Paul Turek
speaker
358 appearances
1 recordings
1 series
first heard Jun 2025
last heard Jun 2025
Paul Turek’s voice in public audio — every appearance, attributed to the second.
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And that's based on the New England Journal paper where they looked at, I think, 700 couples and they had them keep diaries. It was a Boston-based paper. Keep diaries of how they had sex, when they ovulated, and when they got pregnant. And then they said, do what you normally do and then give us the diaries.
And then they evaluated them and they found that having sex, say ovulation is day 15 of the cycle. When they started having sex on 9, 11, 13, there were significant pregnancy rates. And every other day was the optimal interval. But even five days before and three days before, there were substantial pregnancy rates. before ovulation.
But if you waited to ovulation and then had sex, that's about 20% of conception. So when you get the kit, don't react to it. Predict in front of it. So front load the sex. Very important. And why is that? Is that because... There's a reservoir effect in this uterus. It's managed. Sperm will survive for a day or two.
Remind me where the oviduct is. So there's the uterus and the fallopian tubes.
And that's the oviduct. The oviduct is right below where the ovaries sit.
They bind to the endothelium and just park.
80% of conceptions naturally or at home occur when sex is front-loaded as opposed to reacting to ovulation. And most of the apps that are available nowadays will tell you that. Peter, you're drawing a graph. I am. I have to draw.
There was a study that showed how long it took to make a sperm. And it was published in Science, I think, in the 60s. And they gave men tritiated water. They gave men radioactive hydrogen. And then they biopsied their testicles, which could never be done nowadays. But I did it all different. I gave deuterated water with a group at Berkeley, and we gave healthy men deuterated water for a week.
That's wild. But that was the best data. And we did deuterated water, which is not radioactive, and we could measure that. So we gave them a dose and then we watched their ejaculates weekly. And we looked for when deuterated, the hydrogen showed up in the DNA. And it was an average of 74 days. So normally say three months to make a sperm.
So some went for 42 days, and that's going through the epididymis and getting ejaculated. We talked about maybe two months in the testis and two weeks, a week or two in the epididymis, and then maybe a couple of weeks to ejaculate. And this was all the average 74 days. So it actually changed the timeline enormously to a much faster one. So 74 days.
So when you do anything to a man fertility wise, you're not going to expect to see anything change for at least two and a half months. And when you talk about full replacement of that semen, it's probably in the being 90 days when it's all replaced, the pot is replaced. That's a limitation of what we do. 42-year-old women want now. And we have three to six months.
When I did a study on fixing varicoceles, which is an infertility problem in men at surgery, and I looked at the mean time to conception, it was about seven months after repair, which is two cycles of sperm production.
Okay. Doesn't have to be timed intercourse, just has to be whatever the couple does when they think they're trying to conceive.
There's a large bias in Western worlds about how infertility is evaluated. The reasons are complex, but I would say my practice is not typical. So most of my patients have been through a lot before they come to me. And typically, I think Keith Jarvie's data was good at about 23% of men get a formal evaluation for infertility before couples go through IVF in North America.
And how does that differ from the rest of the world? I don't think it's been studied in the rest of the world. But there are countries like Germany and Spain with single insurers and government pays. And it's also recommended by society guidelines like American Society of Reproductive Medicine, WHO, et cetera, that both partners get evaluated simultaneously.
But the bias is female gets very evaluated for lots of money. And the men typically may get a semen analysis, but may not. And it's very complex reasoning there. It's a different beast. They're not part of the problem. They refuse to do it. There's a lot of denial. It does get at your masculinity a little bit to get checked out and things. So it does go deep.
For men, it can be a little bit of a problem. So I would say that lately with... large insurers coming in, Progeny, Maven, and things like that, you're seeing a lot more men up front, which is fabulous. And we can have long discussions about the biomarker concept, why that's good for the field and good for men's health and good for longevity.
Usually they're dragged in by their partners. Usually the partners come along to make sure they show up. For me, it's one visit. So we do one visit and I do everything else where they are, where they are. I don't ask them to come in a million times anymore. So it's a very different kind of practice.
But I try to get everything done in one visit because when you get them there, it's rare to get them there. And the physical exam, so you do a history, a very thorough history, which is usually preceded by a questionnaire. I give 200 questions and that has all the hot bath stuff and all the exposures they have. And they have to do that before they see me. That's a really important part of it.
If you could pick one in a multiple choice question, what matters the most is probably the history. History of paternity matters, a history of exposures matters, et cetera. Physical exam, very important. One to 5% of male infertility can be due to a major medical issue, testis cancer, diabetes, things like that. So physical exam, varicoceles, is very important.
Showing 61–80 of 358 · page 4 of 18
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