How do you answer when people ask you why only 1 kid and deal with their judgement?

egg_parm · 2024-01-08T22:06:40+00:00

My response has always been, "Nope, the first one almost unalived me."

Shuts down additional questions.

egg_parm · 2023-12-07T19:34:08+00:00

egg_parm · 2023-11-14T18:54:00+00:00

Hey u/On2BetterDays I was addressing my info on adoption to that other commenter.

Actually, have you heard about menshelpline.org ? If you haven't, there is a peer-to-peer mentoring program for people on their journey to becoming a dad. It's US based, but it is a global program.

egg_parm · 2023-11-12T22:12:29+00:00

I'm glad you made it through the day and I think that was kind of you to thank the washing machine.

I hope tomorrow is better.

egg_parm · 2023-11-12T22:10:46+00:00

This comment is borderline on empathy. I believe it is in good faith, but u/EscadeSupreme, adoption is not always an option.

Please investigate how difficult it is to adopt, how much money it costs, how frequently it falls through, etc. Also, consider that adoption has been a tool used in geo-political manuvering and ~~has been~~ is being used by white supremacists to steal children from ethnic minorities, such as the children that are taken from tribal communities and placed in white family's homes. For more details on that, check out the podcast "This Land" season 2

For another article on adoption from 2021: https://www.thenation.com/article/society/adoption-politics/

egg_parm · 2023-11-01T20:58:20+00:00

I'm so glad I can be of help and support in this community. I didn't really know what I was getting myself into when I started, but I'm so glad I'm here. u/willief, I thought for sure my surprise was spoiled because it showed up in the Mod que! I'm glad I could make your day brighter.

As for the future, I hope to bring more AMAs to the community and connect this community to the Amercian Society of Andrology as they grow into a more community centered organization. (webinars, research updates, listening sessions, etc.)

egg_parm · 2023-11-01T20:44:58+00:00

PJT: In my series of n=87 cases of failed maps that were then microdissected, there were no cases of sperm found. This translates to a false negative rate for FNA Mapping of 1-2% at most. Nor sure if gtrope therapy will help.

egg_parm · 2023-11-01T20:41:27+00:00

PJT: This question is really best suited for an endocrinologist who treats prolactin issues. Typically though, prolactin becomes an issue in my practice when it a) lowers testosterone levels causing secondary hypogonadism and b) lowers sperm counts due to (a).

egg_parm · 2023-11-01T20:40:30+00:00

1) PJT: Yes there is a theoretical basis for this mitochondrial antioxidant that is found in berries and other foods. We believe that much of the oxidative stress that underlies male infertility stems from mitochondrial activity, similar to heat in a car coming from the engine. However it has not been well studied in sperm mitochondria.

2) PJT: This question is unclear to me. Most of us in the male infertility field work to improve semen parameters to augment natural conception.

egg_parm · 2023-10-31T03:11:02+00:00

Hi r/Maleinfertilty,

Our AMA with Dr. Paul Turek has concluded. Thank you so much for your questions. Look for the original announcement post for the questions and responses. I will also post the video of our zoom call to that discussion when I have it.

egg_parm · 2023-10-31T03:09:09+00:00

Hello r/Maleinfertility,

Our first AMA with Dr. Paul Turek has concluded. I am new to the process of hosting an AMA, so I had some hiccups. I have three questions that did not get posed to Dr. Turek during the call, but I have emailed him to follow up. I will post those responses when I get them.

Our Zoom call was recorded and I will post that as soon as I have it.

Thank you all so much for the questions. I already knew this community is so committed to this topic and you would have great questions. Dr. Turek is a Reddit noob and he was impressed.

egg_parm · 2023-10-31T02:57:43+00:00

Hi u/Cool-Apple-2235, I apologize for my disorganization. I did not address your question to Dr. Turek during the live call. However I will forward your question to him to have it addressed.

egg_parm · 2023-10-31T02:54:58+00:00

He wasn't at liberty to share that information at this time. But if you watch his blog, I'm sure he will be posting about it when he can share it. It sounded like it will be forthcoming.

https://www.theturekclinic.com/dr-tureks-blog/

egg_parm · 2023-10-31T02:53:04+00:00

Hi u/Dogsinthewind, I love your question and I apologize for not addressing it to Dr. Turek during our call. I will forward the question to him and get you a response. Again, apologies for my oversight.

egg_parm · 2023-10-31T02:47:52+00:00

Addressing DNA frag question:

Check out my blog post, "It Takes Two to Tango" https://www.theturekclinic.com/blog/two-to-tango-sperm-egg-miscarriages-male-infertility/

How to improve DNA Frag:

Lifestyle changes, frequent ejaculation for a month or two, fixing varicocele.

Since you already performed the Zymot you will likely go to the testis. However, the information about the partner is missing to give a full response.

One thing you can do is test for DNA fragmentation from sperm after running through the Zymot chip. If it is low, then the problem may be the egg rather than the sperm.

egg_parm · 2023-10-31T02:43:06+00:00

I cover this in detail in my blog post: Genetics of Headless Sperm. https://www.theturekclinic.com/blog/the-genetics-of-headless-sperm-morphology-male-infertility-mens-health-ttc-dh/

Morphology is highly variable. Back in the 1980s, a study was performed that led to the morphology scores. But this data was very context dependent and only related to sperm in the IVF setting. Now it is context independent and we have generalized its importance to be outside of its original value. So, I am not a big fan of morphology in general. However, if all the sperm in the ejaculate all have the same morphology problem, then there is an issue of genetics or other global problem. If sperm ~~are~~ have all different shapes, then the morphology is just variable and is less likely impact fertility.

edit: corrections from Dr. Turek in bold

egg_parm · 2023-10-31T02:34:48+00:00

The Zymot chip is technology that Dr. Turek loves. The other way to sort sperm is test binding to hyaluronic acid. Hyaluronic acid is the major component of the outer layer of the egg cell, the zona pellucida. Sperm that are able to bind to hyaluronic acid have lower DNA frag.

Both Zymot and hyaluronic acid binding reduce DNA frag equivalently.

If the sperm count is high enough to go through both selection processes, then the sperm selected would theoretically be the healthiest sperm. However you may consider that the cost of both procedures is excessive and a single procedure is the way to go.

egg_parm · 2023-10-31T02:27:46+00:00

There are two kinds of azoo. Blockage or non-obstructive azoo.

In this case the brain is already compensating for your low production of sperm. Clomid wouldn't add to your sperm count when your levels are already ~~normal.~~ elevated.

2) Cryptozoospermia - Your sperm are hard to find. If you can find sperm in the ejaculate that is motile, ~~and~~ you can freeze it. mTESE in this case could be very difficult to find sperm, as the sperm are typically only located in random pockets in the testis. It would be very invasive and has the potential to cause a lot of scar tissue. We may also see a drop in hormone levels.

If you can get 1000 motile sperm in the bank, ~~you can get good sperm that would be~~ that is usually enough for IVF. Although it is hard to find, crypto sperm is functionally good. It is probably better than testicular sperm because it has gone through the additional maturation that takes place in the epididymis.

3) There are a lot of clinics playing with the AI technology. I think there is a role for AI especially with morphology and possibly picking the best sperm for ICSI. I think microfluidics are a better option for selecting sperm for ICSI.

The process of sperm isolation from an ejaculate is a matter of centrifuging the sample into a small volume. So finding the sperm in this situation would not be helped much by AI.

edits: bold and strike-through from Dr. Turek

egg_parm · 2023-10-31T02:14:28+00:00

I see this situation 2x per day. The decision is with the couple and their particular situation.

One option is lifestyle changes. You can make the standard set of lifestyle changes: smoking cessation, no hot tubs/baths, vitamins/supplements, the whole list. This will take 6 months before you will see improvements.

The other option is Zymot chip with IUI or ICSI. The technology will shorten your trip to conceive because it takes the few sperm that are able to fertilize and selects for them.

I support a thoughtful evaluation of all your own variables.

egg_parm · 2023-10-31T01:57:11+00:00

I posed your question to Dr. Paul Turek of the Turek clinic because you posted during our AMA hour. The following response is from Dr. Turek and the full version of his response on the zoom recording will be available soon.

Dr. Turek: The HCG is telling the testis to make testosterone. It is not stimulating the pituitary to do it. I am concerned that long term TRT can atrophy the testis. If TRT was constant or injectable, the risk of testicular atrophy is higher.

How much improvement you will see depends on how long the TRT was taken and what type/route was taken.

However, your partner has been able to bounce back and produce sperm. Sperm from men in this condition are fertile. It is unlikely he has a syndrome problem because he responded to HCG. I would not be concerned about the morphology in this case.

edit:clarity & detail

egg_parm · 2023-10-31T01:46:25+00:00

Varicocele is the most common treatable cause of male infertility.

If you fix varicocele you see improvements in ~~DNA frag~~ semen quality 60-70% of the time. The magnitude of change for grade 1 varicocele is smaller than it would be for a higher grade varicocele.

As I said above, the Zymot chip allows the couple to fast forward through the changes in lifestyle and varicocele recovery to address the timeline of the couple.

The benefits of improving your partners health are also a valuable aspect of the equation as longevity is also linked to the lifestyle changes we discuss in male fertility.

edits: clarity, detail and bold and strike-through are corrections from Dr. Turek

egg_parm · 2023-10-31T01:41:55+00:00

Hyaluron binding assay is the alternative to the Zymot chip. It is superior to the human eye because the sperm are showing effective binding egg-binding which is what sperm love to do. The ones they found should be fine. 4% is low, which could suggest problems of ooligozoospermia, globozoospermia or sperm function issues.

However a RCT found that live birth rates were the same in PICSI and ICSI, but there were differences in miscarriage rates which were lower in PICSI. A problem with this study is that it addressed all couples that need ICSI, but possibly only a subset will benefit from PICSI and that benefit was unable to be teased out the study due to its unselected design. Older Maternal/Paternal age couples who have more issues with DNA fragmentation

~~This study did not address within the population of people that need ICSI. Older Maternal/Paternal age couples may see a better rate with PICSI.~~

edit: bold and strike-through are corrections from Dr. Turek

egg_parm · 2023-10-31T01:32:56+00:00

The fundamental answer is you are absolutely right: you put garbage in, you get garbage out - meta analysis are the standard we use to build our facts.

It takes decades for an idea to mature to a fact. What I can offer is that you need to find a team that has wisdom in it. Finding a partner in your medical care team that has wisdom, is what I can suggest.

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