0:00:00 - Speaker 1 Well, Dr Fru, welcome to Ever Forward Radio. It's a pleasure to see you again.

0:00:04 - Speaker 2 It's a pleasure to be on with you, Chase.

0:00:06 - Speaker 1 I'm so excited to have you here because this is something that I have not often talked about on the show. That is, in my opinion, a very important part of our overall health, a part of the success and continuation of the human population, and that is fertility health, reproductive health, sexual health. And this first really got on my radar about two years ago when I read a book that I'll link in the show notes for everybody Countdown by Shanna Swan, and it really blew my mind as to how much of an issue we have with fertility health. And just to kind of share some quick statistics that I found with you I'm sure you were very aware of this, but with the audience, and now I'd love to kind of have you expand on it, please, and just to kind of shock a little bit. You know this area of our wellness and human civilization.

I'm finding that fertility has dropped more than 50% over the past 50 years worldwide, and 20-something women today are in fact less fertile than their grandmothers, so just two generations above less fertile than they were at 35. And a man today has only half the number of sperm that his grandfather had. So my question to you, dr Fru, to kick things off. Here is why is this happening? Why do you think we are seeing such a drastic decline in overall fertility health?

0:01:37 - Speaker 2 Well, that's going to be a really tough question to answer. I can take a stab at the potential reasons why we're making these observations.

But we're paying a lot more attention to the reproductive health overall for both men and women, and what we're finding out is that, for reasons that don't exactly lend themselves very easily to a biological explanation, there are economic reasons for why people are delaying their fertility journey and establishing their families.

People right out of college don't make as much as their grandparents, for example, did, and with women worldwide becoming more educated and becoming part of the workforce, there is more pressure on delaying childbirth in order to get through with education and training, and, especially in the US, once you get done, then you've got all your student bills to take care of before you even stop to think about establishing a family and reproducing. So this question of reproduction, which used to come up much earlier in a woman's life in a man's life, for that matter, when we were hunter gatherers has gotten delayed for both parties into the 30s and 40s, and I even have some 50-something-year-old patients. And, of course, reproduction is key to human survival of the species, and it is of utmost importance that we have this discussion because people need to be more aware of the fact that the World Health Organization projects that one in six adult couples will require some assistance in order to reproduce in the coming decades, and about one in six, really wow.

And about 20% will need in-vitro fertilization specifically in order to have offspring. So I'm glad that we're talking about this topic. I could talk about it all day.

0:03:47 - Speaker 1 In your response and I know you kind of just leaned into a couple things. I'm sure there are many, many things that we could talk about, about why we're seeing such this drastic decline in overall fertility health. This is true. I heard you really kind of lean into time And what I'll say is economics. I'm hearing you say that people men, women, couples are waiting longer to have children or to even be interested in exploring. You know, am I fertile or not? as well as the aspect of you know what life. It's not getting any cheaper. We've got all these other economic woes to worry about or we're prioritizing, i feel like this generation, maybe even the next generation as well, we're kind of shifting the priorities of what has been a long time standing belief system of it's family. First you get married, you have kids and then you kind of worry about all the life. Why do you think the delay in reproduction and the reprioritization of economics over reproduction has kind of come to the top right now?

0:04:55 - Speaker 2 Well, there's a very practical reason, a very simple practical reason the cost of child care, the cost of raising the human. That's just economics across the board.

0:05:05 - Speaker 1 It's just money, money, money. Yes, it is.

0:05:08 - Speaker 2 I hate to put it that way, because the access to care issues that we have in a reproductive space are all financial right. The financial piece well, it's not all financial, but the financial piece is huge. There are lots of patients who get their diagnoses and have a treatment plan in place and they just simply cannot afford it. And so you have couples who otherwise have treatable infertility who do not go on to have children because they cannot overcome the economic barrier to actually access the care. And then there's the access to care issue of we don't talk about it And so people don't realize that it is as common a problem as it is. when I was in training, it was like 10% of the adult population of reproductive age people, male and female, and in certain racial groups. the discussion is not had to the point where black and brown women, for example, will seek out care for the child care. Black and brown women, for example, will seek out care four and a half to five years later than their white cohorts.

0:06:22 - Speaker 1 That is pretty damn significant, in my opinion, wow.

0:06:26 - Speaker 2 Yeah, so there are a lot of reasons that play into it, and the fact that you don't realize your reproductive potential until you actually start trying, and the fact that we're delaying trying to then figure out who is infertile and who is not, just compounds the whole issue. So I feel like if there's one thing that anybody takes away from this is we need to start talking about it and addressing it in a more proactive manner because, like I said, the survival of their species depends on it. Whole economies. When people talk about falling birth rates in the developed world, for example, so we have falling birth rates in every age group, except for women over 40. And so these falling birth rates do have impacts on the working population being able to take care of older adults. I don't mean to come off like an economist, but it's all tied in And in developing countries, the birth rates are falling there too because, say, for example, in my country of origin, which is Cameroon, if you had a large family, that meant you had a large workforce.

For an agrarian society, you had enough people to help you with farming. However, as we move from agrarian societies to more industrialized societies, you don't need as many children in order to get the work done. They're not working in the farms anymore, they're going out to the cities. And then there becomes the economic factor of how much it costs to educate said children so that they have good jobs in the city. So this trend is happening at a vast pace all across the world, and so, with more and more girls getting educated, things are getting delayed And I don't see the problem going away.

And the one other thing that I haven't touched on is, as time goes on, you acquire more and more medical diagnoses. The human body is designed to break down And our job is to try and keep it going for as long as possible in an optimal manner as possible. But if you wait long enough, something will happen. The healthy woman with no high blood pressure in her 20s, she waits till her 30s And then her hypertensive complications are present during pregnancy, which have impacts for both her and her child, and in a subsequent pregnancy she is coming in hypertensive. And then there is the trend to its increased weight gain across the world, especially in developed countries, because people are more and more sedentary and use cars to drive everywhere. I remember when I grew up, it was I walked everywhere. I could eat a lot more calories because I was constantly walking. You had to walk to the store, walk to the farm, walk to the market.

0:09:36 - Speaker 1 You're burning things off long before you ever digest them to some degree maybe.

0:09:43 - Speaker 2 But then if you move from that to this so I live in Georgia now and there are no very few walking paths and you have to drive to get anywhere And that's just. It just creates a very different dynamic And you have to be very intentional about focusing on nutrition and exercise and keeping yourself healthy. But even with that focus, things will break down if you live long enough, and so we're introducing trying to have children in the system. That is aging and it doesn't work as well. And for women especially for women especially Every woman is born with all the eggs that they're ever going to have. In fact, the peak number of eggs is in the third trimester, while they are still in utero.

0:10:40 - Speaker 1 I've heard that. Yeah, that's really kind of it's like an inception model. when you really think about it, you know we're talking about your future. reproductive health began before you even existed, as you know you to be, you Correct.

0:10:55 - Speaker 2 And then there is a steady drop off in the number of eggs. And I tell women that when you menstruate every month okay, if you're a normal ovulatory individual, meaning you release an egg every month you don't just recruit that one egg out of the millions, you recruit multiple. So, for example, if I do an IVF cycle, i encourage the growth of all recruited follicles that contain eggs, one each, so that I can retrieve them all at once. But that same number let's say it was 20, would have been recruited that month anyway And there would have been a competition and only one or in some people two would have gotten ovulated And those would be the ones that had some opportunity to meet with sperm and potentially turn into an embryo and turn into a person if it had plants.

But the idea that out of those 20, only one will make it, the rest will die, is something that is just, it's constant. This is happening to you over time And the, the, the. You know an egg is a cell. It's a large cell and it is exposed to all the metabolic stressors that the woman sees. So weight gain, for example, can cause the egg to behave less efficiently than it otherwise would. Age will cause the egg to behave less efficiently than it otherwise would. Things like smoking, excessive drinking These are all modifiable risk factors, except for age. They will all cause the egg to behave worse than it otherwise would.

0:12:45 - Speaker 1 I'm so glad you bring this up because actually this one thing I really wanted to discuss with you as we talk about sexual health, reproductive health, fertility health, particularly with women here. I've heard it. as a guy, i can only imagine how many times a female might hear growing up especially depending on you know, culture and environment, and maybe even religion When you're gonna have kids. when you're gonna have kids, your biological clock is running out. is this term air court here, biological clock as real of concern as many people make it out to be? Because, like we said earlier, you know, women are in fact waiting longer to have children, waiting longer to get married, waiting longer to be in long term committed relationships should they even want to be in a relationship to have children. I feel like, like we talked about, women are waiting longer in general, so they're getting everything else kind of squared away. but what about this biological clock?

0:13:41 - Speaker 2 So the biological clock, i feel, is applied to rigidly, it only speaks to the majority under the bell curve and of course they're going to be outliers. So for every woman that comes a time where there is what I describe as terminal dysfunction, because the brain is who really runs the show when it comes to reproduction for men and women, and so at some point the brain produces large amounts of hormone called FSH, follicle stimulating hormone, and the ovary stop responding.

That is menopause, and so, for everybody, you are on a steady march, should you live long enough, towards that end game where your FSH is really high and you're estrogen as well, and so, in an abstract way, yes, there is a clock, but this clock looks very different for every woman.

0:14:40 - Speaker 1 It's not just hey, by 30, things start going downhill.

0:14:43 - Speaker 2 It's not so cut and dry, no no, it is not, and in fact for some women, even younger than 30, things start going downhill pretty fast.

0:14:53 - Speaker 1 So for it could happen sooner or even later. It's so independent.

0:14:57 - Speaker 2 I mean, i'm sure we've all heard of a woman who's 49, you know would have surprised pregnancy spontaneously, and so the clock isn't fixed, as more as it's an idea that you will eventually run out of an opportunity for an egg to be released. However, when we all die post-menopausal, hopefully there will be eggs on that ovary that never got a chance to get ovulated. Wow, wow. The system shuts down when the efficiencies of conversion from egg to embryo is so inefficient that it is not worth doing. So it's not that you've run out of eggs on your ovaries, it's these eggs are not worth the effort.

0:15:52 - Speaker 1 Interesting. So it's not so much you've waited too long and things just expire. It's the timeline in which you have lived your life and done everything else to support the possibility when those things become less ideal, less optimized, when they begin to break down, and no longer supports that potential for a prolonged timeline, if you will.

0:16:17 - Speaker 2 Well, and we're not particularly sure what sets that, what triggers that set point for everybody? It's not. it's not that cut and dry. So it's not in such a way that you can actively modify what you're doing in order to give yourself more runway.

0:16:35 - Speaker 1 Okay.

0:16:36 - Speaker 2 The one thing. I'm sorry, go ahead.

0:16:38 - Speaker 1 Go ahead.

0:16:39 - Speaker 2 So I think that women are now doing if they foresee that things might take a while is capturing their reproductive potential and storing it. That's by banking eggs. They can go through and collect eggs at a younger age for the potential of converting over into embryos if and when they should choose later on in life. So that's one way of preserving their reproductive potential and I support it and I do a lot of it Amazing, and we're going to get into some of that here soon as well.

0:17:11 - Speaker 1 But I do want to ask another question here, as we're still discussing women and female reproductive health. What are some other health concerns a woman might experience or should be aware of that can really affect their fertility health the most? Should they be focusing on chronic illness? Is it a virus? mental illness? What other components of their general well being should they be most concerned about as it relates to affecting their fertility health?

0:17:39 - Speaker 2 So, in a word, all of it Yeah. Because, they are all intertwined. So if there are chronic illnesses, my advice to every new patient is always to optimize those. You want your. I'm not saying a diabetic cannot get pregnant, I'm saying your options look a lot brighter for a live born, uncomplicated birth If your hemoglobin A1C is under seven, which requires tight if you're managing your diabetes.

And you can have high blood pressure and successfully go through a pregnancy. It is better if we start out with well controlled blood pressure, if we have enacted dietary changes, we're doing some exercise and we're taking medication to keep it as controlled as possible. Same thing with mental health. I don't take people off their men's unless I think it will negatively impact establishing a pregnancy. If someone is well maintained on a drug that has been shown to be well tolerated in pregnant women, we keep them on it, because the happier someone is mentally, the better they will ingest nutrition that will support their pregnancy and the more critical they will be about the entire process.

It sets us up for better outcomes, so it's a bit of everything that we manage prior to someone conceiving. Weight is a big one. You can take a young person, and if you have them gain a large amount of weight, okay, their eggs will behave like that of somebody much older than them.

0:19:27 - Speaker 1 Really.

0:19:28 - Speaker 2 Correct, wow. I'm constantly encouraging patients to lose weight or get as close to normal as possible, understanding that there are two factors at play. Right, it takes time in order to lose enough weight to make an impact, and that time is something that I cannot recover up the back end, so I'm much more likely to apply the strategy to a younger patient than to an older patient. For an older patient, i start encouraging intervention that maybe gets eggs from them and fertilizes it and holds them while they optimize the rest of their health to support them in pregnancy.

0:20:10 - Speaker 1 By older. You mean, are we talking over 30, over 40? How would you define that for what you're talking about here? So the weight versus age thing comes from your Eximata palantroval weight versus eximata years. over a certain age you would live for.

0:20:24 - Speaker 2 Yeah, it comes to a head, typically around age 38. Do I have time to Do? I have six months, for example, to properly lose enough weight to make a difference versus the additional six months of ovarian aging.

0:20:40 - Speaker 1 Would you say? let's say someone right now is focusing on their age as a factor to their fertility, health or their weight, and by weight I will say here as significantly underweight or significantly overweight They're not in the optimal healthy weight for them to be to have a healthy pregnancy to full term. Would you recommend focusing more on one? If you're a certain age, you should probably get things going sooner. or is it the weight? Which one would you kind of be prioritized there for?

0:21:10 - Speaker 2 that person. So I would say, if you're in your 20s, focus on the weight. Focus on the weight. You've got some time. You can take six months, eight months a year and get down to normal weight and then proceed with treatment. Your outcomes will be much better.

In fact, a lot of women with ovulation issues who don't release an egg every month due to conditions like a polycystic ovarian syndrome. Once they lose about 10% of their body weight, they sometimes click over into ovulating and now they're releasing an egg that has an opportunity to get fertilized and they do not need my intervention.

0:21:46 - Speaker 1 If they're young, 10% really is not that much.

0:21:50 - Speaker 2 No.

0:21:52 - Speaker 1 But it has such a powerful positive effect on fertility, correct?

0:21:56 - Speaker 2 And so for my young patients, who are otherwise healthy, I always evaluate the male and the female. If we've got good sperm and the issue is we've got weight and we're not ovulating, I encourage them to do that first If they optimize their health. Sometimes I get a phone call that says Hey, Dr, Free, we're pregnant.

0:22:14 - Speaker 1 There we go. I'm done, all right Give advice.

All right. Well, you know you brought it up here, shifting gears a little bit into the other side of the equation, should someone go the I'll say here, you know traditional route of male sperm, female egg. We're in a partnership, we're in a marriage, we're whatever The role that the man plays in conceiving is one that we are finally now shining a light on as equal, at least 50%, contributing to this fertility health, to this possibility, sometimes even more, depending on what's going on with the guy. The old school thought here was that it was all the woman, and that's simply not true. And I was actually looking into a lot of your work, at what you do in with Oma, and saying that 40%, 40% of infertility cases are due to male factors and sperm count in men is decreasing by 2% every year and only 4% of sperm cells are normal in a healthy sample. Now, this is a lot of numbers, a lot of stats I'm showing with you guys here. But basically, please help us understand the role that the male has in fertility here.

0:23:30 - Speaker 2 I'm glad you asked that, because I have this conversation with my couples on the daily.

0:23:36 - Speaker 1 Guys, listen up. We got to take responsibility here.

0:23:39 - Speaker 2 I like to remind them that we as humans do not reproduce asexually. No one can have a baby on their own. We're not that kind of animal. You need male gametes, that is, sperm, and female gametes those are eggs And then those things need to come together to make an embryo, and then that embryo needs to go into a uterus, which typically the person with the ovaries has. So reproduction is at least a two-body problem, and if you are a single male or a same-sex male, it becomes at least a three-body problem. We're getting more cooks in the kitchen there.

You need a uterus that works, you need an egg that works and you need sperm that work. Those are your components, and then a baby can grow and develops a placenta and supports itself till delivery. But the idea that it would be a female-only problem is just mind-blowing. How women cannot get pregnant on their own And in fact, a lot of the solution to male factor infertility, where the sperm count is really really low or the motility is really poor, as in we don't have enough moving sperm cells to get to an egg, because, remember, the sperm travels from the vagina through the cervix into the uterus and goes down an open fallopian tube, finds an egg and then fertilizes the egg close to the ovary And then that fertilized egg tumbles back through the fallopian tubes over five to six days before implanting into the uterus. And the sperm has to be able to move And there is going to be loss of sperm as it moves through all those body cavities. And so you need high enough numbers in order to affect this.

And then the last part is you need, like, perfectly shaped cells. The sperm cells are nothing but a DNA delivery device And they need to be able to deliver their DNA to a nice, healthy egg. So if they are malformed, the tails don't work. They've got two heads, they've got blebs in the midpieces. They're not going to get the DNA package dropped off in the egg. So it is imperative that we focus on the overall health for the guys so that we have a large enough volume right, because this is all a numbers game. So you need at least 1.5 mL of sperm volume.

0:26:32 - Speaker 1 Yeah, this is great. I really wanted to dive in Kind of. my next area was talking about sperm health for guys. Help us understand these areas of count, motility and morphology. Can you kind?

0:26:42 - Speaker 2 of continue to break that down for us, absolutely. I was about to launch into that.

0:26:46 - Speaker 1 Guys, here's your sperm masterclass.

0:26:49 - Speaker 2 All right, here we go.

0:26:50 - Speaker 1 Many of us think we probably know everything about it, but I promise you we don't. There's way more going on here.

0:26:55 - Speaker 2 But producing sperm that's the good thing The volume needs to be at least 1.5 mL. Okay, that's about the minimum. Guys who drop way below that are at risk for being need to get evaluated, especially to make sure that the sperm isn't going back into the bladder like called retrograde ejaculation and that is actually coming out. If it goes backwards, well, it's not doing anybody any good because it's not going to wind up in the vagina. And then the concentration needs to be at least 15 million per mL, and guys always go what? That's a lot of sperm.

0:27:39 - Speaker 1 Those are big numbers for throwing out.

0:27:41 - Speaker 2 That's because most of the sperm are going to die off before they get to an egg.

0:27:44 - Speaker 1 Sorry fellas, this is a battle. It's not every sperm that makes it on the battlefield, that's for sure.

0:27:51 - Speaker 2 Lots of dead sperm. And then let's see we need to talk about. So we've got volume, we've got concentration. Now we go about the percent motile sperm. So we need over 40% of the total fraction of sperm need to be moving And, most importantly, the ones that we like, the ones that are effective, are moving forward. So they have forward progression. They actually go from point A to point B. If it's twisting or spinning around in circles, not going to get the job done, So at least 40% of the time.

0:28:27 - Speaker 1 They need to know their GPS coordinates. They need to have the tools, the rudder to get them there, instead of just spiraling out of control.

0:28:32 - Speaker 2 Correct. So not all movement is good movement. We need forward progression. And then the morphology number that you alluded to is the fraction of a sample of the sperm cells. So if you look at, say, 100 sperm cells from a random sample, you need at least four out of the 100, very low bar that have a perfect head, a perfect midpiece and a perfect tail. That says they're going to move in such a way that when they find an egg, they will be able to effectively deliver their DNA into the egg, thereby moving forward for fertilization.

0:29:15 - Speaker 1 So that's it.

0:29:15 - Speaker 2 All right, sperm 101.

0:29:18 - Speaker 1 Now I want to share something with you that I don't know. If you've ever had this happen on a podcast, i'm sure you know, in your clinic you see this, but I actually went through and I had a sperm test done. Okay, now I would love to kind of just share, you know, these key concepts we're talking about. This is you know, i'm an open book when it comes to my show, my social media. You know I love sitting down long format and cracking open these conversations more with experts like yourself. But I'm also going to, you know, share what I'm going through as well, so people can get you know, clinical, technical, scientific, and then you know, hey, what does the real world look like? So I actually went through and got a sperm test done And I would like to just share my concentration with you. And you know, please, feedback here. You know I've got my analysis and reading, but I can put my clinical hat on.

0:30:05 - Speaker 2 It's never often.

0:30:06 - Speaker 1 You know this might be a billable hour, so if I see an invoice, you know I walked into it.

0:30:10 - Speaker 2 Okay.

0:30:11 - Speaker 1 But I'm looking at concentration. It says you have 129.8 million sperm per milliliters ML. Now this is showing me. It says normal range and in top 25%, based on, i guess, my age range and things like that Correct.

0:30:27 - Speaker 2 It's usually age stratified. Okay, so if you were 18, i would not be shocked if that number was north of 200 million per ML. Damn teenagers, man That's why they are so fertile.

0:30:42 - Speaker 1 All right, all right, okay, and so then in volume, it's showing me I have 4.5 MLs of semen in my total volume. Okay, it says normal range here.

0:30:55 - Speaker 2 So the sperm volume can vary depending on your hydration status and the number of days of abstinence. So typically for a semen analysis which is something we should point out we require more than at least two days of abstinence no sex, no masturbation, and no more than five days of abstinence.

0:31:18 - Speaker 1 This test was five days. It was five days of total abstinence.

0:31:22 - Speaker 2 That makes sense. That makes sense that the volume was on the higher side 4.5 MLs. Yes, okay, So what if I see that I go? how many days of abstinence did this guy have?

0:31:31 - Speaker 1 Great follow up question. Yeah, and actually this report kind of gave me some other information on volume and really every section quickly, if you have anything to highlight here. it says that Ashok Ganda, or Indian ginseng, has been linked in some studies with increasing semen volume. Is that true or what can realistically help a guy increase his total semen volume?

0:31:57 - Speaker 2 You don't really want to increase your volume. If I were picking things to increase.

0:32:04 - Speaker 1 Okay.

0:32:05 - Speaker 2 Increase the concentration and I would increase the motility.

0:32:10 - Speaker 1 Okay.

0:32:12 - Speaker 2 And I would optimize for the morphology Because-.

0:32:16 - Speaker 1 How would one increase their concentration? What are best practices for that? Exercise Really How so.

0:32:23 - Speaker 2 Exercise. So exercise naturally stimulates increased testosterone production, which is the cells, the hormones that come from your brain. To stimulate the gonads, stimulate both sperm production and testosterone production.

0:32:42 - Speaker 1 All right.

0:32:43 - Speaker 2 Two birds, one stone.

0:32:44 - Speaker 1 All right. I tell my guys, if your couch This just says, exercise is good people.

0:32:49 - Speaker 2 Get up and get moving. Your sperm will thank you. If it's good, it's going to be better. So exercise. and then actually most people don't pay attention to this Their hydration status and your sleep hygiene.

0:33:04 - Speaker 1 Really how what role does sleep play in male fertility particularly? we're talking, you know, sperm concentration here.

0:33:11 - Speaker 2 Sleep for both partners is something I emphasize. It helps with mood regulation, it helps with stress management And it's just I feel like it is undervalued. There's no direct link. I just know that my well rested individuals do better. I think their bodies are just overall. They're able to recover from the stress of the day.

And we don't prioritize that in our go, go, go world. Work, work, work, work. We take the work home with us, we're on our laptops in bed and we're sleeping, you know, five hours a night. That is not the way the human body was designed to work. You're supposed to get some down time so that your cells can rest, recuperate, rewire your brain, remember the things that are important, ditch the things that are not, so you're not hanging on to all of it and causing stress So that. And hydration I think we are an under hydrated bunch. We are all indoor plants. Our vitamin D is low. There are a lot of things we can do to optimize.

0:34:21 - Speaker 1 You know, fertility, health aside, you know kind of putting on my health coach hat here again, no matter what the dilemma would be that someone would come to me for working on in their health or wellness, their life. Probably, regardless of whatever it is, i would go drink more water, get more quality sleep not necessarily more of sleep, more quantity, leveling out and getting good levels of hydration and sleep In most cases more of both. You would be surprised at the amazing ripple effects that it has on your particular goal. But you know, especially here, fertility.

0:34:56 - Speaker 2 No, i'm not surprised, because I've seen it.

0:35:00 - Speaker 1 I would say is would it be a fair statement that, let's say, a male comes, comes to you and presents with less than ideal fertility? health talking, you know sperm concentration, volume, motility, total motor count, and they did nothing else different for 30 days but prioritize their sleep, would you say. Would be fair to see an increase in overall all things from health for them?

0:35:24 - Speaker 2 Well, possibly. However, caveat, the life cycle from lifestyle interventions to seeing it in the sperm is approximately three months.

0:35:40 - Speaker 1 Okay, so, so, so 90 days. So it's still that one thing prioritizing. If nothing else, i know we're dealing with a lot of other colors, but if they really prioritize sleep and got consistent quality sleep within 90 days, they could potentially increase their fertility health. Correct, correct, wow, amazing.

0:36:00 - Speaker 2 So it's always exercise, exercise, exercise, sleep well, drink more water, and then the other ones that are really hard to do, that really affect the shape of the sperm.

0:36:11 - Speaker 1 Smoking I've heard smoking and alcohol can really can really cut it here.

0:36:16 - Speaker 2 Oh my gosh, i've never seen alcohol drop concentrations like nothing else. Really Yes, but that's significant Smoking will make the morphology, the shape of the sperm just the worst.

0:36:29 - Speaker 1 Now, is that chronic smoking or like a pack a week, a pack a day, a cigarette a week?

0:36:34 - Speaker 2 Any smoking.

0:36:36 - Speaker 1 None of it is good. Yeah, of course.

0:36:39 - Speaker 2 The tobacco has got to go.

0:36:41 - Speaker 1 Now is it particularly smoking or tobacco use in general through other forms, Like maybe dipping, hookah, things like that?

0:36:49 - Speaker 2 I think it's a combination of nicotine and smoking in general. And the second piece is we are seeing, as recreational marijuana is becoming more and more accepted, that if you are a daily marijuana smoker, it lengthens the time to pregnancy.

0:37:11 - Speaker 1 So it sounds like smoking or anything. in general, we're seeing correlation, at least here.

0:37:17 - Speaker 2 So I've been telling guys please stop, please stop. Maybe your stoner friend has gotten three girls pregnant in the last month, but he's not you. You're in my office and he's not, and you and your partner need a child. So let's just cut it out, please. It will help all of us in the long run. There are other health benefits, but I really care about your sperm.

0:37:47 - Speaker 1 You brought something else up earlier. I want to circle back to, particularly to guys testosterone, TRT, testosterone replacement therapy. Can you kind of crack open for us really how much is TRT affecting our fertility health And if it is, can we bounce back?

0:38:07 - Speaker 2 Okay. So I'm glad There should be a PSA for every guy out there who wants to have children or is trying to get pregnant. Please stay away from testosterone. It has actually been studied as a potential birth control for men.

0:38:29 - Speaker 1 Wow, because? Which is kind of productive, because actually, speaking with someone who has been on it, it really kind of does the opposite. Your sex drive is way up. You feel like you got a lot of feelings going on, but it sounds kind of productive.

0:38:44 - Speaker 2 So do you remember when I said that the brain is what drives your testes to make testosterone and sperm?

0:38:51 - Speaker 1 Mm-hmm.

0:38:53 - Speaker 2 It is a negative feedback loop. It has a set point with how much testosterone it will allow naturally in your system. So if you're getting the testosterone from injections or patches, not from your testes, your brain will see that and it will downshift the amount of FSH and LH that it is producing to drive your testes. So there will be a decrease in your own natural testosterone production and your sperm count.

0:39:31 - Speaker 1 What about when guys come off of it? Is it a little bit of a waiting game again for the brain to signal reproduction and to create endogenous instead of getting it exogenously again?

0:39:41 - Speaker 2 So it depends on what, the length of time and the dosing that an individual was on the testosterone replacement therapy. So, yes, it doesn't matter where the testosterone is coming from. It will cause the increased libido, lots of energy, those feelings you know, and that's good for copulating but not so much for reproducing.

0:40:07 - Speaker 1 Well, you're kind of shooting blanks here.

0:40:09 - Speaker 2 Correct, correct. And when my couples find out that the testosterone their husband got prescribed because his testosterone was low is actually negatively impacting their fertility, they get really angry.

0:40:28 - Speaker 1 Yeah, you know again, total honesty here. In my experience. I now, as we're recording I'm this my last week I've been titrating down off of TRT. I was on it I'd say, a lower dose for about the past almost 15 months And it was due to long story short, just significant lack of motivation to want to train. I noticed my body composition wasn't even maintaining the way that it used to, And someone who loves taking care of himself and also in the health and wellness field, I kind of you know I needed a little bit of help and I got my labs drawn and I did all the things through, you know, proper protocols And now I'm happy with my body composition again and I'm happy with the things that I've now been able to implement in terms of sleep, hydration, training, nutrition, And I have now shifted into prioritizing my fertility health with my wife, because that's the next phase we want to get into in life, And so I've been titrating down for the last six weeks to be completely off, to maximize my fertility health again.

0:41:30 - Speaker 2 There you go, so for people who haven't been on it at high doses for years, to where we're seeing physiologic changes like not just azospiromia, which is lack of sperm at all in semen analysis sample.

0:41:45 - Speaker 1 That's a possibility.

0:41:46 - Speaker 2 Oh yes.

0:41:47 - Speaker 1 Wow, Wow. So you have a semen sample but no actual sperm in the semen.

0:41:52 - Speaker 2 Correct.

0:41:53 - Speaker 1 Wow, i don't know if a lot of guys know that.

0:41:54 - Speaker 2 I don't know if you guys know that And unpleasant news to share. And then I go back and I ask very pointed questions about what the guy has taken, not taken, And then I discover oh yeah, he forgot to mention he's been on testosterone for the past five years.

0:42:12 - Speaker 1 Wow, wow, yeah.

0:42:13 - Speaker 2 And they've been trying to get pregnant for the past five years. It's like finding out your partner had a vasectomy and didn't tell you.

0:42:20 - Speaker 1 It's at that level, wow.

0:42:23 - Speaker 2 Wow. And so we try a couple of things for these individuals, because it's frequently not intentional, right? They wanted the increase in testosterone, but also wanted to preserve their fertility, but somewhere in there somebody didn't quite understand what their goals were, with regards to reproducing, for example. I don't know, or they didn't ask, and so they got placed on testosterone. So what we do, or what I do, strongly recommend, because some guys don't want to get off their testosterone. There's that little tidbit If you are to the point where we've got a decrease in scurril volume, like markedly smaller testes because you've been on it for that long, Was that a hypogonad?

0:43:16 - Speaker 1 Am I butchering the term here?

0:43:18 - Speaker 2 This is just looking at the testicular volume.

0:43:23 - Speaker 1 Okay, gotcha.

0:43:24 - Speaker 2 Okay, so if the testes have shut down to the point where there are, believe it or not, normal volumes that are established for males at every stage in their life, Interesting, really well.

Yeah, i know We've measured and quantified just about everything, and so the volume is looking like that of a 13-year-old, and you are 30 and have been on testosterone that long. That's a problem. The possibility of recovery, even with intervention, which I'm about to describe, is much lower. So the first thing to do is to stop the testosterone. Okay, taper off, stop it. Then the second thing we can try is we can give you medication that blocks your brain from seeing endogenous meaning from the testes, or exogenous androgens, which should then trick the brain into producing higher amounts of FSH and LH, which will then attempt to stimulate the testes to produce testosterone from testicular cells and making sparma as well. The medication that we frequently use is clomid, which is a medication that you've heard.

We use it the exact same way in women. We hide the estrogen that is coming back to the brain, because that's the feedback in both men and women, and so more FSH and LH get sent out to the ovaries to allow for follicular recruitment and growth. So that same mechanism is used in men and women, for women to allow for ovulation and in men to allow for increased testosterone production and increased sperm production. So if your issue is low testosterone but you're wishing to preserve your fertility, those interventions work better. For people in whom that doesn't work, we can use HCG, which is the pregnancy hormone. It binds to the LH receptor, which is luteinizing hormone. So LH and HCG work kind of the same, just HCG binds stronger, longer half-life, so it's really potent. But small doses of HCG given spread out over the course of weeks and months, can stimulate the testes more aggressively to produce more testosterone and more sperm. So there are pharmaceutical interventions that we can use to help men with low testosterone, replace their testosterone and preserve their fertility.

0:46:12 - Speaker 1 Amazing Now to kind of wrap up this TRT segment here. is it more of a concern when the goal now is fertility? Is it more of a concern for someone who has been on, a guy who has been on testosterone replacement therapy, the length in which they have been receiving it exogenously, or the dose And I'm sure the longer the higher the dose is never a good thing.

0:46:41 - Speaker 2 I'm a fan of testosterone replacement therapy and people who've completed the reproduction.

0:46:46 - Speaker 1 Fair enough, all right. Kind of reprioritize your goals here, kind of just shift things around.

0:46:53 - Speaker 2 If we are trying to get more testosterone, I would say let's use the medication to get endogenous testosterone production.

0:47:01 - Speaker 1 All right Okay.

0:47:03 - Speaker 2 Use your system to work harder for you, and that way we don't mess with anything, because I never know exactly how each individual is going to react to medication.

0:47:15 - Speaker 1 Very true, very true. Yeah, and that could potentially have negative effects on fertility. You might take one thing to solve a problem for one, but it opens up a can of worms for another.

0:47:23 - Speaker 2 Correct. And then there are some men in whom we don't ever get sufficient recovery of sperm production, and in those cases we might attempt Ixii, which is where we take the sperm and inject it into the egg in order to facilitate fertilization, and it might not work. And then we come back and we're talking about donor sperm, and that's really a hard conversation to have.

0:47:47 - Speaker 1 Oh, wow, yeah, well, thank you for shining a light on that. So, guys, hopefully you're not buckled over cringing too hard on that stuff. I feel like when we talk about fertility health, guys, we take things too personal. But we need to know these things And looking our best, feeling our best are great things And not to knock those goals for anybody. But just really take a moment and think about is reproduction on your radar? And even if you're not even with a partner right now, or it's not on your radar right now but you have not decided, i never want to reproduce this is the time to kind of think of future, self Correct, kind of just put your goals and the methods in which you pursue these goals in maybe a different priority, absolutely.

0:48:34 - Speaker 2 And for the guys too. Sperm preservation has been around for even longer than we've been stimulating women to freeze eggs, So that's always an option If you feel like testosterone replacement therapy or something else that you might not be able to come back from is the path you want to go on.

0:48:56 - Speaker 1 Get your sperm analysis now, in 2025. If everything looks good, freeze it. Then you're good. Then go ahead and do all the things to get jacked and the energy and libido and all the things.

0:49:08 - Speaker 2 Do it, do it. I'm not saying don't live your life. I'm just saying that people need to be more proactive about partnering with their healthcare providers. We want what you want, especially in this field, when people come in. I spend an hour not only getting medical history and figuring out lifestyle choices, et cetera, so that we can figure out where we can optimize, but I'm trying to also figure out what the goals are so that I can make them happen. So.

0:49:40 - Speaker 1 And speaking and making them happen. To kind of get to the last portion here of the conversation. Thank you again so much for your time and your expertise. When we've been doing these things to better, to optimize our fertility health as a man, as a woman, sometimes we're just still not there And we do need to look for outside help, and that is through a lot of what I know you do and that OMA fertility, and we're talking about IVF and vitro fertilization. So I would really, if you can, kind of give us a high level explanation of what is IVF, who is best suited for it? I know that might be kind of a big blanket response there, but you know how is this technology here to maybe pick up the slack where typical health cannot?

0:50:23 - Speaker 2 Okay, So number one seeking help is powerful. It says I'm in charge and In everything.

0:50:35 - Speaker 1 I love that as just like a blanket statement to know what we're here to talk about or work on. Yeah.

0:50:39 - Speaker 2 Yeah, if you have decided that you need help with a problem, you're way ahead of the rest of the class. You figured out A, there is a problem and you're going to an expert to get it solved, so way to go. Okay, there's no shame in seeking out help. I run a very busy practice because of all the people who need the help for various reasons, and a good third of the time it's going to be female only reasons after a full evaluation. Another third of the time it'll be male only reasons after a full evaluation. And then there's this magical third where it is a little bit of female, a little bit of male, and I have to you know, consecutively solve problems for both of them.

Okay, in order to get us to the outcome of a healthy child And for some individuals it's as simple as giving medications to force ovulation to happen, like I've described before, that is all that is missing. It is a young person who's otherwise healthy. They just don't ovulate for one reason or the other. And so we give medications, make sure ovulation happens. We put sperm in the uterus to go and meet the egg and fertilize it And boom pregnancy. That is intrauterine insemination simple, effective therapy. You need to meet certain criteria in order to qualify for this therapy. And anachronism with really good sperm is a good one, like if the only issue is we're not releasing eggs but we have open tubes and really good sperm and a nice looking uterus. Boom, that's. That's my candidate for this. Okay, for everybody else, say the ones who've gone through, you know, three or more IUI rounds and are still not pregnant.

I describe IVF, which is in vitro fertilization, as a diagnostic as well as therapeutic process. So it is diagnostic because in the, in looking through the process, we stimulate a whole bunch of eggs to be grown in a cycle, as opposed to mostly wasted and one ovulated right. We encourage all the eggs to grow all at once And I describe it as a cooperative race. They have to grow in tandem together. This means the woman is injecting herself with higher doses than what her brain would normally make of the follicle stimulating hormone, and I tend to use HCG, which works just like LH, which is lupinizing hormone.

This encourages the growth of multiple follicles. The reason why multiple follicles is so I can collect them all. It's called an oocyte retrieval, an egg retrieval I can collect them all. This is the process that you would go through if you were freezing eggs, however, if you were making embryos to solve infertility. After we collect the eggs, particularly at OMA, we use the OMA sperm insight to help us select the perfect sperm that is moving and perfectly shaped, in order to grab it and inject it into each mature egg, and then we check the next day for fertility. The eggs that have been fertilized are called 2PNs and they are kept in culture for another five days And we look on day five and I call it the embryo beauty pageant.

0:54:03 - Speaker 1 They get great.

0:54:04 - Speaker 2 They get a baby or a seed. The book is You get second runner up.

0:54:08 - Speaker 1 First runner up.

0:54:10 - Speaker 2 Exactly exactly, and so you know. You have the ones that are, and they're graded based on the outer cell mass of the trifectoderm that becomes the placenta And then the inner cell mass becomes the baby. So both of those get graded. So you might see things like AA, ab, the CCs do not, we do not hang on to those, those don't turn to babies, all right, and the Ds are discarded. Ds for discard.

0:54:38 - Speaker 1 You are the weakest link.

0:54:39 - Speaker 2 Goodbye, Yeah like no, but the whole point of IVF is to be able to discriminate, because we discriminate against all the millions of other sperm that don't make a cut. We just don't look at those. We need only as many perfect sperm as we have mature eggs. So if I have 10 mature eggs, guess what? I need 10 sperm out of the entire sample of millions. So this is a very useful tool, particularly for male factor.

0:55:10 - Speaker 1 Absolutely Yeah, it sounds like it.

0:55:11 - Speaker 2 A woman winds up carrying the load because of the stimulation process and the surgery that is, the retrieval. And if the man can produce some sperm but it might not meet the criteria that we just went over for normal sperm, we can still look within that sample and find the perfect sperm, because we only need as many perfect sperm as we have eggs available. Okay, Okay. And then, additionally, once they get to day five or day six and have been scored on this beauty pageant, all the good-looking ones can then have some cells sampled out of the outer cell mass that becomes the placenta and before they're frozen, And then we send it off for genetic testing and you get results back on the chromosomal constitution of each one of those embryos. So you know, before we transfer it back, if it has the normal complement of chromosomes and part that my patients are always going oh my God tell me is if it's male or female. Because we look at all the chromosomes, we get the sex chromosomes as well.

0:56:14 - Speaker 1 Wow, right away Correct. Before we transfer Amazing, yeah, what I've kind of been able to look at and understand with what you all are doing at OMA. Fertility is pioneering, i know you all you're losing the greatest technology, even incorporating some AI, and I'm just kind of bringing fertility, health and technology together in a really incredible way, which really speaks volumes to me and a lot of what I highlight on the show. I mean, look at me here, i'm double dipping and wearable my Apple watch you know I'm smart, everything.

And so I think there's this sweet spot of quantitative data, qualitative data, the human experience, getting better at understanding this vessel and optimizing it through best practices, natural practices. But no, look, we're in a day and age where we can lean into technology, lean into experience to really bring these two together in the best way possible, which I think for many people. Sure, many people want to lose weight, gain weight, they want to level up in life in general, but for most people, i think the most trying thing they go through when they don't get it out of the gate is reproduction Correct, and I have seen it affect people in horrible ways, unfortunately sometimes even drives partners apart And so like, why not? Why not? if we can, why not?

0:57:36 - Speaker 2 So our goal is really to democratize the whole process.

0:57:42 - Speaker 1 So, on the what, do you mean by that?

0:57:44 - Speaker 2 On the access point. I remember I told you that most people don't wind up going through a treatment because of price. So we are 30 to 50% under market across the board for all our therapies 30 to 50% under market.

0:57:57 - Speaker 1 Wow, correct.

0:57:58 - Speaker 2 And that was a deliberate choice. We prioritize our patients over profits, and then, on the back end, because of the artificial intelligence that is employed in the lab, the goal is to get people pregnant in fewer transfers, which also saves cost.

0:58:17 - Speaker 1 Save cost, save time, save stress saves. I mean worry, I mean everything. Yeah, I know a lot of these things that people go through over and, over and over again.

0:58:25 - Speaker 2 Correct. So our goal is to try and get the most people pregnant in the shortest amount of time. We're trying to build efficiencies into an inefficient process, and I tell people that all the time I'm like normal fertile couples who don't need my help are at 20% chance of success per try. Wow, well, that blows people's minds.

0:58:52 - Speaker 1 You got the stats, you got the technology, you got everything. So I mean, i think we're, of course, going to have all of your information listed down in the show notes and video notes for everybody. If you're interested in tapping into your fertility health and maybe you're at the point where IVF and technology is on your radar, it sounds like you all have some great resources to get people going.

0:59:11 - Speaker 2 Absolutely, and we provide the initial work up for free.

So if you just wish to have a better understanding and an hour of my time, Beyond this podcast To have a discussion about where things stand with you and what therapies might be open to you or what lifestyle changes might be a good idea to embark on. I say go ahead and take advantage of it. Again, knowledge is power, Like making that decision, identifying the problem. If you have irregular cycles and you never know when you're going to be on, then you're probably somebody who doesn't ovulate and you need my help right away. So don't wait a year. The old descriptor is a year of having unprotected sex without pregnancy. That only applies if you're not in the same sex couple or single.

So if you're trying to figure out where you stand in general and what your options are. Go find somebody like me. Go find a reproductive endocrinologist. Have a chat.

1:00:19 - Speaker 1 Do it, get help. Like we said earlier, no matter what you're here to work on, no matter how you are choosing to move forward in your life, living a life ever forward. I say we can go far on our own, but getting help, there's no shame in it And more often than not we need it. We really do.

1:00:34 - Speaker 2 Oh, we're social creatures. We all need help.

1:00:37 - Speaker 1 Yeah Well, dr Fru, i want to ask you my final question here. Again, thank you so much for your time and expertise. Living a life ever forward, i say, is a lot of things, but primarily for the show. It's leaning into and creating a better sense of awareness around the multifacetedness that is the human experience, so that hopefully we can extract something from this conversation, apply it, test it, keep what serves us and dismiss what doesn't move forward in life. When you hear those two words, i'm curious what does that mean to you? ever forward? How would you say you live a life ever forward?

1:01:12 - Speaker 2 By feeling forward. I'm a scientist by training. I have a PhD in population, and so my goal in life is to always try something And if it doesn't work, figure out what works, figure out what doesn't work. There's always something to be learned about trying, but if you don't try, then you don't make any progress, which is why I aligned with OMA, because they were willing to take a risk and it's paid off And we generate more data with every patient that comes through. We can actually provide the service that has traditionally been provided, while improving the data that we do have, so that we provide a better service in the future. So that is the definition of failing forward.

1:02:08 - Speaker 1 So yeah, when I get ever forward.

1:02:11 - Speaker 2 I think why not try it, calculate the risk and run the experiment?

1:02:21 - Speaker 1 Love it. There's never a right or wrong answer, and the concept of being an experiment is one that I talk about. A lot N equals one here. Be a study of one at all times.

1:02:31 - Speaker 2 Absolutely fail forward. I tell them I go, you are an N of one. Everything I have described is the bell curve. I don't know where you are.

1:02:41 - Speaker 1 Ooh, i like that. I like that a lot, okay, well, dr Fru, again we're going to have you your information, oma fertility, everybody that wants to go check out fertility, health, ivf, all the above, anything and everything we've covered. We got it linked for you down on the show notes under episode resources. Thank you again so much for your time here today. It's been great.

1:02:59 - Speaker 2 Well, thank you for being willing to have the conversation and educate people on this. It's really important.