.

Thomas Walsh MD (06:55):

Yeah, those are great. Those are great examples. There are genetic diagnoses. Perhaps people have heard of a disease called Cystic Fibrosis. Cystic Fibrosis has a genetic component that specifically disables men from being able to conceive naturally, yet, with help from a specialist or a team of specialists, those men can conceive too.

Richard Pelman MD (07:17):

So we have a couple, and they are either pre-attempt and want to be screened, or they’ve been attempting and haven’t had success. What sort of evaluation would they be looking at initially?

Thomas Walsh MD (07:31):

So I would start by saying that most physician practitioners in the reproductive realm would always encourage a couple to imagine a simultaneous evaluation where not one partner is singled out. For a man, since we’re talking about male infertility, the cornerstone of a male fertility evaluation is typically an interview talking about health history, prior surgeries, diseases they’ve experienced, drugs they take, some of them prescription, some of them self-prescribed; a physical exam that specifically focuses on their male characteristics and their genitalia, and then, importantly, the test that Annie alluded to, which is called a semen analysis, which is essentially examining the contents of a man’s ejaculate to quantify and to qualify their sperm.

Richard Pelman MD (08:30):

So in an initial evaluation, would that be something that you’d recommend being done by a specialist?

Thomas Walsh MD (08:41):

You know, it’s a really good question. I think I really believe that men need to seek healthcare where it’s available and where it’s comfortable. In an ideal world, I would love to expose all men to a specialized center like we have where really pointed questions can be asked and really specific testing can be done at the point of care. I acknowledge that that kind of care isn’t available everywhere. So, I think it’s important for general health providers to have some baseline knowledge of this. There was a time in Western culture where it was assumed that all fertility issues resided with the female. And there was very much a neglect of male-factor infertility. I think that that needle is swinging. That bar is swinging, but I think talking with a general doctor, if that’s who’s available, is very appropriate.

Richard Pelman MD (09:29):

We have seen an evolution in the ability to help men in the sense that, going back to when I was in training, if a man had no sperm, there was really very little we could do. And that means that on the semen analysis they produced, there was fluid, but no visible sperm seen. And really we looked at those men and said, you need to adopt. Now in this day and age, we have the ability to help men who have low counts and we have the ability to help some men who have no sperm. Want to elucidate a little further about what we can do?

Annie Kuo (10:08):

Well, I’m not the medical expert, but I have heard what some of the men, and say both the general infertility support group and the third party reproduction support group, have experienced in seeking treatment. On one extreme, is what the third-party guys call the Nutcracker surgery. 

Thomas Walsh MD (10:39):

Sounds like I better jump in here. So I think this is a good time for some statistics. So let’s go back to where we started. So we talked about 15% of all couples, half of them being a male contribution, and of those men where there is this contributing factor, one in 10 of those men will have no sperm in their ejaculate. And these are the men that you’re talking about that not more than 30 years ago, there was no hope. There were no options. Today we know that at least half of those men may actually be manufacturing sperm within the testicle. We know that we have really advanced techniques where we can find those sperm, where we can extract those sperm. And those men can go on to successfully father pregnancies using advanced reproductive technologies with an exceptionally high success rate. For some of these men, the pathway is easier than others. If we talk about what the most amazing advance in medicine is, there have been many, and in this era, they happen, it seems like we’re hearing about almost every day. But the advances in reproductive care are unbelievable.

Annie Kuo (12:00):

I spoke on one extreme, but the other extreme is that even with male-factor infertility, some of these advances in reproductive medicine are so great, that it almost seems for some couples who might have minor male-factor, that IVF is great for male factor. It’s harder for female-factor infertility where perhaps there’s an air quality issue. But for sperm issues, that’s why it’s so great to have ICSI where they directly inject the sperm into the egg and bypass the fallopian tubes.

Richard Pelman MD (12:43):

So in-vitro fertilization. With ICSI, you are actually taking a sperm that may have derived from the testicle through exploration.

Thomas Walsh MD (12:49):

So back, really it was mid-late nineties, we had this layer of technology called in-vitro fertilization. This is where a woman is given drugs to stimulate ovulation. You know, normally a woman would ovulate I believe one egg per month. This causes her to hyperovulate. These eggs are extracted from her. They are matured in a pristine laboratory environment. And in traditional IVF, I’d like to think that you take the eggs in a Petri dish. You’ve got the sperm in a dish and a little bit of mood music and may the best sperm win finding an egg. And that does require a lot of sperm now. It requires a lot of normal behaving sperm. But it was really in the mid-late nineties that it was discovered that it turns out when you had very few sperm, and even sperm that weren’t fully matured, but had their normal genetic compliments; sperm that maybe came directly from the source taken directly from the testicle, it was discovered those sperm, with assistance, were also capable of fertilizing an egg, maintaining the growth of an embryo, and developing into a healthy pregnancy. And this is the technology that we use to help many men today. Many couples today.

Richard Pelman MD (14:08):

So in the quest to resolve fertility issues, it can be stressful, and a significant stressor on the relationship sometimes. Do you want to speak about some of what you’ve encountered in some of the support groups?

Annie Kuo (14:22):

Sure. Yes. Infertility is a very stressful life event and for many couples who are going through it together, it can sometimes be the first test of their marriage or partnership that they’re going through together. The obstacle that they have to overcome, some studies have shown that infertility is as stressful as cancer. You know, it’s like a never-ending rollercoaster every month. There’s highs and lows that you ride. When the woman gets her period and is not pregnant yet again, then you ride the wave of hope and it comes crashing down. You know, it’s a ride people want to get off of. So when we have people come to us in the support groups, and thankfully we have a lot of couples come together, I always love the men who approach. You know, men who reach out on behalf of the couple because with infertility treatment, a lot of times, unless there’s very serious male-factor issues, the woman is going through a lot of the treatment.

Annie Kuo (15:32):

The male provides the sample in lots of routine cases, but the woman is the one who’s having the drugs injected into her body, having the egg retrieval surgical procedure done, and going under anesthesia. So, when men can play an active role as a partner in the infertility journey and pursue the resolution, it’s really great. It’s great to kind of even the playing field. We have a lot of couples in our resolve support groups that come and I have, as in the intro, seen it really play out as half female-factor, half male-factor. And then, in the cases where neither of these factors are identified, it’s usually a combination of male and female-factor, or just completely unexplained infertility, but they’re coming to find community. There’s often a visible sense of relief that I can see on their faces that they’re not alone and that there are other men and other women who are going through this as well as other couples who are on this rollercoaster together. And so we try to provide them with mutual support and even social outlets so that they can forge lifelong friendships for this kind of bonded experience that everybody’s going through.

Richard Pelman MD (16:51):

So if a couple was looking for a resource online, they could go to Resolve?

Annie Kuo (16:55):

Yes, Resolve.org is where they can connect to three different platforms of free support. The first one is an online discussion board forum on inspire.com. That’s an infertility section hosted by Resolve. Inspire.com is a health and wellness platform and there’s a Resolve hosted section. There’s also in-person support groups. The second platform support is in-person support groups, and they can be found by searching for your zip code on Resolve.org. and it will point you to the group or groups nearest to you. And the third platform support is a helpline. This is a voicemail system where people can leave a message and within 24-48 hours get a call back. Their call is put into one of, say, 8-12 buckets, and then a volunteer from across the country will call you right back. So there are three different ways to pick and choose from the buffet of how you feel most comfortable receiving support. And some people don’t feel as comfortable sitting around in a circle, but they can do a phone call. Some folks you know, myself included, feel very comfortable having electronic pen pals to talk about your diagnosis and Resolve just really tries to offer different platforms for people to find support.

Richard Pelman MD (18:23):

So, Dr. Walsh.

Thomas Walsh MD (18:26):

Since this is the guide to men’s health, you know, one of the things that I want to point out is something that Annie alluded to, which is some of the specific stressors that are associated with male-factor infertility. And this is something that’s been studied in the academic environment. How do couples who are experiencing fertility issues related to the male factor compare to couples who are experiencing fertility to unknown factors or to female factors? And it turns out when you compare those buckets of individuals, the stress on relationships, on marital aspects, and on sexual function are actually much worse in couples where fertility issues have been ascribed to the male factor. And I think that’s really important for everyone to know. Now, I don’t know that we know why that is. I think we could hypothesize a lot of different things. But we see this insinuating itself into how couples progress through their treatment and I think it’s really important for physicians and support groups to be aware of.

Richard Pelman MD (19:32):

Now I know there’s issues of various etiologies or multifactorial reasons why somebody might have infertility on the male side, but a lot of patients seek homeopathic remedies, herbal remedies, they go to the store, or they see something on TV that can improve their infertility. There are certain things that need to be corrected such as a varicocele with a low count. So you should get evaluated before you go to supplements. Now let’s say somebody has a lower count and doesn’t have anything obvious on an exam. Are there supplements that are useful or not?

Thomas Walsh MD (20:05):

Well, so of course you’d love a simple answer wouldn’t you? We talked about this incredible advance in the treatment of infertility, right? This incredible toolbox that we have to help couples. But what if I were to pose the question, are there any U.S. Food and Drug Administration approved drugs for the treatment of male infertility low count? The answer is no. Are there any on the horizon? I’m unaware of any. And it gets at this issue that we are really in the infancy of fully understanding what the root cause of male infertility low sperm count of unknown reason is. There is data to support various changes in how somebody behaves, including what they put in their bodies that can affect their fertility. For example, we know that men who lead incredibly sedentary lifestyles have lower sperm counts on average. We know that men who smoke tobacco at a threshold level have lower sperm counts compared to those who don’t. And we know that men who smoke marijuana habitually have this exact same phenomenon and maybe even in a more severe way. What we don’t know is what are the things that somebody can go to the natural food store, or the grocery store, or the drug store, and buy off the shelf and put in their body to improve their fertility. There is very little data on that.

Richard Pelman MD (21:39):

If somebody is carrying extra weight.

Thomas Walsh MD (21:42):

You know, the data, absolutely the answer is yes. If it’s something you can do to live longer, it’s probably going to improve your fertility as well, including weight loss, stress reduction, strong nutrition, and we see this play out time and time again. So I don’t think we can neglect the obvious things. We think about things like metabolic syndrome, you know, obesity, high lipids, and diabetes. These things have a significant impact on fertility for the individual, but across a large population, it’s very difficult to measure these things. But if it’s something that’s going to shorten your lifespan, it’s probably going to lessen your fertility. And we see data beginning to accumulate on this.

Richard Pelman MD (22:30):

For speaking to a young audience of developing young men, we tell them don’t smoke, stay healthy, try to watch your weight, don’t indulge in marijuana, don’t overindulge in alcohol, and don’t take testosterone or testosterone supplement.

Thomas Walsh MD (22:48):

Absolutely. I can’t go many places today or watch many things on TV or listen to many ads without hearing something about testosterone. And I think it’s really important for physicians and patients alike to understand that testosterone in various forms, and its many forms, is the most potent contraceptive in men. It’s just like a woman putting an oral contraceptive pill in her mouth.

Richard Pelman MD (23:17):

So a young athlete who is trying to move up is putting his potential fertility at risk. 

Thomas Walsh MD:

That’s right. That’s right. 

Richard Pelman MD:

Another reason for young men to be aware. 

Thomas Walsh MD:

Absolutely. 

Richard Pelman MD: So a man comes to you. He’s got a low count. You do an exam and you find a varicocele, that’s extra veins.

Thomas Walsh MD (23:45):

Yeah. So what is varicocele? Well, probably most of your listeners have heard of things called varicose veins, and there are a few ways in which varicose veins manifest in the human body. We’ve probably seen a man or a woman at the beach in the summertime with dilated veins in their legs. You’ve probably heard of things called hemorrhoids. These are all varicose veins. Varicocele is the manifestation of these ill behaving veins as they drain blood from a man’s testis. So all men have veins that drain blood from the testes. Veins serve a very singular purpose in all humans, to bring blood from an organ back to the heart to recirculate, and it should be a one-way street. Varicoceles are veins that have lost their ability to be a one-way street and under the influence of gravity blood pools in these veins and it alters function. In men, it can cause pain in the testis, but it can also cause dysfunction of how sperm are formed and how they behave and it can alter their ability to fertilize an egg. And what we know is that it’s probably one of the more common reversible negative influences over male fertility and something we can actually take action on. It can be treated with a minor surgery or a minor procedure, but it may not be the ultimate etiology in all men. But it’s something that should be examined for.

Richard Pelman MD (25:10):

And as you mentioned, a review, a thorough review of medical history and medications, there are some medications that can put fertility at risk?

Thomas Walsh MD (25:18):

There are, and it is a long list. I think the ones that I like to talk about are the most obvious ones. We already mentioned testosterone, as an FDA approved medication, is probably the most common threat to male fertility. But any of the treatments that we would consider cytotoxic, so any therapies that are being used to treat cancers, to treat severe inflammatory conditions, rheumatoid arthritis, things like that, things that are stopping normal cells in the body from dividing and proliferating, those are the same medications that can have negative influence over sperm production. Medications that alter a man’s hormone profile, certain diuretics like spironolactone, also act as anti-androgens and have a very negative influence. Some of the medications we use to help men urinate better that are ubiquitous amongst men of a certain age can alter the ejaculate and they can alter spermatogenesis in some cases. But the medication that I think is really important and we see most commonly used in this era are the selective serotonin re-uptake inhibitor family which we see so commonly across the age categories for the treatment of mood disorders. Multiple studies have demonstrated that these medications have a clear negative impact on sperm production, the ability of sperm to swim, and probably their ability to fertilize an egg.

Richard Pelman MD (26:45):

If we were to look at the potential of say, a middle-aged man achieving fertility, it’s been said that as we age, we lose some of our ability to produce good sperm.

Thomas Walsh MD (27:04):

It has been said. Look, the production of sperm is a labor intensive process. It requires massive amounts of cell division and as cells are dividing in the human body, there are many checks and balances along the way that make sure that if we’re going to reproduce a cell, that once it goes through that process, we get an exact duplicate. We get the exact DNA copy of that cell. Unfortunately as we age, and it’s the process by which we age, those checks and balances become less effective. And in this really demanding process where a man is literally producing hundreds of millions of sperm, the process does break down, and the quality control mechanisms whereby we maintain DNA fidelity break down, along with production breaks down. So for all men, we see a decline in the ability to produce sperm over the lifespan. No man is exempt from that. And along the way, we probably see declines in quality as well.

Annie Kuo (28:08):

Isn’t there a statistic about higher risk of autism or schizophrenia?

Thomas Walsh MD (28:15):

So the diseases that have been specifically associated with advanced paternal age are exactly those, the autism spectrum disorders and schizophrenia.

Richard Pelman MD (28:27):

And then looking at a population that could be at risk, you mentioned somebody going through chemo. We had advised those patients prior to starting any chemotherapy or radiation to sperm bank, to preserve potential future fertility.

Thomas Walsh MD (28:43):

Yeah. So anybody who’s going under a reproductively compromising therapy, whether they’re being treated for testis cancer that’s required to actually remove the testis, or another cancer lymphoma, radiation treatment, keep one of these cytotoxic medications. I think it’s really critical that not only providers or healthcare providers be informed, but that patients themselves advocate for their fertility preservation and that’s something that’s readily available. One of the challenges here in the U S is that reproductive caring, including fertility preservation, is not economically available to everyone. And that’s one of the greatest challenges we face. And one of our critical needs is to look for ways to provide this support for people, young individuals undergoing these types of compromising treatments. Most young men who are embarking upon cancer treatment don’t have the resources to imagine the hundreds or the thousands of dollars of costs of fertility preservation. And the resources are limited.

Richard Pelman MD (29:47):

For a group of our servicemen, who in this modern era of warfare face IED blast injuries, there is some relief and potential for them to sperm bank before, and then some help if they do sustain an injury.

Thomas Walsh MD (30:06):

Yeah. And this type of support is relatively new and really excites us. It’s one of the methods by which these men actually have available to them really expensive care, the use of in vitro fertilization, through their veterans health benefits.

Annie Kuo (30:26):

Which is a temporary bill that we’re pressing to become permanent because it expires through the VA in September of this year. So we’re hoping that it will be assigned into permanent law through the Mil-Con. It’s currently enacted through the Mil-Con ‘s Appropriations Act, but it’s only temporary. And on Capitol hill, there are veterans who have come out in their wheelchairs from having sustained blast injuries and have a service-related infertility who say, “you know, we’ve given our lives for our country, support us in our attempt to build a family.” So I would encourage anyone who cares about this issue to write to your lawmaker.

Thomas Walsh MD (31:14):

And I think, you know, one area that this has been a challenge is that it is a narrow group of individuals where their fertility concerns are really attributable to the injuries that they sustained. And there are whole other groups of people who have served in the armed forces or served in foreign wars who we don’t know why their sperm count is low. It wasn’t due to an IED blast. And currently this bill does not support them moving on for further treatment, and it can pose some challenges

Richard Pelman MD (31:51):

As we wrap up, anything else you want to pass on to the listeners?

Annie Kuo (32:00):

I have a question for Dr. Walsh. Can you speak to the recent headlines in Newsweek and Time about the sperm count crisis in the west? Are these due to environmental factors or what can these be attributed to? Cause it does seem to be a phenomenon. There was even a scientist surmise that if a scientist from Mars came to earth and looked at sperm counts here, they would think that we might go extinct in a couple of generations.

Thomas Walsh MD (32:35):

Yeah. That is science fiction at the extreme. So there’s an agenda here, right? This idea that sperm counts are declining in the Western world has been reported for quite some time. And there are real challenges, sort of, in evaluating this kind of data, including, we evaluated sperm quality in so many more men in the last five years than we ever did compared to a reference group, which is one of the greatest challenges, you know. Do we really have apples to compare to apples, or oranges to oranges?

Annie Kuo (33:17):

And what is causing that increase in testing? Is it just the access to reproductive medicine driving low-income patients?

Thomas Walsh MD (33:23):

Absolutely. Oh, a laundry list, but I would go back. I would use my parents as an example. My parents started having children when they were in their early twenties. Okay. So in that generation, it was really calm and patient. You know, parents from my parents’ generation, the good time generation, they began their family planning sometimes out of high school, sometimes at a college. But we are now in an era where it’s much more common for women to begin their reproductive lives in their mid to late thirties. Now this is a great, I call it the “great unveiling,” right, because, the term we would use is fecundability, or the fecundity of a woman at that age, is much lower. And so the threshold that it requires for her to become pregnant is much higher. And so the question is, is it possible that there were men amongst us who had sperm counts that were below, you know, I’m putting my fingers up in quotes, “the normal range,” but we never revealed them because their partners were so easily impregnated and they really believe that’s true?

Thomas Walsh MD (34:34):

And I think many authorities do. But now we’re pulling back the curtain because these men, their sperm counts, are in a certain range. But the challenge of initiating a pregnancy in a woman of a much more advanced maternal age is much more challenging and so I think we’re discovering a lot more low sperm counts. What I don’t know is, were they there before? Now, I don’t say this to discount the idea that it’s something that requires our attention. The environment that we live in today, my personal behaviors, your behaviors, are different than my parents’ generation as well. My parents drank their milk from glass bottles. My kids drink from plastic. You know, what we’re exposed to environmentally, I think is a different milieu than before and I think it does require our attention. We know that these plasticized, these ubiquitous plasticizers, which we think we know the names of them all, but we’ve only heard a few, right? I mean, the moment we discover one that we think has a negative impact on a human hormone profile, I can guarantee the industry has changed the isomer in there, and we just don’t know what it is yet. So we are baked in these things. They flow through our events in the hospitals. They’re part of the materials we sleep in. We close ourselves in and they are different. It is a different landscape in a different environment. It requires our attention. Do I believe we’re going extinct? I really don’t. I’m doubtful.

Annie Kuo (36:14):

[Inaudible]…people’s attention. Right?

Thomas Walsh MD (36:16):

And I  think, you know, that this attention is important. But it is also being championed by a few strong voices.

Richard Pelman MD (36:24):

Any other resources for listeners that they could find online besides Resolve?

Thomas Walsh MD (36:29):

So I think a great resource for some of the basic conditions that affect men and male fertility is AUAhealth.net, which is a great resource for patients as with regards to just some health conditions that men may be affected by. They may hear terms from their doctors. It’s a great patient-friendly resource. The Society for the Study of Male Reproduction, which is a sub-society of the governing body of urologists, also has a website with great resources. So that’s SSMR. And Resolve.org of course.

Annie Kuo (37:15):

Not only for those support resources, but for the great content on its website, which has the encyclopedia of different fertility factors that can be diagnosed.

Richard Pelman MD (37:30):

And Sexual Medicine Society of America. Sex Health Matters is the patient portal.

Thomas Walsh MD (37:35):

Yeah, Sex Health Matters is a fantastic portal for information. And I think last but not least, for people who really want statistics about reproductive treatments and their outcomes, I would urge visiting SART.org, which is a resource for the Society of Assisted Reproductive Technology.

Richard Pelman MD (37:55):

I thank you both for spending some time. It was wonderful and enlightening. I appreciate it. 

Thomas Walsh MD:  Thanks for having us. 

Annie Kuo :   Thank you for having us here.

Richard Pelman MD (38:04):

This completes another podcast chapter of the Washington State Urology Society’s Original Guide to Men’s Health. This is Dr. Richard Pelman reminding you to take care of yourself. Washington State Urologists Society wishes to thank all contributors who volunteered their time and knowledge. The information presented is the opinion of the speakers. The society also wishes to thank Sean Fox for his invaluable technical assistance. The music theme, San Juan Bell’s, was written and performed by Dr. Dave Whiting. The podcasts are the property of the Washington State Urology Society. Reproduction and use without the express consent of the society is strictly prohibited. For more information about men’s health visit wsus.org or visit your physician or care provider.

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Episode 55:  Biotech Pt 2 – Cardiology meets Alexa Technology 

Learn how innovation in bio technology had led a cardiologist and his team to train Alexa to determine abnormal from normal heart rhythms. Still in development, this fascinating interface highlights how leading innovators take technology and smart devices forward to enhance clinical care.

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Episode 54:  Bio-Technology Part 1: Simulations Role in Enhancing Health Care and Safety

Bio-Technology is exciting and rapidly expanding. It is the future of health and healthcare. While the technology is far-reaching. One aspect is simulation technology. What is simulation technology? Consider how we use simulation to train pilots; what about using simulation to train surgeons and the surgical team? In this episode, we interview Dr. Robert Sweet, MD, a leader in simulation training for healthcare professionals.

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Episode 53: Health and Driving Safely

We all or mostly all consider ourselves competent drivers. In this episode, a Driving Safety expert reviews health-related concerns and conditions that may negatively impact our driving skills and experience. She also reviews some very important data and recommendations on how to become an even better driver.

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